Leaming from the Sickkids journey SickKids in Toronto is one of the world's leading children's hospitals, with a successful multi-year continuous improvement program. Having supported the introduction of SickKids' work of the leadership team and front-line ward staff in order to understand best practice. SickKids began its operational excellence journey in 2012, with the help of external consultancy support from Gordon Burrill of KPMG and Kim Barnas of ThedaCare. Departments have been empowered through their Daily Continuous Improvement Program (DCIP), to solve problems at the department level, and the hospital has achieved significant success with local improvements and innovations. SickKids has SickKids has a dedicated team of 5 full-time staff, mainly with industrial engineering backgrounds, whose job is focusing on empowering staff to: Identify improvement opportunities Design efficient processes Implement viable solutions This team offers training in Daily Continuous Improvement Programme, as well as in process improvement at the Yellow Belt Level (one-day training) and the Green Belt Level (six-day training spread across six months, plus the completion of a project) SickKids is currently developing a Gemba (httos://www. processexcellencenetwork.com/lean-six-sigma-business-transformation/ articles/gemba-kaizen) tool, to help its internal teams who focus on process improvement and innovation to provide meaningful feedback to departments and teams on their performance. Examples of how SickKids apply operational excellence 1. Safety briefing call During the visit, the group joined the daily safety briefing phone call at 8.40 am with leadership from across the hospital. The call focuses on quality, safety and risk issues across the organisation and is alwavs led by a hospital executive, who reports back each Monday to the full board on the week's calls. Conducted calmly and methodically, the daily call takes a look back at the past 24 hours and anticipates any problems set to arise in the next 24 hours. At SickKids, this has proved invaluable to identify and resolve problems quickly: it has had the side effect of making interdepartmental links much stronger. A notable feature of the call was evident 'coaching moments' when incidents were described. The executive leading the call described such an incident as "a good reminder of using our 'STAR' (stop-think-act-review) error prevention technique. these are really great coaching moments, when we can identify that a patient identification error has occurred. It's great we can use this call to educate ... lessons for all of us." Where problems are raised on the safety calls, the SickKids process ensures there is always a follow-up: the expectation is that a problem raised today will be solved tomorrow (or a plan to resolve it developed by tomorrow). Repeating issues that arise will be noted by the internal team identifying quality and safety trends. 2. Status meeting and improvement huddles The status meeting is a methodical run-through of operational, technical and logistical issues conducted in all units affecting every team, following a detailed single A4 sheet of questions. The safety huddle is a scheduled 15-minute meeting (timed with a countdown clock on the standardized huddle board). All members of staff can put a 'ticket' detailing a quality or safety problem on the board at any time. These tickets are reviewed and filed for action (or further review) at every meeting, with verbal updates on progress or re-filing the ticket into a different board category. Some teams agree that the individual who writes up the ticket cannot themselves solve it The 15-minute countdown keeps the focus high: "it raises anticipation. If it were not timed, you'd lose enthusiasm" Participants felt that it was helpful for teams to build in time to schedule the huddle as early as practicable towards the beginning of the working day, to ensure energy: "don't tack it on to the end of a clinic" Safety huddles help to grow a sense of team and empowerment: one team member observed, "when you get your tickets dealt with, it feels great. They also suggested that, correctly done, the huddles are effective means of teambuilding and positively influencing staff satisfaction. Ques 1) For kids section how to achieve operational excellence