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Have you visited our main website and signed up to our newsletter yet?

In return you will receive a free copy of our eGuide 'Lean for Practitioners' which whilst focused on the Healthcare sector has much broader applicability.

Also, you will shortly receive our new free eGuide 'Sustaining Lean Healthcare Programmes' which is due for release in November.

Lastly, you might want to visit our Lean Healthcare Blog which has some useful hints and tips to help your Lean programme go further and faster - it is also where the really interesting stuff will be posted from now on.........see you there soon!

Lean Healthcare

Just a short announcement to say that you will also be able to find out about our thoughts on Lean in Healthcare at our Lean Healthcare Blogsite.

Why haven't you already got it?

You might be living proof that not everyone has read our FREE eBook (Lean for Practitioners) which was described as 'Inspiring' by one reader and 'Excellent and Really, Really Useful' by another.

To obtain your free visit our WEBSITE and join our Newsletter Network when you will be sent a link to enable you to download our free gift to you!

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?

Why not join me on the journey?

This simple post is a copy of the newsletter contents for August 2007. I invite you to join our network by emailing Nicky English (nickyenglish(a)amnis-uk.com). At the very least, this edition (like every one) contains some links to useful download material - so please feel free to download and enjoy!

What can you learn from other sectors?
Working with a wide range of organisations from the private and public sector we see different sectors encountering the same problems occurring and find that solutions from one sector can easily be applied to others.

For example, dealing with capacity issues in a customer service call centre for a manufacturing business is broadly the same as improving the capacity of a call centre in a healthcare organisation.

Apart from differences in terminology, technologies and some special circumstances (political environment, trade barriers, regulations etc), organisations can learn a lot about how they improve their own organisation by not only looking at best practice in their own sector but in other sectors too.

What do you think? Send us your thoughts to info(a)amnis-uk.com.

Lean Healthcare Conference – 28th September 2007
Amnis’s Mark Eaton will be speaking at the Lean Healthcare Conference on the 28th September 2007 on how to turn your Lean change programme into long-term improvements in behaviours and patient safety. To find out more about the conference click here http://www.lean-thinking-healthcare.co.uk/.

We are also speaking at the Institute for Risk Management’s ‘Risk Forum’ on how to integrate Lean with patient safety on the 13th September 2007 and you can find out more here http://www.theirm.org/riskforum.

If you are unable to attend either of these two events, you will be able to meet Mark and other members of the Amnis Team at our forthcoming events which are listed here http://www.amnis-uk.com/events.htm.

Regular Download Slot
Every month we offer you the opportunity download interesting guides, materials and presentations to help you get the most out of your improvement programmes. This month’s selection includes:

§ eBook (Worth £20) Lean for Practitioners – http://www.downloads.amnis-uk.com/LfP.pdf
§ Embedding Lean Article – http://www.downloads.amnis-uk.com/EL.pdf

For a full list of downloads or to ask a question about how to get the most out of your improvement programme, please send an email to Ruth Bodman at ruthbodman(a)amnis-uk.com or ring her on 0870-446-1002.

Developing Knowledge, Transforming Performance
We would be delighted to welcome you to one of our popular development workshops in September which will include:

Sustaining Lean (London) – 6th September 2007
Many improvement programmes fail to deliver the long-term benefits organisations want. This workshop focuses on how to effectively recover from a stalled programme and prevent future programmes for suffering the same fate. To find out more click here:
http://www.amnis-uk.com/workshops/Sustaining_Lean_IW.htm

Value Stream Analysis (London) – 11th September 2007
Value Stream Analysis is a practical tool used to map pathways from end to end. This practical workshop will involve participants in learning the practical skills to enable them to map and improve their own pathways. To find out more click here:
http://www.amnis-uk.com/workshops/Value_Stream_Analysis_IW.htm

Delivery Value through Effective Risk Management 17th & 25th September 2007
This workshop, which is delivered in partnership with our strategic partners at the Institute for Operations Management (www.iomnet.org.uk) and Det Norske Veritas (www.dnv.com) focuses on how to reduce risks and simultaneously improve performance using an integrated approach to improvement. To find out more click here:

17th September 2007 (Coventry)
http://www.amnis-uk.com/workshops/Institute_of_Operations_Management_Workshops_in_Coventry.htm

25th September 2007 (London)
http://www.amnis-uk.com/workshops/DVtERM_IW.htm

Leading Lean Improvements – 20th September 2007
This exciting workshop focuses on helping organisations to create the right leadership environment for improvement programmes to succeed. To find out more click here:
http://www.amnis-uk.com/workshops/Leading_Lean_Improvements_IW.htm

To book an on-site workshop or attend one of our open workshops contact Ruth Bodman at ruthbodman(a)amnis-uk.com.

Leading from the Middle
Every edition we offer a ‘30 Second’ Management Tip on how to get the most from your people, processes and organisation.

Is it possible to lead your improvement programme from the middle? Can an organisation without a board level champion and board based support hope to achieve success?

The simple answer is that without top level management support for your programme it is very difficult for middle managers to engage anyone outside of their own area of influence. However, this simplifies the important role that middle managers can play in influencing and inspiring senior managers to engage in the improvement process.

Looking at this problem from a different dimension such as an improvement programme covering an entire pathway that spans two or more organisations, even the CEO of one organisation is leading from a position of parity at best, and sometimes from a position of weakness.

In both these scenarios the only way to achieve success is through building relationships, creating energy around the need to change and trying to find common ground with peers and those above and it is a fact of life that having high levels of ‘Emotional Intelligence’ will make this process a whole lot easier!

To download a free Emotional Intelligence inventory click here http://www.downloads.amnis-uk.com/EI.pdf.

If you would like to know about Emotional Intelligence and how it can help you get more from your team and help you to work better with your management please drop an email to us at info(a)amnis-uk.com.

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?

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.

Two for One!

In the style of the retail BOGOF offer (Buy One, Get One Free!) I have covered two topics as to why Lean Improvement Programmes fail in one post. These represent posts 7 and 8 of what will be 9 reasons.

As ever, I would welcome your feedback and comments on the following, so here goes!

Two common reasons for Lean Improvements failing to embed themselves are to do with how people behave when Lean is introduced, namely the reactions they have and whether or not they take ownership for the improvements.

The five most common problems that are experienced in Lean programmes related to reactions and ownership of individuals and teams are proposed as:

1. Not involving people in the design of the Lean process
A very common problem is trying to impose Lean on a group or using only a subset of people to implement improvements without others having the opportunity to comment.

2. Not dealing with genuine concerns of individuals involved
If people involved have a genuine concern that is not addressed or is rail-roaded over, they will not commit to the solution - simple.

3. Blaming Individuals for Success
If people feel they will get 'blamed' for the solution that the team achieves they will attempt to distance themselves from it.

4. Not Creating the Compelling Need
Failing to inspire people as to the reason for Lean will often lead to a failure to understand why it is being imposed and a general lack of enthusiasm.

5. Not Saying 'Thanks'
Very simple to forget but it is essential to thank individuals for their contribution to a project - if you want them to commit to the next that is!

What do you think?

Systemic Failure

Welcome to the next instalment in our series of posts about why Lean fails and in this short post we explore the way that organisational systems contribute to Lean projects either falling short of expectations or failing completely.

Systems cause failures through three things:

1. Rigid computerised systems that are built to support faulty processes
Many computerised systems are built around 'common' processes and are difficult to customise for specific changes after installation, and anyway the training required to learn how to operate these systems creates problems with resistance to changes and organisational inertia. This is not an easy thing to overcome and after creating a 'Future State' for your organisational processes may need some additional investment to modify the system to make it 'fit for purpose' and able to support the proposed 'Future State'.

2. Faulty operating procedures which degrade improvements
In making changes to an organisation's value streams you will often find procedures, operating conventions and procedures which need to be changed either by changing what is written or changing behaviours. Obviously there is a need to ensure standards of compliance are maintained but many procedures and practices were designed to operate under the 'Current State' and need to be changed to be suitable for the 'Future State'. Failure to address these issues will bring the change programme to a halt with a bump.

3. Measurement and reward systems that are designed for the 'old way' not the 'new way'
The way that processes are measured and people are rewarded/recognised can severely hamper organisational success with Lean. This is a particular problem within larger groups where corporate finance teams impose certain reporting restrictions that force a certain type of behaviour whilst it is not uncommon to find that Lean can be seen as a penalty or a cause of teams finding it harder to achieve key performance measures - something that will kill it stone dead!

Anyway, if the terms 'Current State', 'Blue Sky State' or 'Future State' are new to you - drop me an email to markeaton(a)amnis-uk.com and I will send you some notes on Value Stream Analysis.

Train 2 Fail

In this series of (what will be) nine posts on why Lean fails, we have already explored failures due to the way Lean is operated, planned, led or communicated.

Having explored these four issues, the fifth reason for failure can normally be found in problems to do with how individuals and teams are trained and there can be a number of critical problems with these areas, including:

Insufficient Training
Not giving those involved the skills to enable them to lead Lean improvement programmes is perhaps the primary reason for failure under this category. Sometimes it is caused by inexperienced leaders and trainers thinking Lean is something 'easy in the head and therefore easy in the hand' and sometimes it is down to the speed of implementation, but whatever the cause it can demoralise teams, remove confidence and delay/stall progress.

Over-Training
The complete opposite of the first problem is the application of never ending training and failing to ever move to action.

Incorrect Training
The Japanese Lean Sensei have a saying, 'Be careful who you learn from' - there are a lot of 'Lean Jockeys' who have read a book, been able to see someone at work and done a couple of events and then set up in business as a Lean consultant - check your references for trainers!

Inappropriate Training
Giving people skills in (say) Jidoka when the processes they will be improving need little more than a bit of 5S(+1) and Kanban is both an inappropriate use of time and demoralising to a lot of people. Make the training appropriate and progressive so the higher skills are learnt at the point they are needed.

To counter these sorts of problems, we focus on developing Change Agents who have higher level skills, along with varying levels of skills and awareness of people directly involved or affected by the change process.

We also run a number of open workshops which can be found listed on our website (www.amnis-uk.com) or you can email me for details of the on-site training programmes we run by sending an email to markeaton(a)amnis-uk.com.

One final thing - we are also running a series of workshops with the IOM and you can download the brochure HERE.

Communicate or Die

Wow - I can't believe this is already the fourth of the nine posts about the key reasons why Lean (and other improvement programmes too) fail to deliver the results that organisations want.

So far we have already explored:

1. How the way the improvement is implemented leads to failure
2. Problems with the way improvements are planned
3. Leadership issues

In this post, we will explore the fourth of the nine major reasons for failure - this one concerned with issues surrounding the communication process. As ever, I would welcome your feedback either directly on the blog or via markeaton(a)amnis-uk.com.

Failing to Communicate 'Why?'
The most common communication problem is not clearly presenting the team with the reason for the change, what I would call the 'Compelling Need' (or sometimes the 'Biological Urge' for Change). Without this, the team will not be able to understand why they are being challenged to improve.

Failing to Communicate the Process
Another interesting problem is the failure to communicate the process that will be used (for example - 'We will do a series of Value Stream Maps looking at the X Pathway which will occur during XYZ Months and will lead onto a number of Rapid Improvement Events') Without providing clarity of the process (or without having the clarity) the team will struggle to understand where they are 'in the process' and the benefits achieved will be reduced.

Failing to Communicate 'Across the Pathway'
Here, I am using the term Pathway because it is very common in Lean Healthcare, but for Manufacturing people the term 'Value Stream' is inter-changeable. Specifically, this is concerned with problems about involving people from across an entire value stream (from End to End) as it is only through involving representatives from all the areas affected that you will get a true picture of the impact of the suggested improvements and whether they are going to introduce any upstream or downstream problems.

Communicating Failure
Not every Lean event will be successful and sometimes even successful events will not achieve the results that are expected - and communicating negatively (what you might say is about managers showing they are upset) will demoralise the team affected and, via the grapevine, will spread across the organisation. Always show how happy you are with the success in public and discuss improvements and changes in private.

Communicating Success
It is important to communicate successes of the programme to inspire others - and Lean becomes easier the more successes you have!

Failing to communicate and involve those Affected
This is different to the points above about involving people from across the pathway as even the best Lean project will not be able to involve every single person affected. This is about ensuring that people are not directly involved in the improvement project have the opportunity to discuss the improvements proposed, provide input and most importantly identify suggestions and changes. With no involvement there will be no 'buy in'.

I am sure there are many more reasons for failure but these are, I believe, the top six - if you think I have missed any then I would love to hear from you!

Leading Lean Failure

In the third of our series of nine blog posts about the reasons why change programmes based on Lean and Six Sigma fail to achieve the results organisations are looking for.

This post focuses on the top ten ways that leadership action or inaction brings down programmes. I would welcome your thoughts on these points:

1. Failing to engage the organisational leader
If the organisational leader (CEO, MD or other) fails to engage, the process will grind slowly (or quickly at times) to a halt!

2. Failing to appoint a board level sponsor
In some cases this will be the organisational leader, but in larger organisations it will be an operational director who will take on the role of sponsoring the improvement programme - without this board level person the improvement project does not have a voice in the organisation.

3. Not setting an effective scope for the improvement
All improvement programmes have to be scoped effectively to focus the organisation and also ensure that by making one change it does not impact negatively elsewhere in the organisation. It is the role of Leadership Teams to help shape the scope of improvement.

4. Failing to communicate the reasons for change
Simply not communicating the reasons for the change will lead to unexpected resistence from the front-line teams.

5. Penalising failure (or complaining about perceived failure)
Failing to support the team by either demonstrating displeasure with their efforts or penalising mistakes is a sure fire way to disengage the staff.

6. Changing things from on high
If the team have designed a solution, having a leader change it back or to something else without consultation will demoralise the team. If they did not have all the facts then the project was not scoped properly or the wrong team were chosen!

7. Failing to celebrate success
When the team do have a success, the role of leadership is to support them, celebrate it and set them the next goal. Sometimes, leaders fail to even show up for closing briefs - just imagine the impact on the team!

8. Not releasing the resources or setting unrealistic timescales
Massive improvement can happen with minimal budgets but the most important resource in the improvement process is the human resource and failing to allow people the time to make the change will doom the team to failure. Making big improvements requires effective resources to be available!

9. Creating mixed messages
If an organisation commits itself to improvement via (say) Lean or Six Sigma and then chops and changes (for example 'We don't have time to do the Lean project this week' or just imposing change) will send mixed messages to the team and demonstrate a lack of faith from the leaders in the improvement process.

10. Too Fast or Too Slow
Individuals take time to adjust to a changed way of working - don't drive them too fast! They also like to feel a certain amount of tempo and to feel that things are actually changing therefore don't drive it too slow.


Well, these are the top 10 ussues from our experience - what are yours?

Planning to Fail

This is the second of what will be nine posts about the main reasons why Lean Improvement Programmes fail.

Some years ago, when I was running the government's Lean programme for Manufacturing in a number of UK regions, I was lucky enough to be able to research a wide range of organisations who had been through Lean programmes and they broadly fell into nine categories.

Well, one of these (how Lean programmes are Operated) has already been published here (see below) and this post explores why organisations seem to sometimes 'Plan to Fail' by highlighting the top ten problems with the way that organisations plan and prepare for improvement.

1. Not Allowing Sufficient Resource
If you want to make fundamental change to your organisation you will need to allocate enough time, money and people to make it happen. As someone used to say to me, "You cannot get an omlette without breaking eggs." The first mistake is thinking there is some 'magic bullet' which will fix all your problems in a morning.........unless you know otherwise, I have never found one!

2. Not Scoping the Problem Correctly
Failing to think about the change correctly often creates subsequent failure. Scoping the Improvement is vital to the success of your Lean project. If you wanted to email me (markeaton(a)amnis-uk.com), then I will email you a typical Scoping Paper that you could use as a template.

3. Not Involving the Right People
If you are going to improve an area, a process or an organisation, it will often involve people from different areas, processes or even organisations and failing to involve these people can lead to you introducing improvements which creates problems either upstream or downstream of where the improvement occurs.

4. Moving Too Slow
Plans are great - but worthless - until they are enacted. Moving too slow will kill a programme of improvement dead as everyone will believe it is just 'not important'.

5. Failing to Coordinate
If you have multiple improvement programmes to run it can often be a problem coordinating them effectively. Having dedicated resource who has the competence and experience to lead Lean improvements will help to counter this, but only if they are involved in setting and scheduling all improvement activities.

6. Designing Rigid Plans
I like to say 'Plan to celebrate success, but accept occasional failure' and having rigid plans can create excessive stress on your improvement programme and slow it to a halt.

7. Not Being Clear Enough
This is different to number 2 above in that this is about being clear to your team about the plans and ensuring they have an understanding of what is required of them. It is all very well have well formed plans in a desk, but it is in the operational areas where it counts.

8. Simply Not Planning
Yep - lots of people do some training and then move straight into action, which can of course be great in terms of short term wins in small areas but trying to move from a 'one day 5S training course' into changing an organisation is often a flight of fancy, but it still happens!

9. Not having a focused planHaving a 'wishy washy' plan that lacks punch, even a well formed plan, can simply just fail to get off the ground through simple apathy. Plans need to be compelling, engaging and meaningful.

10. Not tackling the issue that counts
Having a plan that does not address the issues that your team perceive need to be addressed will lead to subsequent problems with engagement of the team, but more importantly - your people often know what the real issue so failing to take this into account is a potential route to failure!

Hopefully you have found this useful. In later editions we will explore the remaining 7 areas of Lean failure.

I would love to hear your problems with the way you have planned improvements.

Top 10 Mistakes

In all there are generally nine main reasons why improvement programmes fail to deliver the results that are expected. I recently had an article published by the IOM on the nine areas which can be read here and wil be available as a PDF download shortly from the IOM Website.

One of these nine areas of failure is the way in which the Lean Improvement Programme is 'Operated' and I have listed below what I believe are the top ten mistakes made in this area:

1. Failing to allocate the right resource
Perhaps the most common mistake is to fail to allocate the right resource (mostly people but also the right time) to the improvement programme, making it difficult to get going.

2. Thinking there is a 'magic bullet'
A second problem is thinking that one quick event can solve an entire organisation's problems - and as one Swallow does not make a Summer, one Lean event does not solve every problem.

3. Using the wrong tools
Just because I own a hammer does not mean I need it for every job. In some cases applying the wrong tool to an improvement programme can be as much a disaster as not using one at all!

4. Not involving the right people
The act of improving a process must include people from across the entire value stream. Picking people from only one area will mean they make upstream and downstream mistakes.

5. Lack of consistency
An improvement programme should be looked at as an improvement programme not a few events interspersed with normal activity - as this does not embed the changes made!

6. Failing to review and audit the process
Having made an improvement it is important to monitor whether it has occurred effectively through audits and continuous improvement, something people only forget.

7. Failing to prepare effectively
Similar to failing to allocate the right resource is failing to ensure the people in the area are prepared for the change and that the area can suffer the disruption of the change process.

8. Choosing the wrong Change Agent or Advisor
Although this could be argued as being a function of one of the other nine categories of Lean failure, it also affects the operation of the improvement programme. In the words of Toyota, 'Be careful who you learn from!'

9. Too Fast or Too Slow
Too much acceleration on an improvement programme can leave unacceptable 'casualties' in the form of disaffected people. Too slow and the programme runs out of steam very quickly!

10. Wrong Process
Perhaps the most damaging (if not the most common) mistake is to apply the wrong process to your improvement programme. We use the PRISM process which is described as:

• Prepare (the organisation)
• Roadmap (the improvement)
• Implement (the improvement)
• Sustain (the improvement)
• Maintain (the momentum)

Let me know what you think of these 10 mistakes and if you would like further details about PRISM.

Is there such thing as a magic bullet?

I was discussing with one of the team yesterday about whether or not there is such a thing as a magic bullet for organisations to solve all their problems through 'one quick fix'........I would be interested in any views you have about this, but for me - I don't think there is such a panacea!

This is not to say that there are not 'quick wins' that will generate immediate improvement but we need to differentiate these short term gains with long-term sustainable change and one does not automatically lead onto the other (whilst you can make a rapid improvement you may not fully realise the potential benefits that are possible).

As for the 'magic bullet' that converts sticky mud into rivers of gold and which converts poor performance into sustained improvement, if you know where to find it can you let me know please?

Has Lean lost its cachet?

We had a management meeting yesterday and we were discussing the word Lean and how, in some areas, it has lost its value because people associate it with 'a bit of process mapping' and when this fails to deliver results, they want to move onto 'Agile' or 'Leagile' or 'Lean Sigma' etc.

We had a long discussion around whether we should look to change the message we put out to Manufacturing businesses and the NHS, partly because most good Lean people use a 'hybrid approach' which will draw appropriate tools from Lean, Six Sigma, Agile etc as required by the situation.

After a circular discussion we reached an interesting conclusion which was that we needed to maintain the word 'Lean' in all our work, but start stressing that it is a hybrid approach, as without the Lean word people would struggle to 'pin down' what you are doing.

However, it never fails to amaze me that people are so quick to write off improvement approaches so quickly, just because they have had problems with it themselves - and how quickly even the approaches with the highest impact (such as Lean) can quickly lose their cachet with some people.

What do you think?

Admin equals Production

I am preparing to run a Value Stream Analysis process in a trust next week focused on the discharge process and communication with the Primary Care Trusts.

As I sit here bringing my materials together I was thinking about how closely the aspects of Lean in Healthcare Admin are to Lean in General Healthcare.

Much as Lean has started migrating from the production areas in manufacturing into the service and admin areas, we are starting to see the same shifts in Lean Healthcare.

We are also finding that the same problems occur - admin processes are even more 'people focused' than the operational areas (wards etc) and the same sensitivities occur as when we are looking at (say) Theatre lists.

However, it never fails to amaze me that despite the fact that Lean seems to work in every area of every organisation, everyone believes it will not work for them. Now, I realise that a lot of people have been 'Lean'd' by someone inexperienced in the past and therefore have recollections of ineffective Lean, but I look forward to having to go through the normal stress associated with the first day of a Value Stream Event (VSE) which will start with trying to convince people Lean works and facilitating sceptics, only to find that by the end of the day we have created another group of converts!

What is your experience?

What makes a Lean Hospital?

As I was running a series of programmes with the NHS last week and again earlier this week, I was asked several times 'When do we know we are a truly Lean Hospital?'

This is an interesting concept and combines factors such as the numbers of people who are trained as 'Change Agents' and their level of training, the broad awareness of Lean across a trust and a core of 'Practitioners' who have been involved in multiple events.

However, more than this, it is also about attitude, allocation of effort, leadership involvement and perhaps most importantly, achievement of results on an on-going basis.

Over the next few weeks I am going to write a paper on this topic and would welcome your thoughts which you can either post here or email me. Alternatively, if you would be interested in receiving a copy of this paper when it is written, please let me know by emailing me.

You can email me on markeaton(a)amnis-uk.com (replace the (a) with the @ symbol when you do it of course).

Sustaining Lean in the NHS

Lean has the potential to make a major impact on the performance of the NHS, if implemented correctly!

Sadly, the vast majority of Lean projects will fail to deliver the results expected, and in this wake will leave a terrible trail of misery, disillusionment and believe that 'Lean just does not work here'.

Building on over 250 Lean Events in the NHS, Manufacturing, Local/Central Government and the Armed Forces, we are running workshops throughout 2007 to provide people tasked with Service Improvement in the NHS with the skills to enable them to prepare for, implement and sustain improvement.

For further details visit our website at: www.amnis-uk.com.

Also, if you would like a free copy of our book on how to Integrate Lean, Six Sigma and Risk Management then sign up for our regular email.

Lean Healthcare v Lean Manufacturing

Having run major public programmes focused on delivering Lean improvements within manufacturing I became incredibly aware of the ability of Lean projects to go wrong or for even the successful projects to fail to embed themselves in the organisation and this led to in-depth research and analysis into the major causes of 'Lean Failure'.

Following my time with manufacturers, I spent a year working with the RAF delivering Lean and found that many of the same problems applied to them as well, and then around 18 months ago when I started working on delivering Lean into Heathcare I very quickly realised that many of the problems that prevented manufacturing programmes being successful were also clearly apparent within the NHS.

Research into the causes of Lean Burnout involving some 20 Trusts determined that the fit between the reasons for failure in manufacturing were exactly the same as those in Healthcare.

The other interesting fact that was noted about the causes of failure is that the vast majority of them were either due to a faulty implementation process or were visible at the start of the Lean project.

If you are interested in finding out more, I would love to see you at one of our workshops which can be found listed on our website www.amnis-uk.com. Alternatively, drop me a line and I will send you a short paper about the findings.

How do you recognise low-grade Lean support?

Recognising that 'Lean' as a concept is now well known, at least in outline, by a large number of people, but that the level of expertise in the market to actually deliver high quality support is still very fragmented, I put myself in the shoes of a typical organisation looking to engage a Lean Consultant and asked 'How would you know if you were getting quality Lean support or just average or worse?'

I will start by saying there are three problems that create confusion:

1. People have heard of Lean, therefore consultants think 'I can do that' and open up shop
2. There is no standard accreditation of Lean work that would allow comparison
3. People in organisations underestimate the breadth of expertise required to deliver Lean effectively, and therefore don't ask the right questions

It is fair to say that I believe there is a hierarchy of Lean expertise. For people who have led less than 20-30 'Events' (whether that is a pre-change diagnostic or a Rapid Improvement Event (RIE)) they are 'Users' - people who purely understand how to apply the tools in a limited number of environments. Even their exposure to the tools will be limited.

For people who have led 30-around 75-100 events, assuming this has been gained in high quality projects led by 'Sensei' (see below) rather than the typical 'learn by doing it yourself', they will be 'Practitioners' - able to demonstrate real improvements in a range of situations but lacking the breadth of expertise to deal with all situations and are not experienced enough to develop Users into Practitioners, although they are experts at developing and leading Users.

Most consultants have led something like 30-50 events so bridge the User/Practitioner area, but the reality is that the vast majority that I have met have not been trained by Sensei (see below) and have learnt 'on the job'. This means bad practices are repeated, new approaches are not learnt and the 'correct' (or most effective) way of leading improvements is not used.

For the small majority who have been trained by experts themselves, when they exceed 75-100 events they become Sensei, skilled at developing Users into Practitioners and Practitioners into Sensei - able to deal with any situation in most sectors and environments and possessing a strong understanding of the skills required to deliver improvements across the organisation (rather than at a single point in a process or a single value stream or project).

Therefore, the key to knowing whether you are buying a quality 'Lean Consultant' who will deliver value, rather than just invoices, is to determine how many events they have run, who trained them in Lean and what expertise they have in working at the highest (or Programme) level in an organisation, or whether they have been stuck down at the individual process level.

All of this is explained in more detail in my new e-book 'Lean for Practitioners', an order form for which is available by dropping me a line via our website www.amnis-uk.com.

I look forward to hearing from you!