The five pillars

The delivery of the Patient First programme is supported by five pillars, which support the strategic themes and will help us achieve our objectives:

Kaizen is a Japanese concept that, loosely translated, means “continuous improvement”.

It comes from two words: Kai, meaning “change”, and Zen, meaning “ideal state”.

This means to break down or change the current situation and then build it into the ideal state. Kaizen!

The principle is at the heart of the philosophy that has made Toyota and others, including Virginia Mason Medical Center, so successful and sustainable.

It’s about getting front-line staff to approach problem solving and root cause analysis from a different, ceaselessly inquisitive perspective.

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The Patient First Improvement System (PFIS) is the Lean management programme designed to develop our people’s ability to solve problems and improve performance.

During the programme, teams receive specialist training to introduce tools and techniques that will help eliminate waste from everyday processes and begin to improve them on a continuing basis.

These include:

  • Status sheet discussions – a short conversation structured around a series of questions to support planning for the day
  • Use of problem-solving techniques such as A3-thinking, which challenges teams to use a single sheet of A3 paper to identify the key elements needed to resolve a problem they face, and most noticeably
  • Improvement Huddles – small, regular meetings in which teams are empowered to solve their own problems.

The programme is led by the Patient First Kaizen Office.

Improvement huddles are a key element of PFIS. They involve all staff, last around 15 minutes and are the ‘standard work’ of the continuous improvement process.

An improvement huddle aims to

  • identify opportunities for improvement
  • prioritise which opportunities to address first
  • action any simple ‘quick wins’
  • authorise the investigation of more complex opportunities
  • mark any implemented improvements as complete
  • celebrate new successes

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The Patient First Capability Programme provides the skills and training necessary to help you and your teams understand and use the principles and tools available through Patient First.

Using the capability programme, the Kaizen team provides training and coaching to strengthen your Kaizen skills, creating four grades of Lean knowledge:

Awareness – ensuring all staff know that improvement is their business, have some tools at their disposal and know where to go for more information or support.

White belts – are aware of Lean principles such as ‘Plan, Do, Study, Act’, enabling them to make improvements as part of their daily work.

Yellow belts – have completed a two-day training course and have the skills to manage a specific project, typically over a three-month period.

Green belts – have completed a five-day training course and can manage medium transformation projects over a 6-12 month period.

Black belts – have completed a 10-day training course and are Lean experts, who can work across divisions to drive breakthrough improvement and sustainable change.

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Our improvement approach involves using “Lean” principles pioneered by Japanese car producer Toyota after the Second World War. These principles have been adapted for use beyond manufacturing and adopted in many other fields, including healthcare.

Lean is a systematic method of eliminating waste from a process.

Lean identifies different types of waste that should be reduced or ideally eliminated to drive up quality and improve patient experience. For example, having goods or products waiting for the next process or production step is considered waiting waste. Waste through over-processing sees workers carrying out more work or using more complex systems than the patient requires.

In a hospital setting, examples of waste could include moving patients from department to department or ward to ward unnecessarily (transportation), holding more supplies than we actually need (inventory) or delays in discharge or in accessing diagnostic tests (waiting).

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Where theory becomes reality

Strategy deployment is the process through which we identify and review the True North objectives for each strategic theme and cascade these throughout the organisation. It provides a framework to enable staff at all levels to be clear about our priorities, our progress against them and how they can best contribute.

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