What happens in an RPIW?

CommunicationYou may have been asked to take part in an RPIW, perhaps as a team member, or as a Process Owner. But what, exactly, is an RPIW?

Rapid Process Improvement Workshops, or RPIWs, are events at which a team undertakes focused Lean work on a process. Very similar terms can be used by different services- ‘Rapid Improvement Events’ (RIEs) and ‘Kaizen events’ are terms used in some systems. Other systems use ‘kaizen’ to refer to the process of continuous improvement or to shorter improvement events, so it is always worth clarifying how words are used if you begin work with a new system or provider. There is an example of ‘Kaizen’ being used as a term for shorter workshops at this link.

RPIWs are not the only way – or event the main way – of undertaking Lean improvement work. Mark Graban, along with others, has argued that a focus on events such as RPIWs can result in a belief that facilitated events are the only way to ‘do Lean’. This is not the case. I saw a great recent example by a pathology service, where the staff had worked on their internal processes over several years. They had limited external supports, but had produced very impressive changes by applying the techniques, conducting small cycles of change, and persevering over time.

RPIWs are often used, however, when there are large pieces of work to be done, particularly if the process crosses several departments or work streams.  Formats vary, but it is common to run them over a working week. The use of these focused events in healthcare was pioneered by organisations such as Virginia Mason. There are now many examples of the use of RPIWs in health care, including examples in children’s services, and mental health services as well as in laboratories, surgery and medicine.

There is a good Canadian video at this link, which follows the process of an RPIW. The precise structure varies, but in general, there is a preparation period for the RPIW. During this time, which usually lasts around six weeks, information is collected on the service that is the focus of the work. Much of this will be by direct observation of the service. If the process being reviewed involves patients, then this stage will include following patients, with their permission, in an attempt to understand their experience of the process. Information may also be collected from electronic systems, or by observation, on activity and waiting times.

This preparatory work also includes agreement on the scope of the workshop – a decision on precisely what part of the service will be included in the work – and preparation of the staff. Anxieties are common before any service change, and the more staff understand of the process and the intentions, the better the RPIW is likely to run. A Process Owner will be identified, who plays a key role in taking responsibility for the follow-up of agreed actions after the RPIW.

Closer to the RPIW, staff in the service will be asked to identify wastes, and to suggest ideas for change. The group who will lead the work is identified. This will include people who work in the service, a patient representative, and in some cases people who work in similar processes, or processes that overlap with the current work, also take part.

In the RPIW itself, the first day is often spent on training staff on the principles of Lean, and on some of the relevant techniques. This will often include introducing people to some of the forms used for measurement, and letting them practice using them. The information collected on the run up to the RPIW is also presented on the first day. Further mapping of processes may take place on day two of the RPIW, and in some cases work starts on  future state map. Further wastes are identified, and new ideas added to those that have already been suggested. The rest of the week usually consists of trying out ways of making improvements, using PDSA cycles.

The final day, or often half day of the RPIW, prepares for the Report Out. This is not the end of the work, however. The Process Owner takes responsibility for the actions after the RPIW, often using an action plan known as a newspaper. There are further report outs (sometimes termed ‘audits’) at 30, 60 and 90 days, and some systems also have a follow up at one year after the event.

As with all Lean health care work, the focus is on increasing value to the patient. Staff usually find participation rewarding, and it is common to have people who take part become advocates for future Lean work.

Image courtesy of renjith krishnan at freedigitalphotos.net

6 thoughts on “What happens in an RPIW?

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