Process Change v Behavioural Change

For many of the people I work with the story I am going to tell will be very familiar!

I will start by saying that I believe that a lot of improvement programmes fail because people focus on achieving a change in the process but do not address the required changes in behaviour that support the change.

My example is this:

1. My refuse collectors (dustmen) changed the rules on me and insisted that I moved my bins to the edge of my property else they would not take them (PROCESS CHANGE)

2. The first week after this change, I forgot and the bins were not taken.

3. I also forgot the second week and again the bins were not taken

4. By the third week, I remembered to move the bins to the edge of the property but it was conscious (CONSCIOUS ACCEPTANCE)

5. Now, after a number of weeks, my behaviours have changed and I move the bins without thinking (BEHAVIOUR CHANGE)

When people reach the point where the new process does not feel 'new' anymore (like the point when a 'new' pair of shoes become worn in) it is safe to move on to a new set of improvements.

Without reaching this point (ie the behaviours have not changed) it is likely that the process will revert to the way it was 'before' because that is what 'feels right' to them.

I could go on and on with similar examples, including the behaviours around seatbelts, mobile phones and direct debits but I will save those for the workshops we run on Sustaining Lean.

I would love to hear what your thoughts and experiences are on this..........

Becoming a Lean Healthcare Organisation

I was having an interesting discussion over the weekend with an old friend about how to transform a functioning hospital into a Lean hospital given that many see 'Lean' as simply a tactical tool.

I realised that the things that differentiate ordinary hospitals from Lean hospitals also apply to other types of healthcare organisation (Mental Health, Primary Care etc) and I therefore thought I would start the discussion here about what the differences are between an ordinary healthcare organisation and a Lean one.

I believe there are ten key attributes which differentiate a Lean Healthcare organisation from ordinary one and these are:

1. An Improvement Board exists and has the active support and involvement of the The Board and including a Clinical Lead

2. An experienced service improvement team consisting of full-time people who are available as an organisation wide resource to facilitate and lead improvements

3. Local 'Lean Advocates' exist in all departments/functions. These are people who have a full understanding of Lean and how to implement it and take the initiative for local improvements with the support of the Service Improvement team

4. Widespread understanding throughout the trust about the tools, skills and approach to implementing Lean. This means a robust and open two way dialogue

5. Engagement across disciplines - so clinical, administrative and support service personnel are engaged in improvements

6. A focus on improving pathways and involving people from across the pathway (rather than just a focus on local improvements within limited areas)

7. A robust, proven and customised approach to leading improvements within the hospital (and engaging with the wider healthcare economy)

8. A system that is capturing and celebrating improvements that are occurring

9. A process of continuing professional development for the team to raise their skills

10. Learning from across the site and from other sectors - not all the best improvement ideas reside in Healthcare

I would be interested to know what you think......

Either comment below, email me at markeaton(a)amnis-uk.com or visit our website http://www.amnis-uk.com/.

Sometimes Lean is not enough

If you have read any of my other posts below you will begin to realise that whilst I am a big fan of 'Lean', I do not see it as a panacea and recognise that it can be implemented just as badly as anything that has come before (TQM, JIT, BPR etc).

The real art of 'Lean' is recognising when it might not be appropriate to use it or even when you might have to modify your approach to make it fit with the requirements of the organisation you are working with.

I was chatting to an old friend who works for one of the big consulting firms today and he was moaning that they had to apply the same methodology irrespective of the needs of the client. They were not really Lean specialsts and therefore the only way they could get large numbers of consultants earning cash was to develop a fixed structure.

Without the background experience of having down a variety of improvement programmes, he could not see how these inexperienced (but bright) people could really help the clients. Instead, there was a danger that because everyone was getting an 'off the shelf' solution, no one would get an optimal solution.

The ability to flex programmes to meet the needs of clients and the ability to recognise when the approach you are using is not delivering the results you really want only comes with experience, along with a healthy dose of empathy for the organisation you are working with and the environment in which they operate.

So, sometimes Lean is not enough - but do you know when that is? If not, why not call me on +44 (0) 7841 464916 for a chat or sign up for one of our workshops at http://www.amnis-uk.com/.

Achieving 18 Week Success

A wide range of NHS Trusts are using Lean as part of their strategy for achieving the government's target to achieve an 18 Week referral pathway (the period from initial referral until effective treatment begins).

For many, this means that first appointments need to be achieved in around 4-6 weeks to allow for diagnostics to occur prior to treatment starting.

In many areas, trusts are already achieving these targets, but very few trusts will have all pathways that are '18 Week Capable' and will require to focus some effort on to the improvement process and Lean can be both a blesssing and a curse in this process.

The reason for the last statement is that whilst Lean can be used to successfully achieve the 18 Week target it can also be implemented in a manner which increases organisational issues including leading to the transfer of risk to other areas, a negative impact on Patient Safety and generally creating unsustainable improvements which will slip back as soon as management focus turns to something else.

The upside is that Lean can be used to provide a structured process for achieving the 18 Week pathway, with all the associated benefits in terms of patient experience. The problems that normally occur include:

1. Failing to look at the pathway from end to end (which can be avoided by using Value Stream Analysis)

2. Failing to involve representatives from all functions affected - and this often means representatives from outside the organisation

3. Not scoping the improvement process (download a free guide to Scoping Session here)

4. Failing to provide a suitable structure for the improvement process that means often that discussions do not turn into actions

To find out more about how to use Lean to achieve the 18 Week target and receive our free eBook 'Lean for Practitioners' visit our website and sign up to our network.

Don't waste your money on Lean....

.........unless you are going to put in place the systems to make the improvements sustainable!

Making isoldated improvements (ram raiding) can do more damage to an organisation than doing nothing at all! If you want sustainable improvements you need to establish a plan of action, a team to carry forward internal improvements (Change Agents) and look at Pathways from end to end (E2E) to avoid just transferring risks and costs somewhere else in the process.

What do you think?