A guide of the terms we use in the TEWV quality improvement system
Service improvement workshops
RPIW (rapid process improvement workshop)
RPIW’s are used to make improvements in existing value streams. They consist of an 8 week period of intense data collection, during which existing processes and observed and measured. This is followed by a week of intense change activity carried out by the staff who work on that process. During the RPIW week change ideas are tried out and measured. Following the RPIW week the process owner has responsibility for ensuring changes are embedded and further actions are carried through. The process owner and sponsor also have responsibility for repeating the target metrics at 30/60/90 days and at 1 year.
There are specific roles taken during an RPIW – see attached. A complete module on RPIW roles and process is taught as part of certified leader training. RPIWs are used by many organisations to make improvements.
RPDW (rapid pathway development workshop)
RPDWs were developed by TEWV. Their purpose is to develop an integrated care pathway (ICP) as effectively as possible. Prior to the introduction of RPDWs, it was taking months, if not years, to introduce integrated care pathways. During an RPDW, a team of professionals will produce an Integrated Care Pathway based on the best available evidence. The pathway will then be piloted by clinical teams.
ICPs are useful for conditions where there is a good evidence base, for common conditions and where it is expected that 80% of people will require the same treatment. Even the best ICPs will only show 80% compliance as patients vary in their needs.
This is a shortened version of an RPIW, but the same principles apply. They can be used where fewer changes are required, to carry out change prior to an RPIW or following an RPIW to make further improvements. While usually 2-3 day events they can be as short as one day.
3P (production preparation process)
While RPIWs and kaizen are evolutionary in their approach to change – improving existing value streams – 3P is revolutionary. In other words, it is used when new systems, processes or plant are required. This could be either in a situation when something completely new is required or where the old processes are so unfit for purpose they require a radical overhaul rather than incremental change.
3P events do not have the observation stage of an RPIW, but do involve developing an understanding of customer demand prior to the event. During the week, lean tools and principles are used and the new products and ideas are tested ‘in vivo’ as they are developed. Key elements of 3P are looking at both the product and the process ie what needs to be done and how will it be done in real time, real place.
Other QIS terms
Kaizen - Means continuous improvement. It can also refer to a ‘kaizen event’ or a ‘kaizen blitz” which is a fast, furious run through a ‘Plan Do Study Act’ cycle using pre-prepared data and the team that works on that process.
Gemba – Japanese word for ‘place where work is done’.
Visual control – Visual controls are methods, devices or mechanisms put in place to manage or control operations or processes. They can be used to ensure quality, to manage flow, to manage inventory signal equipment availability or to aid communication.
Work in process – Number of service users or pieces of work observed waiting within a process at any given time. So this could be the number of patients on a ward or in an out-patient clinic waiting to be seen, or it could be the number of Serious Untoward Incidents waiting to have reports completed for example.
Standard work in process (SWIP) - The number of service users or pieces of work required in the process to keep it flowing. If there is more than the required SWIP the patients/work waits, if there is less than the SWIP, the staff wait.
Continuous flow – A system where products (or patients) flow through a process without any stops or waits. The product is always in a state of value -added transformation.
One piece flow – Also know as continuous flow. Work or people flow effectively, with no batching, no queues, no stops and minimal movement of people or products.
Levelling – This is a method for ensuring work flows without stops or bottlenecks, by smoothing out the volume and mix of the schedule for the work to be done.
Pull system – Workers in the upstream process take work from the down stream process when they are ready to carry out the next task. The process is considered from the finished product and built by going back through the process from finish to beginning.
Just in time (JIT) – This is what it says on the tin. Ensuring stocks and equipment are at the place they are needed in the correct amount, just when they are needed, at the correct quality.
Set up reduction – any tasks or preparation that can be done ‘external’ to the process to remove waste (eg time or rework).
Kanban – This is a pull signal. Kanbans are a visual prompt that stocks need replenishing.
Supermarket system – A method used in creating continuous flow and pull systems. Every item has a designated location and amount. When something is removed from the supermarket shelf by an upstream process there is a signal to replenish.
Cycle time (CT) – The time taken for one operator (person) to complete one cycle of work ie the length of time taken to complete one measureable step in a process.
Lead time (LT) – Entire time to complete a process. The lead time is the sum of the cycle times and the waits between the cycles.
Jidoka – Japanese word meaning that quality is built in at source – not inspected at a later stage. The wider definition of Jidoka includes techniques such as root cause analysis, asking ‘Why?’ five times and Poka Yoke.
Mistake proofing – Systems that are put in place to prevent errors at source (poka yoke) or to ensure if a mistake is made it can be easily identified and rectified by the person doing the work.
Poke yoke– This is a process where a physical mechanism is in place to ensure safety. For example the nozzle for the diesel fuel pump will not fit a petrol car. Or different anaesthetic gas connectors only fit the correct supply.
Defect - An uncorrected mistake that has either not been identified or rectified.
Andon – A specific signal to alert people to a problem, at a specific place in a process.
Standard work – Precise step by step descriptions of a work sequence, with the time taken to complete the steps. Not to be confused with a standard process description (see below).
Standard process description – a document that describes the step by step sequence of a process or part of a process, who does the task and the resources required to complete the task. It can also include cycle times for each task.
Takt time (TT) - A measure of customer demand, defined as time available divided by the demand.
Value stream map – A visual representation of who carries out what steps in a process and the waits between those steps. A value stream map also captures waste (muda) within processes and differentiates between value added and non-value added work.
Muda – Japanese word for waste. Taichii Ohno defined 7 wastes: time, transportation, inventory, defects, irregular processes and/or over-processing, motion of people and overproduction.