An Evaluation of a Lean Change Programme

Lead researcher: Sarah Pajak

Programme Director: David Guest

Aims

This project arose from discussions with the Crisis Resolution and Home Treatment Team Liaison Nurse at a London NHS Foundation Trust, who approached King's PSSQ with a request for an evaluation of a change programme taking place at the Trust, based on Lean management principles.

The Crisis Resolution and Home Treatment Teams (CRHTT) aim to provide comprehensive and timely crisis resolution and home treatment for individuals presenting in the acute phase of mental illness in the borough. The proposed changes are that the three existing Home Treatment Teams merge into one borough-wide CRHTT service and the three CRHTT leaders report to a manager who would also oversee the Psychiatric Liaison Nurse Service and bed manager. This process will be supported by both the Trust's Service Improvement Team and the NHS Lean Healthcare Academy.

The broad aim of the evaluation is to determine the impact of the change project. The more specific aims are:

• To provide a ‘before and after’ measure of impact of the interventions in Lewisham
• To provide an after the intervention evaluation of impact in the CRHTTs
• To evaluate the Trust's Lean model whereby the intervention has its initial impact on team structures and leadership behaviours and through this on staff attitudes, behaviour and ways of working and, in turn, on patient outcomes.
• To contribute to the work of King's PSSQ which has, as its brief, to evaluate innovative interventions designed to improve patient safety and service quality.

Why is this important?

The expected outcomes of these changes include improved efficiency, clinical input and multi-disciplinary skill mix and increased operational sustainability and flexibility, as well as a greater ability to meet guidance targets. It is important to carry an independent evaluation of this change programme as a contribution the evidence base of such approaches.

Participants

A mixed method approach using interviews with those staff involved or affected by the change programme and an analysis of hospital data will be taken.

In the case of the interviews, it is anticipated that a sample of staff from each of the three CRHTTs will be interviewed both before and after the phases of the change programme are rolled out. The CRHTTs contain roughly 30 staff in total, and the aim will be to conduct interviews before and after the changes are introduced with a representative sample of these staff, consisting if possible of half the staffing contingent.

The aim of the interviews will be to capture feedback from as wide a sample of staff as possible and appropriate, including social workers, nurses and managers. It is expected that around 15-20 individual staff members will be interviewed, for approximately 30 minutes each. Questions will be structured to enable the evaluation team to gain understanding of the relevant issues.

Anticipated Outcomes

There are direct benefits to be gained from this evaluation for the Trust. It will provide evidence of where changes have led to improvements and where further action may be required. It will also provide independent evidence of the impact of the changes on staff attitudes and behaviour. A report will be prepared for the Trust and a summary report of the findings presented for wider circulation.