Healthcare organisations urged: “‘Don’t give up on ‘Lean'”

Healthcare organisations – including hospitals – are giving up too soon on ‘Lean’ based improvement initiatives, according to specialist healthcare quality, innovation and productivity improvement enabler, Amnis.

Amnis’ Mark Eaton, explained: “A number of improvement initiatives underway in the healthcare sector are based on the concepts of ‘Lean’ and ‘Lean Sigma’ but, like many organisations in manufacturing where Lean has its origins, there is already evidence that some healthcare organisations are giving up on these initiatives before they realise real results or are simply changing processes and doing nothing to change the underlying culture and behaviours.”

According to Eaton – author of the book ‘Lean for practitioners’ – the top five reasons why this happens are:

1. Lean is not a Board issue but, instead, is launched at divisional or even individual department level. This leads rapidly to fragmentation of activity and dissipation of effort.

2. Not ensuring that the productivity improvements expected through Lean are aligned with the organisation’s objectives. This leads to Lean being ‘out prioritised’ by other activities and put on hold and, once it is on hold, it is one step from being mothballed.

3. Not building on previous experience. This is where Lean tries to undo all of the good things that have gone on – and are currently going on – and this builds resentment from frontline teams.

4. Building reliance on external consultancies or agencies. Building internal capability and, even more importantly, involving a healthcare organisation’s frontline teams, is the only way to get Lean out of the textbook and into the clinic.

5. Many organisations simply give up when they encounter problems, resistance or changing priorities because they have not built up the resilience that is needed to get through the initial period of turbulence.

“Starting out by treating Lean as a Board level issue, approaching it in a flexible manner and recognising the difference between changing processes and changing behaviours are the keys to long-term success,” said Eaton.

To help organisations to understand how Lean helps drive improvements in quality, innovation and productivity, Amnis runs a number of workshops for executives and front-line teams – including its Accelerated Lean Skills Programme.

 In partnership with the Institute of Operations Management, Amnis is running an ‘open’ version of this programme from 8th to 10th September 2009. For more information, contact Amnis at info@amnis.uk.com or call 0870 446 1002.

About ‘Lean’ and ‘Lean Sigma’

Six Sigma is a business management strategy, initially implemented by Motorola, which enjoys widespread application in many sectors of industry. Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and variation in manufacturing and business processes. It uses a set of quality management methods, including statistical methods, and creates a special infrastructure of people within the organisation who are experts in these methods. Each Six Sigma project carried out within an organisation follows a defined sequence of steps and has quantified financial targets (cost reduction or profit increase).

Lean Sigma incorporates the speed and impact of ‘lean’ with the quality and variation control of Six Sigma.

Coined by Jim Womack’s research team at MIT in the 1990s, ‘Lean’ means doing more with less. The core idea behind ‘Lean’ is to maximise customer value while minimising waste. A Lean organisation understands customer value and focuses its key processes to continually meet those needs.

About Amnis

Working with both public and private sector organisations, Amnis is a consultancy which specialises in quality, innovation and productivity improvement, helping clients plan and deploy strategies for successful transformation. Its goal is to help clients not only deliver sustainable change but also to develop their capability to tackle their next challenges.

Providing both consultancy and training services, Amnis’ team are leaders in Lean/Six Sigma, organisational development, strategic planning, change management and systems thinking.

Further information from: Bob Little, Bob Little Press & PR, 00 44 (0)1727 860405; bob.little@boblittlepr.com

Efficiency & Effectiveness in Healthcare

Efficiency is about things right – for example, ensuring patients are admitted and discharged effectively and for minimum cost.

Effectiveness is about doing the right things – for example, ensuring that only those patients who need to be admitted are and that discharge processes are carried out safely.

They are not the same thing and the drive for efficiencies in terms of cost reduction can lead to a drop in overall effectiveness.

The real focus needs to be on improved effectiveness and then focusing on efficiency in what can be called an ‘Effectiveness First’ programme that combines some strategic work to decide on which services are needed and how they can best be delivered followed by some tactical work to make them cost efficient.

To find out more about how we are helping organisations to be effective and to become efficent in the process contact us today on 0870-446-1002, email info(a)amnis.uk.com or visit our dedicated healthcare consulting website at http://www.amnis.uk.com/healthcare-consulting.

Creating Positive News Stories

Almost everyday the papers carry a different story about problems in the NHS. From medication risk to poor nutrition to simple neglect it seems as if ever penny spent on the NHS is wasted.

However, the reality is so far from this ‘truth’ as to be almost unrecognisable. Hundreds of thousands of exceptional people deliver exceptional care every day of the week and whilst there are problems as a percentage of all activity they are very small.

Whilst even one error, mistake or omission is bad, demoralised staff make more mistakes and there is a need to balance the bad news stories with the good, and even to use the bad stories to drive continuous improvement rather than generate defensive behaviours.

Don’t your team and patients deserve that?

To find out more contact Mark Eaton on 07841-464916 or email markeaton(a)amnis.uk.com.

Slogging away at infection and medication risk

With the Department of Health suggesting trusts need to keep slogging away at infection risk and the on-going fight against medication risk the issues never seem to go away.

There is an old adage that if you always do what you have done you will always get what you have always had and that if you change nothing, then nothing changes.

The key to improving infection and medication risk is to combine the current activities being undertaken to combat both issues and also to maintain the process of continuous improvement that occurs whenever incidents arise. However, this can be combined with a new way of thinking about infection and medication risk that combines Lean with Patient Safety to fundamentally change the way your organisation works and the way it manages risk.

Amnis are leading such changes in a number of trusts and to find out more contact us via info(a)amnis.uk.com or visit our dedicated healthcare consulting website at http://www.amnis.uk.com/healthcare-consulting.

Protecting Protected Mealtimes

With a report this week on malnutrition on the wards in the Health Service Journal it reminds us that protected mealtimes are not as protected as they should be and that other efforts to maintain the health of patients are hampered by difficulties in accessing the right equipment (which could be as simple as having working scales to weigh patients).

Programmes such as the NHS Institute’s RTTC (Releasing Time To Care) (aka Productive Ward) provide a starter for organisations to enable them to release nursing time back to giving care but this needs to be underpinned by robust management processes and good standard work for nurses and nursing so that the cultural change that underpins the change in practices can become a change in behaviour.

The net benefit of changing not only processes but behaviours will be in diverse areas but as a first point of call patients who are hungry for support will get the care they need.

To find out more about how we are helping healthcare organisations to change behaviours and practices contact us today on 0870-446-1002 or email info(a)amnis.uk.com.

Nicholson’s Efficiencies

With the CMO David Nicholson’s statement ‘all bets are off’ this week as the signal of major changes in the NHS, driven by the changing budgets the key focus will be on creating a culture that looks to deliver more and better care with less and fewer resources.

Delivering more and better with less and fewer are not mutually exclusive activities and indeed we can prove that patient care and experience and clinical outcomes improve significantly when the processes and systems are properly designed.

The real issue will be managing the change in culture that is required to enable this approach to work. At the moment, people feel rushed and stressed because of the poor organisational processes and it is this pressure that drives the recurring statement of ‘we need more staff’.

Engaging teams, creating purpose and then enabling individuals the freedom to be innovative are going to be key things for leaders in the NHS to do in the next few years and to find out more about how we can help contact Ruth Bodman on 0870-446-1002 or email ruthbodman(a)amnis.uk.com.

You can also find out more by visiting our dedicated healthcare consulting website at http://www.amnis.uk.com/healthcare-consulting.

Leadership Impact at the frontline

By Mark Eaton

When the news came in yesterday that Alan Johnson had left health I was running a clinical systems redesign programme across five clinical pathways (urology, gastro, orthopaedics, gynae and cardiology) with some 60 people and five supporting facilitators.

During the session I visited each group and announced the Alan has gone and I was surprised by the various responses which included:

• Who’s he?
• So what?
• Well, it’s just another person we’ll never meet
• I doubt that will impact on what goes on here

Whilst there were a mix of other responses, the ones above made me think about the impact that Leaders really have at the front line in healthcare. It is like saying that soldiers fight for ‘Queen & Country’, when in reality the most important leaders are those nearby, the junior officers and non-commissioned officers, as well as the friends they fight (work) with.

Day to day the most important leaders and influencers in healthcare are those who are closest to the front-line delivery teams. Whilst CEOs and even Secretaries of State can have an impact in the long-run, if an organisation wants to make change quickly they will need to focus on developing their local leaders, and engaging them in the process of transformation.

If you want to find out more about engaging frontline leaders in the process of changecall me on 07841-464916 or email markeaton(a)amnis.uk.com.

Efficiency is not about cutting budgets

This is the third in a series of posts that have been inspired by the presentation given by Andrew Lansley MP (Shadow Minister for Health) at the Royal Society of Arts on the 28th May 2009.

Efficiency, Effectiveness & Equity go hand in hand in healthcare. Whilst we will look at effectiveness and equity in later posts, the issue of efficiency is one to tackle today. Efficiency in healthcare is, as stated by Andrew, not about cutting budgets dramatically but about doing more with what is available.

Efficiency is therefore about working together across organisations to ensure smooth patient journeys and effective transfers of care and is also about working across organisational boundaries to ensure that care is delivered in the right setting by the most appropriate professional who has rapid access to the right diagnostic facilities and equipment.

The basis of an effiiciency programme starts with a clear definition of the needs of stakeholders and progresses rapidly to implementing changes and improvements, something Amnis has been doing in healthcare for nearly five years. To find out more about what we have been doing and who we are working with contact Ruth Bodman on 0870-446-1002 or email ruthbodman@amnis.uk.com.

UK Healthcare League Table

This is the second in a series of posts that have been inspired by the presentation given by Andrew Lansley MP (Shadow Minister for Health) at the Royal Society of Arts on the 28th May 2009.

It was quoted by Andrew that up to 100,000 lives could be saved each year if the UK reached the top of European healthcare league in terms of performance and outcomes.  Some of the drivers for this are going to be public health and health promotion work to reduce the incidence of illness and injury arising but also some relies on changing the way services are delivered, identifying problems earlier on, improving access and shortening lead-times.

In particular, Andrew was keen to point out that we needed to avoid a tickbox culture and instead focus on changing processes fundamentally and sustainably. This certainly resonated with the 200 participants in the audience and is something that Amnis has been driving toward with our clients for five years.

To discuss how you can change the direction of your organisation for good email Ruth Bodman at ruthbodman@amnis.uk.com and she can direct you to our specialist Primary, Acute or Mental Health improvement teams.

Designing to overcome failure

This is the first in a series of posts that have been inspired by the presentation given by Andrew Lansley MP (Shadow Minister for Health) at the Royal Society of Arts on the 28th May 2009.

A point raised by Andrew was the need to have local responsibility within healthcare for designing effective systems rather than central control and in particular having the responsibility for dealing with problems. This reminded me of a meeting last week where the team wanted to develop a community based service to deal with the impact of a poorly designed process within an acute setting.

The team had already started working on their solution by the time we got involved and we had to dampen their enthusiasm a bit to take them back to first principles in that is seemed a waste of resources to design a second process purely to deal with the fact that a main process was not providing the right outcomes. Wasn’t it better to go back to the source and work with the Acute Trust to redesign their processes so that it delivered the right outcomes?

The enthusiasm for the team to solve ‘the problem’ as they saw it (ie dealing with a process with poor outcomes by adding a new process) did not actually address the underlying issue (ie a process with poor outcomes) and it was only when the team took responsibility for dealing with the root cause and committed to working across the health economy and not just within their sphere of influence that there was a chance the problem would go away for good rather than just be patched up.

To discuss this post and the issues that arose email Mark Eaton at markeaton(a)amnis.uk.com or ring him on 07841-464916.