EQUIP: making Tower Hamlets the best place to work, and the best place to receive care.

The world of General Practice is currently under significant pressure. Across the board budgets are being cut, and resources constrained. ‘On top of this, practices face a rapidly growing population, thus in turn increasing demand for GP services. The growing population has different health needs from those of the past, forcing practices to re-evaluate the efficacy of their business models and clinical processes. As a result of these challenges, practice staff are under unprecedented levels of stress, leading to recruitment and retention challenges.

Our response to these conditions is to roll up our sleeves, and address these issues head on. The EQUIP (Enabling Quality Improvement in Practice) programme is designed to do just that, by providing practice staff with the tools to create meaningful and lasting change. This is done by allowing practices to work on what matters most to them through a tried and tested Quality Improvement methodology. By doing this, we hope to improve the lives of staff and develop a culture within practices that values bottom-up change and continuous improvement. We also hope that we will make General Practice resilient and effectively able to manage current challenges and variation, and lead change so it can deliver even better care to patients in the future’.

Our Latest Newsletter (23/09/2019)

One of our most loved GPs, George Farrelly, takes the stage today with the Chrisp Street flu project team. No other words needed from my end – few people tell a story better than George. Get comfortable, open your mind, and welcome this moment of opportunity, through George’s eyes.

I have been asked to tell a good story about my experience as a coach. I have a lot of good stories, but I will tell you the one that first came to my mind when this question was asked.

I was standing in the corridor at the Chrisp Street Health Centre with the flu project team. I had just finished giving the team an introduction to the Scrum-inspired wall task board and I had showed them what another team was doing with theirs.

Then there was a moment: they got all excited, engaged, and started planning. They were going to create their own board the following Tuesday, they divided up the tasks. I just watched them. Wow! That’s the good story: this team shifting gear, getting excited about their project, and how they were going to get it done.

I’ll give you a very broad overview of this; if it works out, I might give you some more details in 6 months.

In my improvement apprenticeship/learning journey (which started unexpectedly on Friday 21 November 2014) I have visited many corners of the large improvement forest. Along my way I encountered Agile, which is the improvement mind-set which evolved in the tech industry (software development) in the 1990s and since. Two of the main frameworks used in Agile are Kanban and Scrum. Don’t worry about this now. Suffice it to say that they both commonly use a task board. Look at photo 1:

This is the Scrum board at the scrum coach training I attended. There is a left hand section, a middle section with five columns, and a right hand section. The idea is this: a team has a project, a ‘product’ they want to create. They create a list of the items or features that will be needed for this product. These go into the left hand section of the board, called the Product Backlog. You can see a number of cards; each card represents one of the elements of the product. The team then orders the cards, working out which ones need to be done first. The team works in 2-week ‘sprints’ (these are focused periods where the team is committed to getting a defined part of the work done; it could be one week, or three or four weeks; most teams choose two weeks).

The designated cards for the sprint are moved to the first column of the central section – see photo 2:

Cards are assigned to individuals or pairs on the team; they further refine their work (represented by their card) into tasks, breaking it down so they can focus on getting each task done. Commonly these tasks are written on post-it notes. The card stays in the 1st column, and the post-it note tasks get put in the ‘Tasks To Do’ column (clearly assigned to someone on the team). The two weeks’ work is then visible to all. Team members will take one or their tasks and move it to the ‘Tasks in Progress’ column; once they have completed that task, they move it to the ‘Tasks Completed’ column, and then take another post-it from the ‘Tasks to Do’ column. One by one they get their work done. Once all the tasks associated with the card in the first column are completed, the card and the task post-its get moved to the ‘Done’ column. At the end of the two weeks, the team reviews the work that has been done and how the process has gone. The completed cards then get moved to the right hand section, the ‘Sprint history’. Then they plan their next 2-week sprint.

A final point to complete this brief overview. There are two central planks to this framework: make your work visible and limit your WIP. WIP stands for Work in Progress (the ‘Tasks in Progress’ column). The evidence is that if you do not limit your WIP that the work slows down. If you limit it (say to one or two tasks) you will get the work done more quickly and effectively.

Let’s return to the wonderful Chrisp Street flu project team (nurses, admin/reception reps, practice pharmacist). They created their task board on the wall of one of their corridors and they populated it with cards – see photo 3; this is an early photo, ignore the details on the cards and the lack of post-it notes.

We now have our meetings in front of the task board, in the corridor. The team can see their work, they can prioritise what to work on next, they can add items to the Backlog as necessary. And they can keep track of who has responsibility for what and whether it is getting done.

So far, the team like it and are deepening their understanding of how to use the framework. They gave me permission to report this to you as a ‘good story’. Perhaps the team can report in four months or so on how it has turned out.

George Farrelly

This moment of sharing is especially unique as it offers a tool rather than a project – something all of us can use, no matter what we are working on. As we all continue to grow, experiment, succeed, and successfully fail – with many thanks to George and the Chrisp Street team for their generosity and willingness to share a nifty “new” trick.