With the treasury announcing that they will be seeking £10bn worth of savings from the NHS yesterday it means even tighter belts and completely different ways of delivering care. Are you up to the challenge?

The real challenge will be to identify the key strategic activities that will drive the biggest improvements rather than tackling isolated issues. It will mean working across organisations and across political boundaries between health and social care to ensure that care is delivered in the right setting by the right professional in the most cost effective manner. This will be difficult and will require a different way of working for many leaders and senior teams.

The start of this process is to link the strategic objectives of your organisation to the activities that will drive the improvement and then to engage your health and social care partners. This is the process of Transformation Mapping and something that will increasingly be of importance in the ‘new world’ of the NHS.

To find out more about transformation mapping, or simply just to bounce ideas off someone independent, contact Amnis on info@amnis.uk.com or visit www.amnis.uk.com.

In Jim Easton’s recent article in the Health Service Journal he relates the four leadership principles that the Department of Health want NHS organisations to align to as they try to improve quality and efficiency. These four principles are summarised as:

1. To work together to design new solutions

2. To manage improvements at the appropriate level

3. To value clinical leadership and engagement

4. To pull in the same direction

These are worthy principles but lack any indication as to how to do them, or substance to explain what actions this means in practice. The fact that these four principles lack any substance will mean their impact will be extremely limited. 

From a recent article we have produced on creating the right environment to ensure organisations are able to implement change successfully, we identified six key principles that differentiate those organisations who will be successful from those who will struggle and these are;

• Link improvement activities to things that really matter
• Make improvement is everyone’s responsibility
• Be responsive and flexible
• Celebrate and communicate every success
• Constantly adapt and evolve
• Build partnership within and outside the organisation

For each of these principles we have identified some of the key things that leaders actually need to do to ensure success and to find out more visit our website, join our network and be amongst the first people to receive a series of 3 white papers on how to create and effective environment and effectively manage organisational performance.

Just visit www.amnis.uk.com or ring 0870-446-1002 for details of how to sign up to our newsletter.

Whilst a previous article commented on the productivity gap, there is a further gap that can affect success in healthcare organisations and this is the communications gap between staff and teams.

Organisations where teams are not able to communicate and collaborate for success are liable to have significantly lower productivity than high performing teams and in organisations where individuals do not feel empowered to challenge without being ’shouted down’ will have worse outcomes than those that can.

Creating the right environment within an organisation is the subject of a researched article recently written by Amnis and that will shortly be available to those who receive the Amnis Newsletter. To find out more and to sign up for our newsletter (and download a free copy of Uncovering Lean) from this link: http://www.amnis.uk.com/download-uncovering-lean-for-free.

For general information visit www.amnis.uk.com or phone 0870-446-1002.

The way a team performs and behaves is directly related to the organisational environment that is created by the management style, measures and systems within the organisation. Why is it that like for like healthcare organisations dealing with the same types of patients with staff with the same skills and competences can have such widely differing outcomes, including mortality rates? The reason is generally related to the organisational environment – how well people work together, how they deal with problems, how issues are raised and discussed and other such issues.

Toxic Environments are ones where the organisation creates an environment that generates ‘bad’ results. This could be an organisation where managers and clinicians don’t work well together, where individuals don’t feel empowered to speak out when they encounter problems and where the way measures are used by the organisation drive the wrong behaviours.

A focus on 4 hour waits in A&E that does not take into account outcomes and experience will result in driving behaviours that could be unsafe.

The reasons why organisations structure to create the right environment and the actions to be taken to ensure success are the subject of a researched article recently written by Amnis and that will shortly be available to those who receive the Amnis Newsletter. To find out more and to sign up for our newsletter (and download a free copy of Uncovering Lean) from this link: http://www.amnis.uk.com/download-uncovering-lean-for-free.

For general information visit www.amnis.uk.com or phone 0870-446-1002.

In a study by IBM in 2008 they found that 83% of organisations were expecting to have to make some substantial changes to the way they delivered products and services within 2 years, yet only 61% had ever delivered a successful improvement programme in the past.

This creates a 22% performance gap, meaning that 83% need to change soon but only 61% have a track record of success.

This is further expanded when you realise that the ‘over-achievers’, those who have a track record of introducing new ways of doing things successfully, record figures in excess of 80% success rates and have an average performance gap of 19%, whilst the under-performers have an average performance gap of around 30%.

This means for a substantial proportion of those organisations who have no established track record of success in implementing improvements are liable to fail again in the future.

The reasons for failure and the actions to be taken to ensure success are the subject of a researched article recently written by Amnis and that will shortly be available to those who receive the Amnis Newsletter. To find out more and to sign up for our newsletter (and download a free copy of Uncovering Lean) from this link: http://www.amnis.uk.com/download-uncovering-lean-for-free.

For general information visit www.amnis.uk.com or phone 0870-446-1002.

By Mark Eaton

One of the noticeable trends in manufacturing was how service improvement and transformation programmes went through a sequence of names. Having gone through the various iterations of Total Quality Management, Kaizen, Business Process Re-engineering etc during the 1980’s and 1990’s, the ‘revolution’ of Lean in the mid 1990’s rapidly morphed into ‘Lean Sigma’. In the late 1990’s this morphed again into Lean Agile and in the early 2000’s it changed again to the rather bizarre Leagile.

In reality, the differences between each of these approaches was difficult to spot and was often driven by the needs of management consultancies to differentiate themselves from those who sold ‘the old tools’.

The first change, which was the integration of ‘Lean and Six Sigma’ to become Lean Sigm. It was claimed that this brought additional analysis that was not available with Lean alone, but in reality Lean tools are often the same as Six Sigma tools and approaches. Good Lean practitioners should be using Statistical Process Controls and good structured problem solving approaches and these are broadly the things that those pushing Lean Sigma focus on and claim as a radical change from Lean.

It is good to see that common sense is prevailing within manufacturing now and people have realised that the ‘fluff’ of adding new words to the concepts of Lean are just that, fluff. There have been no new significant improvement tools introduced in the last twenty years. Sure, approaches have changed but the basic tool set has not. Sure, technology has improved, but the basic process hasn’t changed.

Sadly, in healthcare I have been hearing about Lean Sigma for the last year and today someone mentioned ‘Lean Agile’ in healthcare. It seems that healthcare organisations are going to go through the same cycle that manufacturing has gone through, namely:

1. Invest in Lean and not do it well so…..

2. Invest in Lean Sigma and not do it well and then….

3. Invest in the ‘next best idea’ and not do it well and then….

4. Finally realise you have to do things well before it actually works.

There are three truisms to healthcare improvement:

1. Lean (and other approaches) are nothing more than structured common sense

2. If you don’t change the behaviours of the organisation you will continue to waste your investment

3. Worrying more about the ’hows’ is far less effective than worrying about the why and where

Contact Mark Eaton (markeaton@amnis.uk.com) if you want to discuss this furtehr or follow Mark on Twitter at http://twitter.com/markeaton.

The article below was published in the HSJ earlier this year. This decision to merge a Welsh health board into a council will drive them along the same lines being adopted by some English PCTs as they ‘de-merge’ Commissioning and Provider Arms, with some of the commissioning organisations finding some financial efficiencies through integrating with local councils.

The model proposed is even closer to that operated by the HSE (Health Service Executive) in Ireland where social care and healthcare are closely aligned (although mostly in primary care). Has this led to efficiency gains in the provision of services in Ireland? Well, it seems that whilst the relationship between health and social care in a primary setting might have been improved, the problems of a disconnect between secondary care and primary health and social care remains, and in some areas may actually be worse than having separate organisations.

The problem is the need to ensure that systems, processes and cultures are all in alignment ideally before but at worse case as soon as the organisations have merged.

To find out more about how we can help organisations to integrate and achieve efficiencies call us on 0870-446-1002 or email info(a)amnis.uk.com.

Welsh health board plots merger with council

Powys teaching local health board is set to merge with Powys county council in the latest example of pioneering joint leadership arrangements.

The first masterclass in a series of five being run jointly by the specialist healthcare quality, innovation and productivity improvement enabler, Amnis, and the Institute of Healthcare Management (IHM) has been hailed a resounding success, with all the delegates rating the programme as ‘excellent’ or ‘very good’.

The programme focused on the problems of introducing Lean and Service Improvement methodologies into healthcare organisations and was called ‘Service Improvement & Lean for Managers and Executives’. Participants came from a variety of primary and secondary care organisations as well as from private organisations.

Jeremy Morris, one of the delegates, said: “The session was clear, well run, participative and engaging. I found the clarity and practicality of the approach excellent. “There are many things that I will take away from today, including the key experiences from other participants.”

Mark Eaton, of Amnis, said: “It was great that everyone derived so much from the session. It is further proof of the benefits of sharing knowledge and experiences both between similar organisations and across health economies.”

The IHM’s Phil Slinger said: “This was a great start to our programme with Amnis and I am delighted by the excellent feedback and testimonials. We’re already discussing running a similar programme in Scotland and are already planning our programme with Amnis for 2010.”

Dates for future events are:

17^th November – Creating a Culture of Continuous Improvement (London)

1^st December – Problem Solving Tools for Improvement & Innovation (London)

20^th January – Sustaining Lean (Birmingham)

26^th February – Thinking Strategically (Birmingham)

The collaboration between Amnis, the specialist healthcare quality, innovation and productivity improvement enabler, and Terema, the human factors organisation, was a resounding success at the Association for Perioperative Practice (AfPP) congress, in Harrogate, in October.

Indeed, Diane Gilmour, President of the AfPP, commented: “The Amnis and Terema stand has been a highlight of the event for many participants.” Amnis and Terema brought together expertise designed to ensure a smooth and effective flow of patients into theatre and effective behaviours from the theatre teams themselves.

To emphasise this, they arranged to bring a flight simulator – staffed by serving airline pilots – to the AfPP Congress and allow delegates to try their skills at flying and landing a modern passenger jet.

According to Amnis’ Mark Eaton: “The focus at the Amnis and Terema stand was on both having fun as well as demonstrating the importance of improving the flow of patients and the way that teams work in high pressure environments.

“Success in aviation is achieved by maintaining safety and quality while providing efficient and effective use of resources in a complex and dynamic environment,” he continued.

“In healthcare, even more than aviation, staff are central to success. Optimisation of systems and processes – provided by Amnis – must be undertaken in co-ordination with the development of people and culture, which is provided by Terema.”

Eaton added: “Over the three days of the congress, there were 86 ‘official’ slots available on the flight simulator. We managed to squeeze 88 people through and we had a waiting list that ran into dozens, so that we could have filled each slot three times.”

Libby Campbell OBE, Director of Nursing at NHS Lothian said: “The simulator was excellent. I can see the link between it and the need for human factors and Lean methodology training in healthcare.” Terema’s Phil Higton commented: “It was great to be able to see the enthusiasm of the theatre staff in the simulator as they got the chance to fly and land a Boeing 737 – with many of them achieving impressive scores.”

An article, by Mark Eaton and Phil Higton, on developing effective operating theatres can be downloaded from: http://www.downloads.amnis.uk.com/ETArticle.pdf

For further details about developing effective operating theatres, visit: http://www.downloads.amnis.uk.com/ETBrochure.pdf.

PRESS RELEASE 

Mark Eaton’s updated book on the secrets of ‘Lean’ for healthcare practitioners – ‘Lean for practitioners’ (ISBN 978-1-905823-58-1) – published at the end of August, has already generated high praise from healthcare professionals.

Sarah Noon, Assistant Director of Service Improvement at Basildon & Thurrock University Hospitals NHS Foundation Trust, commented: “Mark Eaton’s ‘Lean for Practitioners’ is one of the best books on Lean I have read. It’s concise, focused on healthcare issues and provides an overview of the tools as well as how you turn tools into actions and improvements.”

The new, updated sixth edition of Eaton’s book builds on his – and Amnis’ – continued experience of providing both practical guidance and training to healthcare professionals charged with ensuring that both their organisations’ people and processes adhere to the highest standards in terms of quality, innovation, productivity and prevention.

Eaton commented: “This book evolves all the time as we find new and better ways of explaining Lean in healthcare and as new projects and examples of best practice are completed.

“We’re delighted that this new edition has received a great deal of praise – and we’re equally delighted to be able to give away copies of the book in our on-going campaign to promote knowledge dissemination and best practice in this important area of healthcare practice.”

‘Lean for practitioners’ focuses on providing essential basic information on Lean for healthcare professionals. In addition to examples and case studies, the book contains a number of Lean checklists, including how to run Lean Rapid Improvement Events and Value Stream Mapping Events.

After explaining Lean and the concepts behind this philosophy, the book provides a four step guide to ‘going Lean’. It goes on to describe Lean at different organisational levels.

Having outlined how to ‘think Lean’, it concludes by explaining the top five Lean tools and identifying ten key problems healthcare organisations experience with going Lean.

For further details of the book, along with Amnis’ Lean-related guidance and training, contact Amnis at info@amnis.uk.com or call 0870 446 1002.