Clozaril Pathway - Rapid Process Improvement Workshop (RPIW)

Improvement work leads to better service for mental health patients taking Clozaril medication.

Teams across the Trust have improved the service for patients taking the antipsychotic medication; Clozaril by undertaking an intensive rapid improvement workshop.

The Continuous Service Improvement (CSI) team in conjunction with the Cumbria Learning and Improvement Collaborative (CLIC) recently facilitated a workshop focussing on improving the Clozaril Pathway, making it safer by putting patients, carers and staff at the centre of all we do.

Rachael Davies CSI lead said “An RPIW is an improvement workshop which brings together staff from across the organisation or health care system to improve a process. It is a facilitated workshop that helps to accelerate an improvement and change to practice. A fundamental goal is to create a more reliable, efficient patient driven process.  An RPIW is also an educational event with participants learning about improvement tools and approaches and trying these out in the workshop. Prior to the workshop the improvement team works with the service to identify the targets for improvement, capture the current state through observation, measurement and process mapping.”

Feedback from participants is positive. They have said “We all work better as a team; it is possible to improve the service through enhanced working relationships and using the tools. I only saw the service from my perspective, now I see all the bits of the jigsaw. It is an intensive process, we achieved more in four days than we would in a year”.

The four day workshop included professionals from pharmacy and CMHART, a patient, carer and colleagues from the e-health team. On day one they set the scene identifying the targets and expected outcomes, including improvements in holistic care planning to include monitoring of physical and mental health, reduction of waste and streamlining the process. One of the tools used was the waste walk which encourages staff to identify activities that don’t add value for example duplication, defects, motion and over production, removing the waste releases staff time to focus on activities that make a positive difference to the patient.  For the remaining three days the team analysed the process and redesigned an improved future state. 

There were a significant number of improvements which included, 281 hours of waste removed which is equivalent to £5500 per year, collaborative working, improved communication, routine screening of physical, social and mental health. Changes to RiO to improve reporting and access to patient information.  Standard Operating Procedures (SOP) are in place for patients being discharged from inpatient to CMHARTs, for managing alerts regarding blood results and a further SOP for changes in medication which will improve safety.

The process which is owned by the team has a lead in of 10 weeks to enable a detailed understanding of current state and to ensure the right people are involved following the workshop there is a 30 -60 – 90 day follow up schedule to embed the improvements and achieve the targets agreed at the outset.

The RPIW has focussed on the Carlisle area; there are plans to spread the improvements made countywide. If anyone would like more information on a rapid process improvement workshop with the CSI team please contact

Clozaril is an antipsychotic medication used to treat severe schizophrenia, or to reduce the risk of suicidal behaviour.  It can only be administered following satisfactory blood results.