Rapid Improvement Event?

Over the last few weeks I have received a number of enquiries about doing 'Rapid Improvement Events'.

The way it normally goes is that I get an email which reads;

"I would like to discuss you coming to do a Rapid Improvement Event on the X, Y & Z of Month X"

Now, I am a fan of Rapid Improvement Events - but as part of an improvement process not as the 'be all and end all' of the improvement process. Where does training, scoping, communicating and process redesign come into the equation? At the very least there will be a heap of questions that need to be answered prior to the actual event - but that assumes that a Rapid Improvement Event is the most appropriate mechanism for improvement - what about Continuous Improvement Teams (improvement spread out over a longer period), Project Teams (high level improvement teams focused on strategic issues such as changing IT systems) etc?

I can theorise what is causing this confusion in the marketplace and hope that the message goes out more effectively in the future.

To find out more about my views about where a Rapid Improvement Events fits into the improvement process visit the Amnis website and join our newsletter network to receive a free copy of our eBook 'Lean for Practitioners'.

Lean Panacea?

Do you believe Lean is a panacea?

I was in a presentation this week and it was clear that people in the audience felt that 'Lean' was the answer to all their problems. They had all tried things before but this time 'Lean' was going to make the difference.

So what is Lean - is it some form of magical power that transforms unsuccessful organisations into successful ones or a genie in a bottle which (when released) can make improvement programmes go further and faster than ever before?

Of course it isn't.

Lean has the power to do good if done well and the power to do great harm if not.

For many people who think their previous improvement attempts have not worked is because they either have been sold a Turkey (by a consultant who has read a book on XYZ Methodology) or they have not prepared their organisation effectively for the change or supported it after the change.

Will 'Lean' stop these problems? Is it possible that many of the people who claim to be 'Lean Experts' have just read a book or that many of the organisations engaged in Lean will not prepare their organisation and/or support it?

What do you think?

Philosophies, Processes & Tools

I was discussing different approaches to improvement with a friend this week who is very keen on 'NLP' and he took the stance that 'Lean' was just a 'tool' for improvement.

Sadly, this is the perception of many who do not know the detail of how to make organisations better or only understand 'their' way (whether that is Six Sigma, Lean, NLP etc etc)

I would identify three levels of activity to be undertaken:

• Philosophy - what is the strategic approach that best suits your need
• Processes - what are the different ways that you might use to implement your philosophy
• Tools - what techniques or management tools might you use to support your processes

Taking a comparison of Six Sigma, Lean (and because it was raised NLP) at these three levels I propose the following:

Lean
- Philosophy - the elimination of 'waste' and creation of value, flow and pull
- Processes - Value Stream Mapping, Rapid Improvement Events etc
- Tools - 5S, SMED, TPM etc

Six Sigma
- Philosophy - the elimination of variation in process and through this consistency
- Processes - DMAIC, Process Analysis, Focused Improvement Teams etc
- Tools - SPC, TPM, SMED, DoE etc

NLP
- Philosophy - improving relationships between individuals and getting 'more done'
- Processes - coaching sessions, group facilitation etc
- Tools - Swish, Goal Setting, etc etc

Now, if you just assume that 'Lean' is a tool, which of the hundreds of improvement tools is it?

What do you think?

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.

RIE to Lean

It is a shame that some people believe that Lean is purely about Rapid Improvement Events!

Lean can be implemented in a variety of ways and whilst I would always recommend that you quickly create a 'case study' site inside your organisation, the majority of the long-term benefit comes from incremental improvements led by your front line teams. Sadly, the popularity of Rapid Improvement Events is growing, particularly in Healthcare, driven by the fact that they deliver quick returns. However, if these improvements are not backed up by on-going management interest in sustaining the improvements and a culture of on-going review and improvement within the teams themselves, the benefits will quickly erode.

Rapid Improvement Events are great for management consultancies as they allow the best return for the consultancy in the short to medium term and perhaps their popularity is being driven by these consultancies?

The dangers of this approach for an organisation is that an isolated event may create problems upstream or downstream in the process or in another pathway completely. They are also resource intensive, both from external support and internal effort, and can be disruptive and potentially dangerous in high risk environments.

I would always advocate that before any improvement activity occurs, the teams understand the potential impacts upstream or downstream using such tools as 'Value Stream Analysis' or Pathway Mapping and that available data is collated. In addition, your organisation should identify its internal change agents before you look for external support as these change agents will be essential for the embedding of improvements.

Lastly, to back up any Rapid Improvement Events you do run, I suggest you will need regular reviews of progress and the benefit of continuous improvement led by your own front line teams.

What do you think?

Is structure more important than tools?

It is interesting when a group of 'Lean' (or Six Sigma) enthusiasts get together as the talk quickly moves onto the topic of which tools have been used and examples of 'Visual Management'.

However, given that Lean/Six Sigma/Concurrent Design are really just a bag of tools from which a skilled mechanic will draw out one that is appropriate, I believe it is more important to discuss the structure of the improvement process. Fundamentally, what steps will be taken by the organisation to deliver improvements - from outlining the requirement for improvement (setting out the organisational Roadmap and Scoping the changes to be made) to implementing improvements in a flexible manner - the discussions need to cover who will be involved, when and why and how the process will be managed and reported.

I would be interested in knowing what your thoughts are and in the meantime if you would like a copy of a document which will help you set out your plan of attack then please drop us an email to info(a)amnis-uk.com.

Has Lean lost its cachet?

I posted a blog earlier this year on this topic and have decided to post another because Lean is already starting to lose its cachet - particularly in Healthcare - and partly because it has become a vehicle for large consulting fees for little return (and certainly no where near enough knowledge transfer to make the Lean improvements sustainable).

In earlier posts on this thread I have identified the nine key reasons why Lean programmes fail and we are already starting to see that Healthcare experiences are mirroring Manufacturing experiences and that many trusts are moving away from discussing 'Lean' as they realise that it can turn off many in Healthcare who perceive it as a 'Manufacturing Fad' and have also heard the horror stories of those Healthcare organisations who have got it wrong (and sometimes badly got it wrong).

I have always believed that the key to success in the implementation of improvements is not about 'Lean', 'Six Sigma' or 'Agile' but about:

1. A robust structure
2. A focus on knowledge transfer and sustainability
3. Building internal relationships
4. Managing risks as well as managing improvements
5. Doing what is the best for the people and the process and not just what the 'Lean Purists' want

What do you think?

Bringing People Into Lean

This post details the last of the nine main causes of failure. Since starting this series of posts, further research has been undertaken which changes the weighting of some of these causes of failure and which will be outlined in our other blog here.

As stated at the start of this thread of related posts, the results of the work that led to this series was published by the IOM and can be downloaded here.

However, in finishing this series of posts, I can announce that the last issue that affects the success of Lean projects from the original research is 'On-Boarding' or the art of bringing people into the process, either from internal transfers or external recruitment, who have not been part of the improvement process and do not share the values and understanding held by others in the group and who have not been brought into the way things are done in the 'new way' and who bring with them therefore alternative (and often non-Lean) ways of doing things.

Therefore, in conclusion of this series of posts, I can summarise the results of our original research into the causes of Lean failures as being problems with:

• Planning
• Reactions
• Ownership
• Training
• Operation
• Communication
• On-Boarding
• Leadership
• Systems

Collectively, this work spells the word PROTOCOLS. However, whilst each of these areas of failure remain valid, later research (gained partly from Manufacturing with some testing in Healthcare) shows that some can be combined, others changed and at least one needs to be added.

To find out more either drop me an email to markeaton(a)amnis-uk.com or read the post on our other blog here.