Leeds Teaching Hospitals NHS Trust: partnering with the Virginia Mason Institute

In 2016, Leeds became one of five organisations in England to partner with NHS Improvement and the Virginia Mason Institute (VMI). The partnership sought to test the application of the Virginia Mason Production System.

The Leeds Improvement Method (LIM) is the trust’s philosophy of continuous improvement. It combines quality improvement and daily management methods with respectful behaviours and Lean processes. It aims to ​‘put people at the heart of improvement’, sharing improvement tools with people closest to the front line to develop long-term, sustainable solutions to quality problems.

The approach supports the organisation to evolve how it manages quality. Part of this has involved a shift away from having a strong focus on Quality Assurance, and the temptation to ​‘add yet another layer of checks’, to one that shifts the balance much more towards Quality Improvement.

As a partner within the VMI programme, Leeds adopted Lean as a management system, which involves an organisation-wide approach to improve quality and safety and enhance value from the patient’s perspective. It included a monthly meeting of chief executives from the partners, structured learning and teaching of the method across the organisation, and support for staff to apply the methods in their daily work.

Jimmy Parvin, previously Professional Lead for Improvement Method, acknowledges that there remains some variation in understanding of the Leeds Improvement Method approach across the different layers of the organisation, and they are trying to narrow the gap on that understanding.

Although the language of a quality management system would not be routinely recognised across the trust, ​‘we do run a version of a QMS’. For example, their quality planning includes setting annual commitments that are agreed by the Board. These commitments, alongside the principles of their Improvement Strategy, then ​‘permeate the way we do things’. For each of the trust’s 19 clinical service units: 

Jimmy describes a level of connectivity across the different elements of their system. For example, the governance structures include steering groups to routinely capture the learning from data, incidents and other sources, triangulating it to determine where to focus improvement efforts. 

Jimmy acknowledges that it’s very difficult to prove what difference their approach has made. However, improvement is evident in their staff survey scores on questions around people’s ability to improve work, and being listened to by managers. 

Their Quality Account cites how the LIM approach was applied in a range of clinical value streams in the past year, demonstrating improvement in quality while reducing waste in the process. This included a 28% reduction in children’s cardiac surgery cancellations, and a 51% improvement in the correct recycling of medicines. Their focus in future is on scaling up localised improvements and on addressing quality challenges at the care pathway and organisational level.

The VMI approach defines quality ​‘in its broadest sense’, resulting from good outcomes, appropriate care and positive patient experience, minus any waste in the process. This has meant that, while quality of care remains the primary aim, ​‘we now have a degree of maturity where we can bring [into conversations] cost, efficiency and sustainability’. For example, delays in care become part of discussions about quality, and any work on waste reduction has quality impact assessments against it.

Leeds has retained fidelity to the core principles of Lean – ​‘it’s important to choose a system and stick with that system’. But they now have the confidence to test and experiment with different methods, and have worked hard to demystify some of the language associated with the original concepts. This has resulted in a management system that people are using, day and day out, to solve their problems themselves.

• Leeds’ philosophy is marked by an overall shift in the balance of activity, from quality assurance to quality improvement work, and moving from tackling discrete quality problems to adopting a pan-organisation approach.
• Adopting Lean as a management system ensures quality and value is seen from the patient’s perspective, and enables improvement work to include consideration of issues that impact quality, including cost, efficiency and sustainability.
• Improvement is led by those closest to the front line, and they have therefore worked hard with staff to demystify the original improvement concepts while retaining fidelity to their principles.