CAPA is Lean Steve Kingsbury Ann York CAPA

CAPA is Lean… Steve Kingsbury & Ann York

CAPA is Lean Toyota mantra: ‘People + Brilliant processes = Amazing results’ Always: �Add value �Smooth flow �Pull not push Make decisions slowly, implement quickly Relentless reflection Go see for yourself p 198 -199

Add value Only 5% of NHS activity adds value!! What % in NZ? Cut waste (TIM WOOD) 1. Transportation-e. g have notes ready 2. Inventory- only have what is needed 3. Motion- reduce travel 4. Waiting-reduce and make active 5. Overproduction-not too many appts 6. Over-processing-not too many things 7. Defects correction- do it right first time

Smooth flow �Analyse bottlenecks �Full booking �Daily referral screening �Reduce number of queues with Core work �Segment similar needs together �Plan time for admin �Give families things to do until next step HELPFUL Habit p 174 -177

Pull don’t push �Increase pull- draw resources to the user �Flex capacity �Use full booking systems in Choice and Partnership �Specific work added, not another waiting list �Reduce push systems: �fixed appointments- urgent ‘slots’ �Avoid waiting lists

Toyota Production System Goal: highest value to customer, as fast as possible Respect for People Product Development: Continuous Improvement 14 Principles Foundation: Management applies and teaches lean thinking

Pillar 1: Respect for people �Don't trouble your customer �Includes the person after you in the production chain �Develop people then build products �Managers “Walk the talk” �They are lean themselves; eliminate waste etc �Develop teams �Team work not group work �Teams and individuals evolve their own practices and improvements

Pillar 2: Continuous improvement o Go see (gengi genbutsu) o Solve at the source not behind desks o Kaizen o “My work is to do my work and to improve my work” o Local experimentation o Continuous improvement o Value and waste o Perfection Challenge o Work towards flow

14 principles �Some highlights. . �Use pull systems �Stop and fix problems (this means attend to issues now to save time later �Visual tools (e. g. not just printed schedule information but how to bring the processes and info to life in a visual way) �Decide slowly by consensus, implement quickly �Time boxing � Setting delay small and near time limits to avoid outcome

Lean Thinking �Is a set of tools and ideas that simplify the Toyota Production system �Largely miss out the first pillar of Respect for People �Effective none the less

Lean Principles �Specify Value: every step must add value �Would the customer pay for it? �(don't forget the customer is also your colleague after you!) �Identify the Value stream �I. e. what acts add value? �Make the Process flow �Create Pull systems �Pursue Perfection

Waste 1. Transportation 2. Inventory 3. 4. 5. 6. 7. (large stock) Motion (having to move to complete tasks) Waiting Over-processing Overproduction Defect Correction

Waste exercise (20 mins) �Separate in small groups of 4 -5. �For each type think about your service �See if you can find waste of this type �Meet and discuss the identified wastes Longer exercise. . . �As a group pick some of the wastes �Go back into the small groups to think of possible solutions �Meet up again to plan!!

Push vs pull systems �Push �Timing of items flowing through system is based on high level commands or schedules �“Up-stream” or “Top down” commands �Or number of things provided is based upon planning �CAMHS examples? . . . Fixed number new patient appointments �Pull �Capacity provided or movement of items in a system based on “down-stream” requests �Services or products are pulled to the customer by their demand �CAMHS examples? �Stock / inventory control examples �Kanban cards in TPS � Visual cards that signal a need for restocking (a pull request)

Exercise: is CAPA a Lean system? �Think about the CAPA system and consider which bits are pull and which are push �Think about which steps add value and eliminate waste cf traditional CAMHS