1682 Improvements in paediatric diabetes service using kaizen – a process of continuous improvement using lean tools
Year: 2021
Type: conference-abstract
Abstract: Background The Lean for Leaders is a 9-month training programme based on Kaizen methodology with the goal of developing skills and confidence of team leaders to use the ‘lean’ tools to transform health care. The aim is removing waste and using efficiency-based methods to deliver improvements in service. Objectives To evaluate the impact of Kaizen, continuous improvement, in Paediatric Diabetes Unit (PDU) after Lead Clinician for Paediatric Diabetes completed the Lean for Leaders Programme. Methods We are a Paediatric Diabetes (PDU) with 232 Children and Young People with Diabetes (CYPD). We submit data annually to National Paediatric Diabetes Audit (NPDA) undertaken by Royal College of Paediatrics and Child Health (RCPCH). Data submitted includes HbA1c results for all patients Health check completion of 7 key care processes: HbA1c, BMI, thyroid function, retinopathy screening, urine albumin creatinine ratio, blood pressure and foot examination for CYPD over 12 years. To improve these performance indicators, we used Kaizen bases lean tools as below, without increase in staffing or PDU funding: Age specific education sessions at secondary school and university entry Diabetes Nurse led review for CYPD with suboptimal control between clinic appointments Negotiated availability of Flash Glucose Monitoring with local clinical commissioning group Designed and used an electronic proforma at annual review appointments for documenting and completing care processes Introduced pre-clinic multidisciplinary team huddle to enable focused consultation and problem solving with clear ownership of jobs arising Streamlined process for obtaining retinopathy screening results Use of ‘live’ improvements board. This kept the entire team involved with the improvement process, defined key ownership of improvement work and progress made till date. This was done via emails and reviewed in team meetings. To evaluate the results from the year prior to and after implementation of these tools: Mean HbA1c results for NPDA 2017/18 (n=218) and 18/19 (n=224) were compared using Two-tail Z-test. Health check completion rate were compared for the two years. The health check completion rate was obtained dividing the total number of key processes for CYPD over 12 years having full year of care in our PDU (n=124 in 2017/18, n=101 in 18/19), by the total ‘expected’ (7 X n) health checks. Results Mean HbA1C in 18/19 showed a statistically significant decrease with p-value of 0.003. Median HbA1c levels in 2018/19 (63.5 mmol/mol) reduced compared to 17/18 (67.2 mmol/mol). The health check completion rate improved from 78% to 88.3%. CYPD getting 4 HbA1c tests per year improved from 62.6% to 100%. CYPD getting level 3 carbohydrate training within 14 days of diagnoses improved from 28.6% to 78.6%. CYPD getting sick day rule advise during annual review improved from 74.8% to 96.2%. CYPD getting additional dietetic 1:1 appointment improved from 85.3% to 94%. Ketone meter training improved 76.2% to 95.7%. Conclusions Kaizen ‘lean’ interventions improved HbA1c and health check completion for our PDU. This was delivered without any additional financial impact to the service provider.
Source: Abstracts
Authors: Neemisha Jain, Olga Lipova, Alex Lipov, Sara Cuming
Institution: Surrey and Sussex Healthcare NHS Trust
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3202542006