Choosing a Service

How do we bring about wholesale improvement in the Health Service?

Experience is teaching us that a ‘bottom-up’ approach is both the easiest and best way of improving an organisation. Organisations who successfully improve themselves start out by choosing one of the services they provide and then set about improving the end-to-end process that delivers that service.

Examples of services that could be chosen for improvement in the Health Service are:

Tackling specific services focuses our attention on the end-to-end process that may flow across several departments. A department can be improved but if the departments either side of it are not, the result can quite easily be a zero overall improvement in the delivery of services.

When one service has been improved – to the patients’ satisfaction – we can then turn our attention to the next service for improvement.

How do we choose which service to improve?

Services chosen for improvement are often those where the capability of delivering the service is not matched with demand, resulting in high levels of complaints from patients, waiting times, etc. Unnecessarily high running costs can be another reason for choosing a service for improvement. Sometimes it is possible to increase the capability of meeting demand while reducing running costs, at the same time. There may be other reasons for choosing a service. It is important that our reasons are perfectly clear before we do anything else. Otherwise, how are we going to know what to improve?

As demand on the NHS system and the system’s capability of meeting that demand is a major issue, this particular reason for improving the service has been highlighted. Major sections on demand and capability are therefore featured in this overall improvement framework.

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Choose a specific service to improve
Identify and measure true demand
Identify and measure capacity & true capability
Map the existing process
Remove waste from the process
Make the work flow
Let the patients set the drumbeat
Draw the new process map
Implement the new process
Continually aim to improve the process
Choose another service to improve!