{"id":34193,"date":"2015-05-13T10:03:48","date_gmt":"2015-05-13T09:03:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=34193"},"modified":"2015-05-13T10:03:48","modified_gmt":"2015-05-13T09:03:48","slug":"billy-boland-what-does-continuous-improvement-actually-mean","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/13\/billy-boland-what-does-continuous-improvement-actually-mean\/","title":{"rendered":"Billy Boland: What does continuous improvement actually mean?"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/10\/billy_boland.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-29534\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/10\/billy_boland.jpg\" alt=\"billy_boland\" width=\"160\" height=\"140\" \/><\/a><\/p>\n<p>I don\u2019t know if it\u2019s just me, but I\u2019ve found a lot of what\u2019s written about &#8220;continuous improvement&#8221; practically impenetrable. On the face of it, it has a lot to offer. Who can argue with an approach that systematically drives up quality? The trouble is, I\u2019ve always found the methodology elusive. I realise that I\u2019ve probably had unrealistic expectations, wanting it all summed up in a few paragraphs. But when I\u2019ve sat down to learn about &#8220;lean&#8221; or &#8220;six sigma,&#8221; within minutes I\u2019m lost in jargon. What, in fact, are the differences between Muda, Mura, and Muri\u2026 Anyone? Anyone? I can\u2019t help feeling that improvements to business performance should be more inclusive than that.<!--more--><\/p>\n<p>Light was shone on all this recently for me by my colleague Eddie Short, transformation team leader at our trust. He is on a mission to try to help people across the organisation understand what continuous improvement actually is, and help them introduce it into their working lives. Eddie managed to get to the heart of the matter in a short presentation that helped show that it\u2019s not all that complicated. So I thought I\u2019d share with you what I\u2019d learnt in a brief, completely unofficial, unauthorised guide to continuous improvement.<\/p>\n<p><strong>1. What is it? <\/strong>Well it\u2019s a few different things\u2026<br \/>\n<strong>a.<\/strong> It\u2019s about continuously improving (I know. Does what it says on the tin). The stuff to improve is the stuff that the &#8220;customer&#8221; (read patient, carer, or family) values, or results in better service. In healthcare these things might be patient outcomes, waiting times, patient or staff satisfaction, safety etc.<br \/>\n<strong>b.<\/strong> It\u2019s about how you go about your business\u2014your mind set (individual) or culture (collective).<br \/>\n<strong>c.<\/strong> The improvement is supported by a method\u2014a systematised way of looking at what you are doing and making changes.<\/p>\n<p><strong>2. Who should be doing it?<\/strong> Everyone. In any organisation, we all have our part to play. If we can measure it, we can improve it. And if we can\u2019t measure it, we can try and figure out an aspect that we can.<\/p>\n<p><strong>3. How do we do it?<\/strong> There are lots of methods to choose from. Here\u2019s a selection:<br \/>\n<strong>a.<\/strong> Data-visualisation and analysis\u2014Look at some data that your service churns out and think about what it is saying to you. In modern health services we are spoilt for choice. Its sobering to think about how much is produced that we could use. Do you need to take action as a result?<br \/>\n<strong>b.<\/strong> Process mapping\u2014draw out what you do. What steps does a patient go through on their care pathway? Are all of them necessary? Can any be got rid of or simplified?<br \/>\n<strong>c.<\/strong> Problem solving\u2014Getting to the root of the problem. Approaches here include root cause analysis (unsurprisingly).<br \/>\n<strong>d.<\/strong> Lean thinking\u20145 principles, 8 wastes, I could go on\u2026 But in essence it\u2019s about delivering only what is needed, when it\u2019s needed\u2014no more, no less. Obliterate waste and maintain or improve quality (and safety, effectiveness etc.)<br \/>\n<strong>e.<\/strong> PDSA (Plan, Do, Study, Act)\u2014This is one of my personal favourites as it\u2019s so intuitive, and fits in well with my current skill set. For clinicians, compare this with clinical audit, measuring your performance against a standard, making changes, and measuring again.<\/p>\n<p>That\u2019s it\u2014simple, huh? For the tech heads, there are plenty more tools to choose from such as Ishikawa diagrams, DMAIC (Define, Measure, Analyse, Improve, Control) and MoSCoW prioritisation. But regardless of your method of choice, know that continuous improvement is likely within your gift. Ask around, potential collaborators may well be lurking, banging their heads against a continuous improvement &#8220;how to&#8221; manual.<\/p>\n<p>Thanks to Eddie for allowing me to adapt and share his pearls of wisdom. He\u2019s also kindly read over my blog to make sure I haven\u2019t got the wrong end of the stick.<\/p>\n<p><em><strong>Billy Boland<\/strong> is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter <a href=\"https:\/\/twitter.com\/originalbboland\">@originalbboland<\/a><\/em><\/p>\n<p>Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I don\u2019t know if it\u2019s just me, but I\u2019ve found a lot of what\u2019s written about &#8220;continuous improvement&#8221; practically impenetrable. On the face of it, it has a lot to [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/13\/billy-boland-what-does-continuous-improvement-actually-mean\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5751],"tags":[],"class_list":["post-34193","post","type-post","status-publish","format-standard","hentry","category-billy-boland"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Billy Boland: What does continuous improvement actually mean? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/13\/billy-boland-what-does-continuous-improvement-actually-mean\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Billy Boland: What does continuous improvement actually mean? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I don\u2019t know if it\u2019s just me, but I\u2019ve found a lot of what\u2019s written about &#8220;continuous improvement&#8221; practically impenetrable. 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