RPIW is an acronym for a Rapid Process Improvement Workshop. It is an event, usually lasting for several days, at which a clinical team focuses on improvement work. There’s a pdf document developed by the Department of Veterans Affairs in the US which offers some FAQs on similar events, and it is available here.
I will cover the structure of an RPIW in the future, but it’s useful to see an example of a report out. This is done at the end of the event, to feed back the work the clinical team has done during the week. They present their work to the project sponsor – the person who asked for the work – and to colleagues and other invited people to whom the topic is relevant. It is usual for everyone who worked on the RPIW to contribute to the report out, to acknowlege their contribution, and to demonstrate collective ownership of the work.
There are numerous examples of RPIW report outs on the internet. An example in a Child and Adolescent Mental Health Service (CAMHS) can be found on YouTube here.
If you watch this video, you will see many features that are common in RPIW report outs. There is no power point presentation. Instead, materials used on the RPIW are projected on to a screen. The speakers give examples of work collected before the RPIW: preparatory work is important in all Workshops, as it saves time during the event, provides material that brings the problem alive, and helps to produce some agreement on the nature of the issues to be addressed in advance of the Workshop. The first speaker talks about PQA data – this is a Product Quantity Analysis – a look at the demand for the service.
For staff who have not had the opportunity to attend Lean training, there is a lot of technical jargon in the video. The main approach is clear, however – the team looked at their activity, and decided to concentrate their work on a sub-team that undertook a considerable part of the total activity. They then calculated, from their demand information, how many people they needed to be able to see in a month, and therefore what patient flow they needed to achieve to keep up with their demand.
The team used various Lean tools to examine their work. They looked at the time for each stage of their process, and identified issues on which they could work. These included time taken away from clinical duties to collect printing, and work to reduce non-attendances. The approach to non-attendances is interesting, as it includes encouraging people to call if they cannot attend, and creating standard work – a common Lean term – for staff, so that there is a consistent response and everyone knows what is expected of them.
Another notable feature is that one of the presenters is a consumer representative. This is accepted as good practice for a RPIW, and feedback from staff supports the impact of having patient / service user / carer input, depending on what is relevant to a particular area of work.
The last point from this report out video is that it is a work in progress: the team did not meet their takt time. Takt time is the ‘beat’ of the process, the rate at which people need to pass through the process to keep up with demand. Despite this, there were demonstrable improvements as a result of the RPIW, with a reduction in wasted time obtaining printing; a reduction in the rate of peope who did not attend appointments; better management of information resources; improved communication arrangements, and decreased waiting in the department for returning patients. Overall, this appears to have been a successful RPIW: it resulted in demonstrable improvements, but inevitably left areas in which further improvement work would be needed – the ‘pursuit of the perfect patient experience’ that Virginia Mason seek, and which is at the core of Lean activity in health and social care services.