LMJ Issue 1, Volume 2

Issue 1 Volume 2

| Jan/feb 2012 | www.leanmj.com

READY, SET, Go! This issue answers questions commonly asked by companies starting out with lean, highlighting potential obstacles and frequently-missed opportunities.

IN THIS ISSUE: Are consultants the way to go?: GkN’s Peter watkins offers you a guide on the pros and cons of seeking external help.

Yeolean, Yeolean, Yeoleeean: LMJ meets Yeo Valley, to discover the main mistakes the company made when it first started implementing lean.

Show me the evidence: In one of the two articles on healthcare contained in the Process focus, Sarah Powell of the Royal Surrey County Hospital explores the role of evidence in making sure medical staff fully commits to change.

Made in lean Italy: This new regular section looks at the application of lean principles in different countries and areas of the world, to understand what we really mean by ‘culture’ when we talk about business improvement.

In this issue, LMJ travels to Italy.

The fifth Column: In the first of a series of regular columns touching on the most controversial issues facing the lean community, John Bicheno discusses 5S. The Lean Management Journal is supported by the Lean Enterprise Research Centre, Cardiff Business School

w elc o me

t o the lean

management

j o urnal

Dear reader, Happy New Year - for some! Sadly, 2012 hasn’t begun in the best style. The crisis in the EU is worsening and investors are increasingly wary. There seems to be no relief for manufacturers and service providers across the eurozone.

E dit o rial

Commissioning editor Roberto Priolo r.priolo@sayonemedia.com

Editorial director John Bicheno

picsiebook@btinternet.com

Contributors Tim Brown Sub-editor

t.brown@sayonemedia.com

D esign

Art Editor Martin Mitchell

m.mitchell@sayonemedia.com

Designers Viicky Carlin, Alex Cole

design@sayonemedia.com

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I spent a good part of my Christmas holidays at home in Italy, one of Europe’s countries that is suffering most from the crippling economic situation. Italian companies are struggling. It’s no coincidence that one of the country’s most important newspapers, the Corriere della Sera, recently launched an online forum where entrepreneurs in trouble can share their stories.

Yet, things are slowly changing in Italy: a new government led by economist Mario Monti and a set of measures that is expected to save billions have been welcomed

by Brussels as a breath of fresh air. Italy defaulting, not an impossible outcome, is something that nobody can afford.

I believe there is still hope for Italy, and it is with this spirit that Lean Management Journal is launching a new section, It’s a lean world. In its first instance, this section will focus on lean in Italy (page 35). There is an increasing interest for business improvement in the country, which boasts some of the world’s most renowned carmakers and a strong tradition of family-run businesses that may be struggling today but have flown the flag of the Made in Italy brand for decades. The aim of this new section of the journal, which in coming months will look at the application of lean principles in different countries and geographical areas, is to understand what we really mean by ‘culture’ when referring to organisational change.

You’ll notice the journal has a new layout, which I hope you like, but this is perhaps the least of the innovation LMJ has put in place for 2012. I am happy to welcome John Bicheno of the Lean Enterprise Research Centre as the journal’s new editorial director: John will help me source material and will safeguard the quality of content, while keeping challenging debate alive through a new regular column (page 40).

This issue, the first of ten we’ll publish this year, concentrates on the initial steps a company implementing lean should take, and brings you some interesting case studies. An interview with Yeo Valley (page 15) will certainly provide food for thought. You can also read what’s new at SCGM in our Lean Diary (page 45).

Many of you are now well-advanced on your lean journeys, but it is my hope that this first 2012 issue will help you to identify issues that you may have forgotten about, remind you why you started with lean in the first place and provide inspiration for new steps.

Happy reading,

Commissioning Editor, Roberto Priolo

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c o ntents jan / f eb 2 0 1 2

c o ntents

04 Lean News 05 Introducing the editors 06 Setting off on a journey

John Bicheno introduces the first LMJ issue of the year, which seeks to answer the main questions a company that is starting out with its lean journey might have.

P rinciples & purp o se 07 Taking the road to lean Rhoda Avanzado provides a good example of lean implementation within the public sector, by looking back at the very start of the journey undertaken by Westminster City Council.

LMJ also interviews Steve Goodall of APS Group to discuss the use of IT to support lean implementation.

12 Are consultants the way to go?

Peter Watkins, of GKN, offers a useful guide to consultancies that will help you decide whether you want to seek external help in setting off on your lean journey.

15 Yeolean, Yeolean, Yeoleeean

LMJ’s editor Roberto Priolo meets Steve Welch, Graham Keating and Chris Coles of yogurt manufacturer Yeo Valley, who give us an interesting insight into the mistakes that were first made as the company started implementing lean.

P r o cess f o cus 18 Lean in healthcare

Ann Esain, Service Operations lecturer, introduces the two articles included in this issue’s Process Focus.

19 Is the Mental Health Productive programme lean?

Following up on the results of her research, Jackie Thomas, head of service and business development at a Mental Health division of a NHS Trust in England, expresses her views on the Productive programme used in the hospital to introduce lean to staff members.

26 Show me the evidence

Sarah Powell, senior change manager at the Royal Surrey County Hospital in Guildford, looks at the role of evidence in securing medical staff support to services improvement.

3 0 S pecial Feature An asset to get a leaner supply chain

This special feature looks at the new point-of-work vending machines, developed by American company Apex Supply Chain Technologies, that have conquered the US and are now available in Europe as well.

3 5 I t ’ s a lean w o rld Made in lean Italy

In the first of a series of specials looking at the application of lean in different countries, we travel to Italy. As we find out, the Tower of Pisa is not the only thing that’s leaning in the boot-shaped country: more and more companies are embracing continuous improvement to survive and grow in a market too often characterised by economic stagnation.

4 0 T he Fi f th C o lumn

This new regular column, written by John Bicheno, discusses some of the most interesting and controversial topics keeping the debate within the lean community alive.

4 2 L etters and c o mment

Contributions in this issue come from Jane Bishop, senior clinical lead at the Leading Edge Group, who discusses lean in emergency departments, and Ben Taylor of Red Quadrant, who explains an interesting model to save and improve.

4 5 L ean diary

In this column, LMJ observes the lean journey of Serbian manufacturer SCGM. Director Sandra Cadjenovic gives us the most recent update on the company’s progress in its continuous improvement programme.

4 8 L M J in c o n f erence

This section features reviews of the events LMJ attends. Find out what goes on in the lean community by reading about some of the most interesting conferences and seminars.

5 0 S pecial f eature An abundance of riches

SA Partner’s Kevin Eyre analyses and compares lean with appreciative inquiry and work-out.

5 4 B o o k revie w

John Bicheno reviews The Little Book of Lean: The Basics by Chris Cooper, Simpler, 2011

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E vents

Elizabeth House, Block 2, Part 7th Floor, 39 York Road, London, SE1 7NJ T +44 (0)207 401 6033 F + 44 (0)207 202 7488 www.sayonemedia.com.

Lean management journal: ISSN 2040-493X. Copyright © SayOne Media 2012.

www.leanmj.com | January/February 2012

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LMJ Lean helps Boeing reach unprecedented production rate Boeing successfully achieved a production rate of 35 airplanes a month for the NextGeneration 737. Employees will focus on stabilising this rate while investments are underway to go up to 38 737s a month in second quarter 2013 and 42 a month in the first half of 2014. Leaders of the 737 programme acknowledged employees’ contribution to achieving the record rate at a celebration at the Renton factory. Employee teams implemented new lean improvements to create production capacity.

“Working as a team, we have achieved production levels never previously reached,” Beverly Wyse, VP and general manager of the 737 programme said. “It’s because of the focus and dedication of 737 employees that we’ve reduced waste in our production.”

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L L o ydspharmacy launches f eedbac k initiative t o impr o ve service q uality High-street pharmacy and healthcare provider Lloydspharmacy will deploy a feedback scheme to improve customer service. Customers at stores in Southeast England will be able to give real-time feedback on their in-branch experience. The system uses a social networking approach to gather information from service users. The company is teaming up with IWGC, which was set up in 2008 to allow NHS patients to rate individual GPs and hospital doctors. Neil Bacon, founder of IWGC, said: “Lloydspharmacy places a lot of importance on monitoring and understanding the experience of its patients and customers to ensure continuous improvement.”

C I P D predicts t o ugh j o b mar k et in 2 0 1 2 The organisation’s Annual Barometer Forecast 2012 found that this year will be the toughest for UK jobs in 20 years, with the number of employed people falling by an extra 120,000. Most of the job cuts are expected to come in the public sector; the Institute thinks that the creation of jobs in the private sector will not make up for these losses.

John Philpott, CIPD’s chief economic adviser, said: “The combination of worsening job shortages for people without work, mounting job insecurity and a further fall in real earnings for those in work may test the resilience and resolve of the UK workforce far more than it did in the recession of 2008-9.” He added that a “relatively benign” outcome to the eurozone crisis will mean the 2012 job recession will still be milder than that suffered in 2008 and 2009.

If you have any news that you think would interest and benefit the lean community please let us know.

Send submissions to the commissioning editor Roberto Priolo: r.priolo@sayonemedia.com

L ean guru travels t o the N o rth w est o f E ngland and visits S iemens plant Masaaki Imai, founder of the Kaizen Institute and a keynote speaker at the 2011 MDC organised by The Manufacturer magazine, visited Siemens Congleton, a global hub for manufacturing variable speed drives, in December. He observed the site’s processes and met with staff. The visit came as Siemens Congleton celebrated its 40th anniversary and one of its busiest and most successful years to date.

Masaaki Imai said: “Visiting Siemens Congleton has been a real highlight of my trip to the UK. I have been impressed with what I’ve seen and also hope I have given the team lots of food for thought to further ensure processes continue to evolve.” The site conforms to high standards of energy efficiency and employs a zero defects policy to ensure operational excellence.

I N T R o D U C I N G

Y o U R

EDIToR S JACoB AUSTAD LeanTeam, Denmark

Articles for LMJ are reviewed and audited by our experienced editorial board. They collaborate on comment against articles and guide the coverage of subject matter.

PRofESSoR zoE RADNoR

Cardiff Business School

BILL BELLowS Pratt & whitney Rocketdyne

JoHN BICHENo

Lean Enterprise Research Centre, Cardiff Business School

EBLY SANCHEz Volvo Group

PETER wATkINS GkN

NoRMAN BoDEk

wENDY wILSoN

BRENToN HARDER

DR kEIVAN zokAEI

PCS Press

Credit Suisse

warwick Manufacturing Group, University of warwick

SA Partners

More information on our editorial board, their experience, and views on lean is available on the LMJ website: www.leanmj.com

www.leanmj.com | January/february 2012

5

INTRoDUCTIoN wRITTEN

BY

JoHN

BICHENo

Setting off on a journey T

o do lean requires doing the right thing, and doing things right. In that order, because, as Russell Ackoff observed, ‘the righter you do the wrong thing, the wronger you become’. Womack and Jones addressed this, obliquely perhaps, in their five Lean Principles of 1996. The five have certainly stood the test of time, but for me the big ones are value and flow. Value should mean doing the right thing: customer, purpose, and striving for perfection. Flow incorporates a deeper understanding of value stream, and pull is about steadily shifting the boundary between push and pull towards pull.

For both value and flow, for the ‘right thing’, a ‘True North’ vision needs to be established. With this, the direction and first few steps are established, even though future steps are unclear. As Stephen Covey says, ‘begin with the end in mind’.

True North value requires an understanding of long-term need, not short-term want.

Holes, not drills. Think ideal future state: free, perfect, and now. Impossible? Maybe, but are we moving along those trajectories? Others are!

The theme of this issue is ‘getting started with lean’. Most readers will have already started their lean journey. So, a time for reflection?

True North flow requires an understanding of variation and utilisation: in short, mura and muri. Why? Because these are the determinants of flow. What can be done about understanding or adjusting arrival variation? As John Seddon observed while standing in a long queue at the airport, ‘They didn’t know we were coming!’ And what about process variation? Remember, as Justin Watts pointed out in an earlier LMJ article, a focus on process variation alone addresses only half of total variation.

Then there is utilisation. What we know is the highly non-linear relationship between utilisation and lead time, or queues in service (have you ever flown into Heathrow?

Their runway utilization is 95%. What is your experience?). Utilisation is load divided by capacity. Certainly, you should give attention to ‘freeing up’ capacity through waste removal. That will increase capacity or decrease utilisation. But that again is only half the story. The other half is load –how much load – work coming onto your operation – should not be there at all? In other words, failure demand or rework – in factory or in office.

Now we have a picture of the ‘what’ to do in getting started (or continuing) with lean.

But the ‘how’ is the big issue.

Perhaps a (the?) great law of managing behaviour and sustainability is ‘the norm of reciprocity’. ‘Do unto others as you would have them do unto you’, said the Bible. By the way, ‘others’ includes future generations. And (again) from Covey, ‘Win, win or walk away’. There must be something in it for all. Or, as Toyota says in one word, ‘respect’.

That applies from CEO to shop floor worker. From banker to Dean of the Faculty.

Without this, all fails. Back to the opening quote from Russell Ackoff.

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PRINCIPLES

&

PURPoSE

PRINCIPLES & PURPoSE

Taking the road to lean T

he public sector does not, in general, have the capability to implement change as quickly as the private sector can. As one of my lean practitioners said, “The public sector is a super tanker and not a speedboat.”

Whilst there certainly are private companies that fit into the super tanker category, the heavyweight processes and strategies needed to steer large organisations are standard practice across the public sector. These are often accompanied by an entrenched culture of bureaucracy and a “this is the way we do it and why change” attitude. At the level of day-to-day operations there is often little incentive to make the sweeping changes now being demanded, and often small scope to reward improvement.

When combined with an organisational culture which has historically been very top-down and directive, the obstacles to the implementation of a bottom-up methodology like lean can seem large and quite daunting.

The solution we found for premises management was to implement lean in an incremental manner where improvement projects were driven by the service teams themselves. We have seen the benefits and are now reaping the rewards of more than a year’s solid work. Some benefits of lean we have found are:

The financial crisis and a changing level of customer expectation have spurred a shift in the public sector to have a stronger focus on costs and efficiency. Rhoda Avanzado, acting assistant service manager of licensing at westminster City Council, looks back at the beginning of the council’s lean journey.

More engaged staff and better morale – lean recognises the team’s expertise on their own processes, giving them the opportunity to identify improvement steps and implement the changes themselves, often allowing them to get rid of the tasks that aren’t adding value to the process flow and are wearing them down. They have more time to invest in more value added activities and to develop their skills and capabilities.

More satisfied customers – because processes are reviewed and waste eliminated, processes are more streamlined resulting in quicker turnaround times.

Better value for money – by applying the lean methodology, management and staff can be confident that all steps in every process are essential. Lean enables the public sector to not only provide services the customers want at the right time but also in a cost- efficient way.

Culture of excellence – lean recognises there is always room for improvement. Staff foster an environment where things get better naturally.

www.leanmj.com | January/february 2012

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TAkING THE RoAD To LEAN RHoDA AVANzADo

GETTING STARTED oN oUR LEAN JoURNEY

LEARN fRoM oTHERS’ SUCCESSES AND fAILURES One important bit of preparation we did was to look at lessons from those local authorities that had already implemented a service improvement programme using lean. We studied their failures and successes and how they adapted lean to a service organisation. This was quite essential as a lot of the standard examples for lean are from the manufacturing and private sectors, and it is sometimes hard to see their applicability.

In June 2010, premises management of Westminster City Council embarked on its lean journey.

Our first encounter with lean was through a free training course my colleague Claire Weeks and I attended.

At that time we had traditional projects running but we wanted to explore new ideas to improve our services. Our department had been through a series of re-organisations and we wanted to ensure we could support the outcomes of those as well as any from future re-organisations.

The course was refreshing. We learned that lean principles were very much aligned to the Westminster Standard that the Council is promoting: excellence in customer service, empowering staff and doing things right first time round.

Lean provided us with tools that are underpinned by the same principles that our organisation believes in. We thought this was a good start and started talking to our director and the rest of senior management about implementation within Westminster.

Our proposal was to start with two pilot projects in two service areas. We delivered them with no extra costs by implementing lean alongside our dayto-day project management. The teams were enthusiastic as we picked two areas previously identified by the teams themselves as in need of reviewing: Street Licensing and Home Improvement Agency (HIA) in our residential section.

We introduced the teams to lean principles and methodologies, conducted the reviews and identified improvement steps. The teams developed their future or ‘to be’ maps and then rolled them out. One very positive outcome we measured was a reduction in the turnaround time for licensing applications.

During the research and trial phase we worked to build a case for the implementation of lean in Premises Management.

8

We found that there were several styles for the adoption of lean in Councils. We looked at case studies and identified what worked and what didn’t, comparing their organisations to ours in all levels.

westminster City Council is one of the biggest councils in London and we knew that it would be difficult to implement the changes from the top down

TALk To THE EXPERTS AND SEE wHAT IS AVAILABLE As we had no one in-house who had any lean experience, we met with experts and did an initial assessment as to what we could do in house, compared to what consultants could do for us at a minimal or zero cost. We looked at opportunities where we could resource free materials or training courses. However we found that even training providers funded by the government grants were struggling, and were not as forthcoming as they had been in the past, and realised we would have to do the majority ourselves.

Look AT oUR oRGANISATIoNAL CULTURE Westminster City Council is one of the biggest councils in London and we knew that it would be difficult to implement the changes from the top down. We decided to start the change in our department only and then work sideways, engaging other colleagues across the council when we needed to.

After the research and development phase, and the successful implementation of the pilot projects we started with a large-scale roll out by sending a selected group of managers and senior practitioners on a lean practitioner course. We chose them identifying who the key players were going to be in the improvement programmes, focussing on who were the decisionmakers, the doers and the influencers.

With the members of this group we organised workshops, mini briefings and training sessions and offered them to a wider group across the department. These were organised without external consultants or trainers, to reduce costs.

PRINCIPLES & PURPoSE

Improvement projects for the lean programme were identified by the group of trained lean practitioners with the participation of their team members. These were then sent to senior management where projects were prioritised and signed off. Prioritisation was based on how aligned each proposal was to the service strategy and to the outcomes promised by the delivery.

At the end of the project identification stage, the service came up with a combination of small easy-to-deliver projects (with very quick wins), medium-sized projects which involved services across the department and a couple of much larger cross-council projects, which unsurprisingly we found to be the most challenging to deliver.

IMPLEMENTATIoN CHALLENGES

As one of the central misconceptions was around the equation of lean with job cuts we knew we had to start there, by demonstrating with our two pilot projects that outcomes did not involve cutting jobs but instead gave us more streamlined processes

Any project, small or big, will always have a group of sceptics, often with good reason. This is particularly true for improvement projects where changes in the past have led to negative outcomes for people on the ground, or had little to no effect, other than perhaps raising false hopes. Lean programmes also suffer from the bad connotation the word “lean” often has, after in the past cost cutting exercises had been deemed “lean” initiatives.

In retrospect, the high degree of opposition from our union should not have come as a surprise when we launched our programme. They felt so passionately about it that they immediately wrote an email asking people not to participate in the programme, including an excerpt stating that lean was “evil” and that it meant we were going to be cutting jobs.

The way lean was portrayed in the email couldn’t be more different from our vision: we realised we had a big task in our hands getting the buy-in and engaging people. Our lean implementation was planned to be bottom up involving staff and giving them a say in defining and shaping how they worked, but with such a response this approach seemed in danger of failing right away.

After this initial shock, we had to work very hard as a team to prove that the fears were unfounded. We asked ourselves some questions – what was the reason for such resistance? What is the best way to communicate the programme?

We knew that we had to get the balance right: while we wanted to approach it as sensitively as possible, we also had to be assertive about it.

As one of the central misconceptions was around the equation of lean with job cuts we knew we had to start there, by demonstrating with our two pilot projects that outcomes did not involve cutting jobs but instead gave us more streamlined processes which were a win-win situation for both staff and customers. To underline the positive side to our programme we also pointed out that front line staff felt empowered by being involved in both identifying the changes and implementing them.

Secondly, we communicated the hard truth about the need to get staff on board and participating in the improvement programme by presenting the alternative, which would have been having external consultants or outside staff reviewing services, something which would have probably ended with job losses.

We made the argument by letting the results of the pilots speak for themselves, and showing that by opposing our lean programme the union was more likely to cause job cuts than to stop them.

www.leanmj.com | January/february 2012

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T A K I N G T H E R O A D T O L E A N R h o da A van z ad o

Other Fact o rs f o r S uccess As well as winning over the staff and unions, we found the following measures being key to the successful implementation of our projects:

C o mment

1

Demonstrate leadership – in a previous article, I wrote about the important role of managers in ensuring the success of a lean project.

Where managers are enthused and really demonstrate to their staff that they can make a difference and embed the improvements in their service delivery, projects are bound to deliver the outcomes desired.

2

Provide the right environment – embedding the programme in the service plan for the department and making it part of the performance review process is also important. Staff need to be given the time to deliver their improvement projects without having to juggle it with the rest of the workload.

3 4

Provide capability – ensure that the managers and staff driving the improvement have the skills and knowledge of the lean principles and methodologies.

Provide support and recognition (before, during and post implementation) – do not only provide training or workshops at the start of the initiative, but also provide forums and briefings for those who are participating in the projects. This will provide opportunities to learn from others as well as opportunities to recognise success.

Councils do not really have a choice as to their future direction. They have to cut costs by finding efficiency savings, improving productivity and identifying more income generating activities. The only alternative is reducing head count. The unions as well as management prefer the first three of those options. Unions are there to look out for the best interest of their members. If lean principles are properly understood and the methodologies correctly used, there shouldn’t be any reason why unions should oppose lean.

By tackling misconceptions and showing both the benefits of lean and the consequences of not becoming involved in necessary change, we have managed to get the union members on our side. Some now lead the improvement projects and many others have contributed to the workshops and in identifying improved ways of working.

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Wendy Wils o n c o mments This is a fascinating case study in change management - especially in the face of such hostile opposition from the unions. The experience of Westminster City Council shows the need for careful assessment of the stakeholders and the need to address their concerns fully. It also shows the need for a tailored approach to introducing lean thinking to the organisation. In this case, proving the benefits through small pilots and then “spreading” to other parts of the organisation culminating in end-to-end value stream design has proved to be an appropriate approach.

The importance of seeing lean as an “enabler” rather than the “objective” is very evident here. Lean should not be seen as “something extra” but “the way we do things around here”. As such, creating a cultural shift in attitudes and behaviours is far more challenging than the adoption of lean tools but it can transform an organisation.

Emphasis on delivering improved customer service whilst reducing costs is at the heart of lean thinking.

Although there has recently been a marked shift away from the idea of lean being about waste elimination, the importance of starting with the first principle of “Identify value through the eyes of the customer” cannot be over-stressed.

PRINCIPLES

C A S E

S T U D Y

& PURPoSE

Lean on IT RP What made you decide to adopt a software solution to track your OEE? SG A few months ago we realised the lean principles we deployed weren’t enough.

We were good at moving pallets for example, but there was still a lot of waste being generated. This time last year I was looking to replace printing machinery, and realised we didn’t have the infrastructure to support modern technology within our equipment. We needed a real understanding of how our machines were working to move into modern manufacturing.

RP What solution did you decide to implement and what results have you seen?

SG All devices carry their own OEE, which means you are dealing with high costs and

Steve Goodall ( SG pictured above) , production director of marketing solutions provider APS Group, talks to Roberto Priolo ( RP ) about the deployment of a software used to measure oEE to add to a lacking lean programme.

multiple manufacturers. If you make changes in the factory, to see the outcome you have to wait four weeks for a manufacturer rep to come in with a 200-page report you have to pay for and referring to just one machine. Traditional usage of OEE doesn’t work in this industry. I needed a device like TRAKsys, developed by Cimlogic, that could work on any piece of equipment.

We tried it for four days, attaching it to two events on the machine to give us an idea of the product. We later bought enough for 100 events, and we were able to reduce wasteage and non value added steps down to 27% on the two machines it was used on. Capacity increased.

RP What were the advantages?

SG We are in control of our machines. Every time a machine stops we know why.

Operators can see the advantages, and that ensures their buy-in. They are now more confortable in approaching management with new ideas: in our industry many seem to think that lean is hitting operators with a stick to make sure they run jobs as fast as possible, but I didn’t want that. We are identifying and eliminating variations, from individual to individual or from day shift to night shift.

This solution shows us the profile of work. It helps us with investment proposals, highliting seasonal changes, risks, and the technology we lack. It told us that 13 weeks of the year were being occupied by changeovers!

RP How did you ensure workforce buy-in?

SG All of the 167 staff went through an overview on six sigma touching on OEE.

Fifty-five people are trained to use the software. At first they thought it was a tool to help me analyse them, but this Big Brother view was taken away after we explained its purpose. Without their buy-in it was never going to be a success.

RP Why do you think many don’t use IT to support their lean programme?

SG A lot of managers and directors don’t really understand OEE. Unless you have

true CI and training programme in place, it will fail. Additionally, people don’t know it’s out there: many are manually collecting data, rather than recording it.

www.leanmj.com | January/february 2012

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PRINCIPLES

&

PURPoSE

Are consultants the way to go?

GkN’s Peter watkins explores the pros and cons of hiring a consultancy to support your lean journey, looking at his own experience and that of other lean leaders, and gives some practical tips for you not to get lost in the immense ocean of available offers.

T

oyota leaders have a sensei to coach them towards the correct lean thinking way, so getting your lean journey started with the right support is critical. One of my favourite lean gurus, Shigeo Shingo, talked about how we need to progress from having a lean tools approach for improvement into system thinking around value flow and then towards a strategy driven by lean principles.

Lean principles drive us to use the Plan Do Check Act approach, by starting any activity with the ‘end in mind’. So we need to be clear about what problems we are trying to solve before engaging external support. Once you are clearer on the problem to solve, you can determine who will provide the right support for you.

In the table opposite I have tried to summarise some thoughts on the benefits and concerns when engaging consultants to support the initial problems you may have when starting your lean journey. This is based on my own experience, and I have also asked other lean leaders from SMEs the reasons why they engaged consultants.

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PRINCIPLES & PURPoSE

Should you engage external consultants?

Initial Problems

Benefits of involving consultancies

Concerns with involving consultancies

Lack of lean expertise and knowledge to get started

They can change leadership behaviours because they bring expert knowledge to challenge and implement the right things the right way.

They can provide successful implementation because of their proven backgrounds in lean tools and methods.

They bring several years of operational deployment experience.

They can be accused by internal employees of not understanding the business.

Some consultancies only specialise in certain areas or focus on certain lean tools so watch out for the “I’ve only got a hammer” approach.

Some consultancies only specialise in certain market segments and are definitely weak in others.

Lead company improvements with a new perspective

They understand end-to-end value flow approach rather than point metric management.

They give good insight from people with a history of lean success.

They have no preconceived notions about your company so they see the business with a “fresh set of eyes”, without the history around it.

They can “coach the coaches” as well as the team members on the floor.

They can take leaders back to “gemba management”.

They can lead to contacts with other companies who have been successful in deployment to share learning’s from them.

Not all consultancies understand or work with the concept that “leaders are teachers”, so sustainment after they have gone can become very difficult.

You would have to work with a consultancy for a very long time if you truly wanted to change the culture of everyone through the path of lean tools - systems thinking - to being principle driven.

Some consultancies send in their most experienced people first to gain the business and then the junior partners to do it! Check their experience.

Pace of deployment / improvement is too slow

They make sure the Check Act is built into the deployment plan so progress doesn’t slip back or timings are missed.

They can speed up PDCA learning cycles by coaching senior management who have never deployed lean before.

They have seen many lean implementations and will often tell you the initial right step to take.

If they miss out engaging senior management in the process by only focusing on people below them, this will make your efforts difficult to sustain in the long term.

Once the project is implemented, sustainment can become difficult without their support to coach the people.

Resolve critical performance problems

They have the knowledge to apply specific techniques to specific problems.

Fresh ideas from outside the situation certainly help to develop new ideas for countermeasure.

They ensure stability by applying a basic learning structure, so you don’t jump from solution to solution without having determined the true root cause of the problem.

Not many consultancies coach practical problem solving to senior managers as a way to coach them through their top level business problems.

Sometimes they will share the point solutions areas instead of showing how the whole flow should be improved.

Problem solving without experience coaching is tricky because you can do a lot of trial-and-error experiments before figuring out which are the better countermeasures.

Need to support training in lean tools and methods

They can provide specialist lean tools and system training.

They have had the benefit of previously training others around deployment so they engage better with employees.

They can introduce new teaching and learning methods such as TWI. They can share their deployment learning’s from experience with others.

Not all training approaches are done through “learning by doing”.

A lot of consultants have focused on their technical skills rather than teaching/coaching methods.

Deploying through classroom training or solely debating with consultants is a distraction from getting something changed in the workplace.

overcome past implementation failure

External consultancies have historic experience to fall back on and can spot the roadblocks and know how to avoid them before they happen.

Using consultants sends the message that you are serious so employees don’t view it as flavour of the month.

Some consultancies try the same approach as before, as they do not understand the past deployment issues.

A lot of them only focus on implementation support rather than teaching leaders to coach the lean tools and methods, leaving unsustainable improvement.

No resources available to support

Using a consultant can be far less costly than self-launching a lean programme, getting some results, slipping back, having to do it all again.

Consultancies can flex when you need them – so you do not have to cover the cost of having full-time employee.

Local training grants and government grants are available to cover some or all of costs – It’s amazing what is available for support if you ask around.

They can be expensive resource with a wide cost range cheap isn’t always better.

Sometimes it’s better to partner with universities or other experienced network groups to learn from them how to deploy with your own leadership.

Ask another external experienced lean leader to mentor you through the process of deployment. You’ll be surprised who will do this.

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ARE CoNSULTANTS THE wAY To Go? PETER wATkINS

Following lean principles we should always evaluate the alternatives. Here are some suggestions you can think about if you don’t want to use external consultancies: Hire someone to the company with the right lean skills and the ability to create change, who can act as an internal coach to the leadership team.

Participate in lean networking or benchmarking activities, like those of LMJ, the Lean Enterprise Academy or AME and of those associated to universities who teach and educate in lean thinking.

Just start “learning by doing” from PDCA experiments with your current leadership team.

This is not for the faint-hearted, though, as your lean journey will certainly be slower and involve big learning curves – but after all this is how the original lean gurus all started.

Once you have thought about the purpose for engaging an external consultancy for support, you can start to form ideas for selecting and using the right consultancy.

PLAN – Develop a plan on how you are going to internalise their knowledge and share it across your business and integrate.

There are literally thousands of consultancies worldwide which claim to be able to support you on your lean journey, so where do you start? Here are some ideas to start your search off on the right foot:

Do – Assign your smartest leaders and people at the do stage to follow their every move, and learn by doing the techniques and methods.

Contact companies who have proven sustained results from their lean journey in your industry.

Attend/join lean network groups, lean conferences or events.

Read lean publication articles on successful deployments.

Ask lean support institutes if they can recommend who you can talk to, or ask universities which consultancies support them on their lean programmes.

Once you have made a shortlist of names, you will then need to check their previous work. The best way to do this is by asking for them to arrange contact with firms they have been involved with. You can then ask questions about their approach and results. Did they get sustainable results? Could they diffuse and share their knowledge within the company? Did they solve the problems for leadership but never involve them in how it was done? Did the employees sustain their changes because they are more engaged in their jobs?

Once you have engaged an external consultancy, use the PDCA approach to make sure your current leadership integrates the “lean way of working” into their current management system.

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Lean principles drive us to use the Plan Do Check Act approach, by starting any activity with the ‘end in mind’.

So we need to be clear about what problems we are trying to solve before engaging external support

CHECk – Constantly check the sustainment of implementation results to ensure behavioural change has happened.

ACT – Finally when your leaders feel confident enough to act alone, adjust your approach to spread the learning’s across the rest of your company with your own leaders.

I will leave you with one more quote from Shingo, who said: “The most dangerous kind of waste is the waste we do not recognise.” External consultancies can be a valuable support when starting out, they help us to see and act on the waste all around us, but only if they are used with clear purpose and a defined process for PDCA can they be a good catalyst for change.

Y e principles o V ally C ase S tudy & purp

o se

principles & purp o se

Yeolean, Yeolean, Yeoleeean Roberto Priolo ( RP ) visits yogurt manufacturer Yeo Valley’s Blagdon site and discusses the company’s lean programme and the main mistakes that were first made, speaking with group CI and yogurt manufacturing manager Steve Welch ( SW ), communications director Graham Keating ( GK ) and continuous improvement manager Chris Coles ( CC ).

go and textbook applications often don’t make sense to us. It’s through practice that we understand what works and what doesn’t for Yeo Valley. Take inventory reduction, for example: it doesn’t mean anything to us, because we have limited inventory. Given the short shelf life of our products, what we have is flash inventory. However, the overarching principles are still applicable.

Another difficulty we had is that we couldn’t afford the time to, say, not produce for a week while we sorted out the best way forward, like the shut downs enjoyed in the motor industry. In the FMCG sector, you have to create time.

RP What were the main mistakes you made in trying to RP Can you tell us about the lean programme at Yeo Valley and how you got around to it?

SW We started with three initiatives at our Cannington

site, where I was the general manager. It was a Kaizen Blitz approach, but the real opportunity came when I was transferred as general manager to our Blagdon site. I had a chance to start from scratch, enrolling on the MSc in Lean Operations, along with Chris Coles, my CI manager, at the Lean Enterprise Research Centre in Cardiff. Over the last year we have created a lean transformation programme, which we have branded Better Than Ever and rolled out together with TWI to lock down the changes for the processes that transform the product. Tools are useless unless they are linked with a strategy.

RP What were the main difficulties you encountered at the beginning?

SW It’s all about rationalisation and repetition. For

example, we have four blending shifts, all blending yogurt and fruit together in a slightly different way. You cannot achieve change, which is a gargantuan task in itself, that way. We are trying to identify learnings as we

ensure buy-in?

SW The hardest part for us was convincing the

management team. In the back of their minds they wondered if this was merely a short lived initiative. By the time you are done with the mid-level and front-line managers, senior management enthusiasm was starting to cool. We are now running cross-functional teams working on data-driven projects aligned to the site objectives. This creates belief in the process, as substantive actions are surfacing. It is a long and arduous process, taking a huge amount of commitment.

GK Ten years ago, we were trying to improve our health

and safety performance. In our industry, there are a lot of wet floors and fast movement, and we soon realised we had to change the way things were. Today people would be shocked if they saw a colleague doing something unsafe, that’s how embedded our health and safety mindset is.

Lean is not there yet, although given the nature of the products we manufacture we have probably adopted some inherently lean practices since the very beginning.

Communication is a contact sport, and you should never forget you are asking people to do something

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Y e o V ally C ase S tudy

difficult, and to be engaged. They have to understand why and what are the benefits, and then they have to be rewarded. When we realised that people read notice boards very infrequently, we introduced our ‘Gateway’ Intranet system and, for those without regular access to a PC, we invented YVTV six years ago, with digital signage screens in the canteens. People now expect effective communication. Blagdon salvaged 15 minutes at the start of each day for each department to have a brief, scripted by the operations manager, covering safety, quality, service and so on. What happened yesterday?

Today? What is going to happen tomorrow? This orientates them for the day ahead.

RP Lean is usually deployed to better respond to

customer requirements, but you were already doing this very well, with a customer service rate of 98%. What was the driver for wanting to implement change?

GK Our market has been changing. We produce

retailer brands, and we also have our own brand.

In the old days, own label often meant one product wrapped into different packs for different retailers. Now they all have uniquely differentiated products. This was a big change in our product development, but it also meant that our production runs have become shorter and shorter. We are also under pressure on price, as the UK market is highly competitive and about 60% of products are sold on promotion. From a manufacturing point of view, we experienced a perfect storm of greater complexity, shorter lead times and increasing costs. Our world is ever more frenetic and demanding, so we had to keep unnecessary costs down.

are captured as the work progresses.

Individual members of the senior management team “observe” the work teams, demonstrating a show of commitment to the process but being careful not to take over the controls.

Individual members of the senior management team ‘observe’ the work teams, demonstrating a show of commitment to the process but being careful not to try to take over the controls

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CC Our response to procedural

non-compliances has often been on a case by case basis. Traditionally issues have been seen as solely the fault of the operator and dealt with by re-training in the procedure, whether it is valid or not. By looking at recurring problems and identifying issues inherent in the system, we are able to stop many issues from occurring. When we are doing this, we talk to the operators who aren’t creating non-compliances, as well as those who are, to ensure that we get the whole picture.

SW It was great in terms of our learning

SW As the company grew, the amount of time we spent

Selected cross-functional teams set to work, a member of the management team facilitating the process and meeting once a week. We provide full access to all relevant data and minuted actions and responsibilities

focus on?

in Cannington an error or a necessary step in identifying the real problems and root causes?

lean strategy?

Directors and senior management teams have a clear sense of purpose, but our management processes weren’t great at communicating it to all levels of our workforce.

This often resulted in localised improvements that might or might not help the business to reach its top-level goals.

To combat this, a concise set of clear business goals were generated, broken down into operational tactics and deployed through the different levels of management, who then break the tactics down further into clear actions.

RP What did your fire-fighting mainly

RP Would you consider the Kaizen Blitz

RP Where did you start with the deployment of your

fire-fighting repetitive issues increased. Historically, whilst a lot of energy has gone into these activities, it wasn’t coordinated with collaboration between different departments. As a result, the root cause is often not determined thus the fix is not permanently embedded, and the problem just comes back.

Tools are then pulled in as required.

Finally, verification and further action if neccessary, following the PDCA cycle, signifies the disbanding of the original team and the creation of the next one in a continual cycle of change.

We have the experience of the Kaizen process, and we can apply it at the right time, constantly keeping data at the core

curve. I would do it in the same way again. It made us understand that a transformation programme won’t stick unless you have enabling factors. Active learning backed up by a theoretical frame work is essential. LERC have been very supportive.

CC We were taught the best way to use

tools. It’s now called for by the team. The guys are asking us to help them do that. We have the experience of the Kaizen process, and we can apply it at the right time, constantly keeping data at the core.

RP Do you believe in rewarding individual success within a lean programme?

CC It is often impossible to quantify the

value of an individuals contribution to the programme. For this reason, we chose

PRINCIPLES & PURPoSE

not to link rewards to the level of contribution as this could lead to individuals being demotivated if their contribution is not as highly valued as another. We ensure that recognition is given when people are involved in activities that have not previously been considered as part of their job. This can be a certificate for attending a course, an article on our YVTV internal information system, or could even be as simple as a thank-you from one of the management team.

RP What is the importance of acknowledging past mistakes?

Sw Openness and honesty go a long way in breaking

RP What sort of support do you provide managers with?

from a manufacturing point of view, we experienced a perfect storm of increasing complexity and costs. our world is more frenetic and demanding.

Therefore we decided we had to keep unnecessary costs down

Sw When you are on a site, the key is

keeping the enthusiasm alive and reinforcing the belief, my job is therefore managing conversations. Keep attention and interest on what Better Than Ever can achieve. It’s constant reassurance. Some struggle to buy in, but we will keep trying to convert them, usually through involvement in the transformation.

With TWI, we have taken procedures that were 17 pages long and reduced them, through the efforts of the operators, to two or three pages. That makes people want to make the next set. When they get a new team member, and it takes 20 minutes rather than an hour to go through a procedure, team managers realise it’s easier for them. With crossfunctional teams it’s different, but only when they know the angle and the importance of ‘busting problems’. They are cautious to start with, because responsibility and accountability comes with recognition.

LEAN ICEBERG MoDEL Technology, tools and techniques

Supply Chain Integration

Process management ABOVE WATERLINE - VISIBLE UNDERWATER - ENABLING

ABOVE WATERLINE - VISIBLE UNDERWATER - ENABLING

Strategy and alignment Leadership Behaviour and engagement

down barriers, so admission of past mistakes underlines the message that the old way of working is not good enough. When engaging with the workforce, everybody would be instantaneously ‘zoned out’ if I didn’t capture the moment. I use previous mistakes and learning as an opener and I mention the fact that this process is not perfect and that we are still learning and making mistakes. It’s going to be a difficult and bumpy road, but eventually it will make our lives easier, our jobs more secure, our business better. We will still encounter moments of confusion, but I believe it is humbling when you hear a general manager say, “We don’t have the answer, let’s find it together”. I don’t want a list of things going wrong, I want to see what we can improve. Excitement is contagious, you need to have the courage to put your beliefs out there, knowing that the conversion process is a bumpy journey.

RP In conclusion, what were the main mistakes you

made at the beginning of Yeo Valley’s lean journey?

Sw My lack of understanding of the requirement for

strategy. Forget the Kaizen Blitz, it culturally didn’t fit. I tended to try and fix a problem before I understood it. Strategy takes an opposite approach, and six months ago I got it: one strategy aligns a company towards its goals and a set of objectives and tactics are developed to achieve them, with feedback loops continually correcting the process, similar to landing an aircraft. In Cannington, it was all about fixing this and that, but not the whole picture. The other mistake was a lack of appreciation of the system. You have to understand what you do as a business.

Culture is something that will only change over time and the process is very difficult to quantify. It is invisible and yet all around us. We found that, until we had a clear idea of what we wanted, we couldn’t take steps in realising it. Our beliefs have been strongly influenced by the work of Dr. Pauline Found from LERC and others, whereby the ‘below the waterline’ enabling factors from the Lean Iceberg model (strategy, alignement, leadership, behaviour and engagement) have to be firmly in place before improvement can be considered.

Going forward, we are rolling out the Better Than Ever transformation programme to the group in the new year, supported by Graham Clarke (ex-director of TRW steering systems and business associate of Cardiff University) and Lloyd Warlow, our knowledge transfer partnership associate. We will apply the model developed at Blagdon but anticipate further steep learning curves as we continue our journey.

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PRoCESS foCUS

Lean in healthcare Service operations lecturer Ann Esain introduces two articles by students who have recently completed the MSc in Lean operations at Lean Enterprise Research Centre. All students on the executive programme are senior practitioners.

T

here is a global need to do more with the same resources in healthcare.

Reported increases in demand for healthcare services and concerns about the rising costs have resulted in the adaption of lean thinking, initially in the Americas but more recently in UK, Australia, Scandinavia and Europe.

The following two articles are of particular importance to the debate on lean in healthcare and practitioners in particular.

The first article augments a special feature published in the LMJ a year ago. The author Nicola Burgess highlighted the increased popularity of using lean in English general acute hospital Trusts. Her work challenged practitioners to be wary about ‘fake lean’.

Thus this article is of particular relevance as it investigates an approach to improvement that is spreading globally as a means of ‘releasing time to care’ not only in hospitals but across healthcare provision in general. Drawing on research in the setting of mental health, it uses seven wards in a single organisation to compare the performance measurement. It evaluates the impact between wards which have introduced the ‘package’ and those which have not. The results support the need to test such interventions and reinforce the need for plan do check act in all that is done.

This article highlights ‘acting’- driven by the need for solutions, before appropriate ‘checking’ perhaps?

The second article delves into the particular role of the professions in healthcare improvement, in particular the role of the doctor. There is a common view that the engagement of doctors is a critical success factor in the success or otherwise of lean transformations. However, many involved in lean healthcare report that such engagement is difficult to achieve, citing an array of reasons. Thus it is refreshing to gain some insights into this issue, which I am sure will be welcomed by managers and those who deal with professionals as part of the overall lean transformation process.

Both articles are excellent examples of the need to continually probe and think about what we are trying to achieve when implementing lean transformations.

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PRoCESS foCUS

Is the Mental Health Productive programme lean?

Jackie Thomas works in service development for a Mental Health Trust in England.

The organisation has been using the Productive programme as a way to introduce lean to staff. In this article she expresses some of her views following the research for her dissertation, “Does the productive ward make a difference to patient satisfaction, staff wellbeing and reflect a positive change in the productive ward measures?�

e are all aware of the need for healthcare to cut costs whilst ensuring increased quality of care. In order to support this, the NHS Institute of Innovation and Improvement developed the Productive programme based on lean principles. The Productive programme uses modules to develop an understanding of the lean tools and continuous improvement. The hypothesis is that it is to provide measures that matter and ensures frontline decisionmaking and empowerment to free up time to care. This ensures that patients and staff are satisfied and engaged in care and that leads to the productive measures being achieved. This, then, leads to improved patient care.

w

According to Jones and Mitchell, lean can improve safety, quality and staff morale whilst at the same time driving down costs. They go on to say the lean story in healthcare is 100% positive. However, does the Productive programme provide this and does it use the lean principles that matter? This question may need further research.

THE PRoDUCTIVE PRoGRAMME

Lean in healthcare is frequently simply seen as a set of rules rather than a fundamental shift in culture

The NHS Institute of Innovation and Improvement produced the productive programme, a house of lean for healthcare (figure 1). This is an approach that prescribes a lean implementation through the undertaking of modules

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is the mental health pr o ductive prgramme lean ? J ac k ie T h o mas

could, therefore, encourage silo thinking and stem creativity and innovation that could be achieved through teams coming together to achieve the organisation’s aims and objectives.

Productive Mental Health Ward Therapeutic Interventions

Process modules

Safe and Supportive Observations

Admissions and Planned Discharge

Knowing How we are Doing

Shift Handovers

Ward Round

Meals

Well Organised Ward

Medicines

Toolkits

Patient Wellbeing

Patient Status at a Glance

Ward Leader’s Guide Foundation modules

Project Leader’s Guide Executive Leader’s Guide

that develop skills in the use of lean tools. The house of lean is built up using different modules, divided into foundation and process modules (figure 2). Interestingly, Jones and Mitchell state that lean could improve the quality of patient care, increase staff morale and add value for money; however, that one sure way to kill this would be to have a national or regional programme. The lead for the NHS Productive Ward states that the Productive Ward gives staff the tools to make what they do meaningful, builds leadership and provides a highly structured methodology to make improvements and this leads to increased motivation.

The Productive programme focuses on the use of tools and techniques (5S, spaghetti diagrams, activity follow, visual management, safety cross, process mapping, cost/benefit analysis, waste walks, 5 why analysis, audits, visit pyramids, dot voting and meetings) and the evidence around the programme seems to concentrate on them and not on system change. However, within manufacturing and lean literature, there is an overall understanding that lean is about system change and not simply about the use of tools. Lean in healthcare is frequently simply seen as a set of rules rather than a fundamental shift in culture.

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Virginia Mason was one of the first American hospitals to undertake a lean transformation and focussed on leadership, process and culture. It was able to transform its service in the following ways: From functional silos to interdisciplinary teams; From managers directing staff to managers who taught and enabled staff; From a culture of blame to one that used root cause analysis to determine cause; From rewarding individuals to rewarding group sharing; From an internal focus to a patient focus; From being expert-driven to being process-driven.

Virginia Mason was able to take lean and implement it throughout the organisation. The Productive programme seems to miss the whole system approach and although it uses lean as a baseline it then develops it is a programme. This approach does not embrace the value to the patient and the value stream mapping across silos. The programme

Like Toyota and other lean organisations, Virginia Mason had an overall vision and then developed this with the focus of all staff within the organisation on achieving the vision. This included staff being supported to understand their involvement and contribution to this achievement (in healthcare this would be towards the best possible patient care).

Although there is an initial meeting with executive teams to ensure buy-in, the focus is on the wards or individual teams. It seems that the Productive programme misses the respect for people aspect of lean and focuses more on the process and the tools that staff can use.

Initially the productive ward was, and in some cases still is, seen as freeing up nurses’ time to care. The name has changed to freeing up time to care but there still seems to be a focus, in the literature, on nursing time and on hospital wards that are predominantly staffed with nurses. Medical staff and clinical leaders need to be fully engaged in taking this work forward and there may not be enough focus within the programme on this aspect of care. This would also need to include changes in culture and ways that staff could feel empowered and able to take responsibility and feel respected for their contribution to patient care.

The productive literature concentrates on the first three modules of the Productive programme: knowing how you are doing, the well-organised ward (or workplace) and patient status at a glance. It concentrates on small single initiative process change rather than, as Virginia Mason did, full system change.

The literature is focussed on general acute nursing and does not reflect the needs and changes necessary in other areas such as mental healthcare. In my experience, as a mental healthcare worker, it is known that many initiatives are simply taken from general acute

PROCESS FO C U S

The Productive Series The Productive Ward The Productive Mental Health Ward The Productive Community Hospital The Productive Leader The Productive Operating Theatre Productive Community Services Productive General Practice

care and implemented in mental healthcare without much thought to the differences in the ways of working. In general healthcare there is a focus on tasks and processes whereas in mental healthcare this focus is less explicit and the predominant feature is on the nurse-patient relationship.

It may, therefore, be necessary to acknowledge this and to work through how lean could be implemented in a way that is innovative and creative and takes this different way of working into account. The patient groups and structures within the healthcare environment are not all the same.

Coming from a mental healthcare background I would like to further examine this aspect or would like to see further research around lean and mental healthcare.

M ental healthcare and the P r o ductive pr o gramme Mental healthcare is provided through NHS organisations that offer community services, alternatives to admission services and inpatient care. Thus the patient journey may, and indeed is likely to, include all of these elements of care.

The Mental Health Productive programme does have the productive Mental Health ward, but does not have a specific community or other programmes; the other general programmes are adapted for mental health and this does cause some issues as described above. It does, however, mean that the silos of healthcare are perpetuated through the Productive programme, which does not encourage the analysis of the handoff points between community staff and inpatient staff and therefore where there is likely to be some conflict and some possible delays in the care pathway.

I have undertaken research within one Mental Health Trust in England and the feedback from staff is that this programme:

is a general nursing initiative which does not take into account relationship-building with patients and the need patients have for a safe space to recover. Therefore some of the time could be construed as waiting but really is time for the patient to reflect and recharge; is a top-down programme from a government organisation and then from the Trust board, with people coming into the teams from management or a team elsewhere to tell them what to do; features executive and management visits that are seen as checking up on them and not about encouragement and coaching; will end once they have completed all of the modules; has added to the paperwork already in place; has seen measures increase overall.

There are overall questions when looking at the productive ward principles that need to be asked; firstly, the customer in healthcare is not welldefined and within mental healthcare is even less well-defined. When asked, most frontline staff believe the patient is their customer.

Secondly, the customer in other services pays at the point of service but of course in healthcare the primary care trusts pay for the service and lastly the general public are also customers of the healthcare system through tax payments and they can have very firm views about mental healthcare. The Productive programme measures customer satisfaction through patient and staff satisfaction surveys.

People with mental health needs can be very clear about their care and provide feedback and ways of moving forward; however, for some patients this would be much more difficult for example, if a patient is detained under the mental health act.

T o c o nclude One of the biggest issues for the Productive programme is that it is being implemented at a time when the government needs to make substantial cost savings in the NHS. The original aim of the productive ward is not about solving the Trusts’ financial problems or cutting nurses.

However, paradoxically, the Productive programme is being used as a vehicle to make efficiency savings. As the

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is the mental health pr o ductive prgramme lean ? J ac k ie T h o mas

NHS’s main asset is staff, it is easy to understand why there might be some fear around this aspect. Lean initiatives rarely succeed unless continuity of staff employment is guaranteed in advance; once jobs are not threatened and involvement at all levels and respect for people are in place, lean can unleash waves of enthusiasm.

The Productive programme could be developed further into a whole systems approach. This could be achieved through:

S o , is the P r o ductive pr o gramme lean ?

Training that includes a background to lean and systems thinking;

Yes, because:

Regular workshops across systems that encourage learning, development and continuous improvement;

It is using lean tools to develop single initiatives; It has made significant changes to single processes and has freed up time to care within some environments; It has a good focus on visual management and 5S; It is a starting point for people to learn tools and techniques and to develop some continuous improvement thinking; Does develop skills understanding what is happening on wards and how to collect data and evidence; No, because: It creates silo thinking - productive ward, productive community, productive operating theatre. It does not provide ways of creating flow through the patient pathway that includes the areas where there are handoffs, for instance between community services and inpatient services; It does not inform staff of the cultural change and what a lean implementation means; It feels like a top-down approach which is driven by a predetermined box; It seems that when the modules are complete then you are lean; It does not reflect continuous improvement and sustainability.

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B ut w hat c o uld be d o ne di f f erently ?

A Mental Health approach that looks at relationships and not just tasks and focuses on the patient and therapeutic time spent with patient; An approach that looks at the crossovers and handoffs within healthcare systems and develops these to ensure flow for the patient. Within Mental Healthcare, this may be helped by the implementation of Care Clustering (which is a way of creating patient pathways and thus could be developed further through value stream mapping); The development of local rapid response teams, including the team and a member of management, to undertake Kaizen events with teams when struggling with a patient process, delay or rework; More focus on respect for people and building confidence and empowerment in frontline staff; Having six to eight measures that are the focus for the organisation (rather than hundreds). Within a lean context, it is well understood that a few right measures will ensure that all else the organisation wants to achieve will be achieved;

A programme that should not be implemented when staff are feeling threatened by change and efficiency targets, but should be introduced after a period of helping staff to understand the reasoning and the benefits of lean or the Productive programme.

In Mental Health this would include education and support to staff to understand processes and tasks and how they affect the time they have to spend with patients; Starting with a patient focus and the issues the patient has and then developing a strategy for undertaking the changes from this viewpoint, thus increasing patient satisfaction and wellness; The introduction of lean ways of working to all professionals within the healthcare system and ensure a clinical leadership focus alongside a real agenda to drive up quality of care.

More research is needed around the effectiveness of the Productive programme and whether there are further developments that can be made.

The Institute has been iterative in its approach and has developed further programmes and is now asking for feedback regarding organisations that have used more than one of them.

Therefore, it may well be working through how the programmes might work together. There is already enough evidence in the literature to say that lean as a concept works. Therefore, why would healthcare want to develop this in the way it has?

However, my last question would be, “How will this programme and way of working be sustained and ensure a better healthcare service for all if the Institute no longer existed, and if staff continued to believe it is a programme with a beginning and end that is driven from the top down? �

LMJ’S VISUAL THINKING WEEK Select from two unique 2-day events: 23/24 April, North England or 26/27 April, South England The Lean Management Journal invites you to a unique week of Visual Workplace Seminars and Visual Benchmarking Visits taught by visual thinking expert Dr Gwendolyn Galsworth.

Whether you are well advanced on your journey to enterprise excellence or just about to begin, visuality will transform your workplace and accelerate your improvement results and make them sustainable.

Visual Thinking Week LMJ readers who participate in either of the seminars and visits during the Visual Thinking Week will understand that a Visual Workplace is not about buckets and brooms or posters and signs - or, for that matter, kanban and a handful of metrics boards. It is a compelling operational imperative, crucial to meeting daily production goals, central to a company’s war on waste, and fundamental to vastly reduced lead times and an accelerated flow.

LMJ readers can select from one of two locations for the seminar and benchmarking visit:

North England – Visual Workplace Seminar & Benchmarking Visit: PepsiCo, Skelmersdale, nr Wigan, M6 junction 26 23/24 April 2012

South England – Visual Workplace Seminar & Benchmarking Visit: Corin Group PLC, Cirencester, Gloustershire 26/27 April 2012

Gwendolyn Galsworth, PhD, is president and founder of Quality Methods International and the Visual-Lean® Institute (QMI).

A Shingo Prize and Malcolm Baldrige Examiner, Dr Galsworth has helped companies all over the world to accelerate their rate of visual transformation, strengthen cultural alignment, and achieve long-term, sustainable bottom-line outcomes through workplace visuality. In the 1980s, Dr Galsworth was head of training and development at Productivity Inc. where she worked closely with Dr Shigeo Shingo to develop, among many things, poka-yoke as an implementation methodology for the West.

Dr Galsworth’s most recent book Work That Makes Sense/Operator-led Visuality (2011) shares over 500 actual visual solutions, along with a step-by-step process operators follow to convert their own work areas to visuality. Galsworth’s 2005 book, Visual Workplace – Visual Thinking, was awarded the Shingo Research Prize. She is a frequent keynote speaker on visual systems, strategic leadership, and cultural conversions.

North England – Visual Workplace Seminar & Benchmarking Visit:

South England – Visual Workplace Seminar & Benchmarking Visit:

PepsiCo, Skelmersdale, nr Wigan, M6 junction 26

Corin Group PLC, Cirencester, Gloustershire

Day One: 23 April 10:00 – 18:00

Day One: 26 April: 10:00 – 18:00

On day one, you will learn the principles, concepts, methods, and tools that show what a visual workplace is, how it works, and why it is important. Gwendolyn will identify the keys to sustainable results through people and how over 100 actual visual solutions from companies that have learned to think visually.

Learn about the triumphs and pitfalls to a visual conversation, and then get ready for your next steps.

Delivered at off-site training rooms

Day Two: 24 April 09:00 – 15:30 PepsiCo Plant Tour, Skelmersdale, Merseyside The Skelmersdale Plant is a multi-functional site making a range of products from crisps to snacks.

The brands “made at Skelmersdale” include Monster Munch, Baked Walkers, Walkers Crisps and Snack-a-Jacks, with the plant employing over 400 people.

The tour will include presentations on its production methods utilising lean tools from a site that is still in its early stages of lean transformation. Using the learning from the previous day’s seminar, delegates will be asked to assess and then discuss the site’s current level of visual competency, and compare your findings with that of the other teams.

On day one, you will learn the principles, concepts, methods, and tools that show what a visual workplace is, how it works, and why it is important. Gwendolyn will identify the keys to sustainable results through people and how over 100 actual visual solutions from companies that have learned to think visually. Learn about the triumphs and pitfalls to a visual conversation, and then get ready for your next steps. Delivered onsite at Corin training rooms.

Day Two: 27 April: 08:00 – 14:30 Corin is a world leader in the development, production and distribution of a wide range of cutting edge, reconstructive orthopedic devices.

Day two will follow the same format as PepsiCo opposite and will involve touring the facility and completing an assessment report.

Places are strictly limited to 25 delegates on each seminar and tour.

Early booking is strongly advised. To register telephone Benn Walsh on 0207 202 7485.

At each seminar you will: Discover the ten core visual workplace technologies and key visual outcomes of each.

Learn how they work together to create significant bottom line results.

Learn to diagnose visuality in your own company & identify your current level of visual competency.

Discover the three biggest mistakes of a visual initiative and how to avoid them.

Learn about the I-driven conversion - the vital journey of the individual as the company converts to sustainable visuality.

Learn to energise and unite your workforce through visual functionality, even in a multi-lingual/multicultural working environment.

Learn how to measure bottom line visual results and how to track impact on people.

Learn the vital difference between measures that monitor and measures that drive.

Discover the three biggest mistakes when launching a visual initiative and how to avoid them.

Seminar and Tour: £595+VAT Early bird: £495+VAT (For the early bird fee you will need to book before 29 February 2012)

Your seminar registration includes a Participant Manual and a copy of Dr. Galsworth award-winning book, Visual Workplace/Visual Thinking.

For further information call Benn Walsh on 0207 202 7485, or email b.walsh@sayonemedia.com

At each benchmarking visit you will: Gain access to the host site’s manufacturing facility.

Meet the teams and individuals who work within the facility.

Insight into the impact that lean thinking has had on specific value streams.

Experience firsthand the visual workplace that supports lean at the site.

Conduct a visual workplace assessment on site and report your findings at the end of the day.

Note: Due to the sensitivity involved in site visits, each host site reserves the right to omit any delegate or delegates from the site visits. Please contact Jon Tudor, LMJ’s Head of Programmes, if you have any queries regarding eligibility.

Jon can be reached on j.tudor@sayonemedia.com

www.leanmj.com

Show me the evidence Sarah Powell, senior change manager at Guildford’s Royal Surrey County Hospital, explores the role of evidence in medical engagement with service improvements.

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he change of government in 2010 saw the publishing of a White Paper, “Liberating the NHS”, which represents possibly the biggest shake up of the health system since the inception of the NHS. It aims to transform the system, reducing the tiers of management, removing some of the targets set by New Labour and further opening up the NHS to market forces and competition. It means acute Hospital Trusts must significantly change their approach to ‘doing business’ and requires them to redesign the service offered to ensure both quality and efficiency for patients.

For the last few years, the Royal Surrey County Hospital (RSCH) in Guildford

has drawn upon lean and six sigma to implement organisational change, looking to improve the efficiency and quality of its processes to ensure patients get the optimum service. Called ‘Patients First’, this programme has achieved many successes in improving the way the hospital works and is a fundamental part of the hospital’s plan to meet the challenges of the latest White Paper. However, an important component has not been totally accomplished: the full engagement of doctors in driving improvements and their involvement in making change stick. Those responsible for leading change programmes recognise the importance of securing this engagement;

Figure 1: The journey from active resistance to active involvement

Attitude

Behaviour

Active Resistance

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Passive Resistance

Scepticism

Neutrality

Behaviour

Acceptance Commitment

Active Involvement

PROCESS FO C U S

Less Visible

Factors

Visible

14

54 4

Doctors’ Medical Training & Background

14

4

Doctors want to improve service for their patients

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Evidence of the “What”

Want to see evidence

54 24

Sceptical (always questioning)

Suspicious about motives

54

How evidence is generated

4

Change must be of benefit to patients

64 Measures and Data

3

4

Want early involvement

Personal experience of seeing the change/process

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I lead the delivery of service to patients

4

2

I want to be involved in decisions about improvements

trying to make change happen without it often means such programmes are doomed to fail.

With the recognition that having doctors involved and engaged with improvement activities is important, it was thought necessary to understand these concepts further and highlight what might influence doctors’ attitudes and behaviours towards improvement activities. The spectrum in figure 1 describes the journey from active resistance to active involvement, which highlights the continuum of attitudes that can be displayed during an improvement activity and how moving one’s attitude from neutral to committed can result in ‘active involvement’ behaviour, and vice-versa.

Whilst there is limited research into the specific factors that influence doctors’ decisions to engage with change programmes, a research team has reviewed the success of an improvement programme called the ‘Safer Patients Initiative’ and from that identified multiple factors that influence medical

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See Managers as leading (large) changes

There is a demonstrable benefit

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No scientific approach

Anecdotal Evidence only

Local evidence Generation 64 Visits to other hospitals

The literature suggests that there is complexity surrounding the use of evidence in doctors’ decision-making, particularly with regard to clinical decisions. This is partly because evidence is rarely definitive and partly because of the role played by the individual in interpreting and reframing the ‘evidence’ presented to determine what is counted as ‘best evidence’. Doctors draw their own conclusions about the soundness of the evidence put in front of them and the science underpinning conclusions and recommendations.

Believe it will benefit patients Don’t believe it will benefit patients Agree with the motives for change Don’t agree with the motives for change

14 Doctors not listened to

engagement, the majority of which have not been researched in detail. They suggested that these factors should be investigated further, so that the influence each factor has on doctors’ decisions to get involved in change programmes could be fully understood. ‘Evidence of efficacy’ was one of those factors found, which, alongside conversations the researcher had previously had with doctors during her every-day role at the RSCH, prompted the researcher to want to understand this specific factor further.

Don’t believe it is worth the effort

1

54 Scientific / Structured Approach 34

34 Decision of what to do already made before doctor involved

Believe it is worth the effot

4

34 24

Decisions

Involved early enough to influence the course of action Not involved early enough to influence the course of action

4

Figure 2: Interpretation of the findings from the questionnaires and interviews

Previous Experience of not being listened to or involved in decisions

Can see “process” of improvement

4

Desire for a scientific approach

Enablers & Barriers

Weighing up all items

Underlying Attitudes/Beliefs

Background

The researcher used questionnaires and semi-structured interviews to gather information about the views of consultant surgeons and consultant anaesthetists at the Royal Surrey County Hospital. In the questionnaires, respondents were asked to express their views on the importance of a range of factors, including ‘evidence’.

Evidence was found to be the second (out of seven) most important factor that influenced the doctors’ decision to get involved in change programmes.

In the interviews, individuals’ views of evidence, and the role it plays in their deciding whether to get involved, were explored in detail.

The analysis of the primary research resulted in the creation of a model to help explain the views and opinions of those who took part. The model in figure 2 is a depiction of these synthesised findings, with each square representing an identified element, and numbered dots highlighting the amount of comments made in relation to each element.

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sh o w me the evidence sarah p o w ell

The model describes how the research discovered four different levels: 1) ‘Background’ elements, which appear to help shape the doctors’ attitudes and beliefs towards getting involved in improvement activities; 2) ‘Underlying attitudes and beliefs’, which, whether they are visible to others or not, appear to help shape the interpretation of the factors; 3) Influencing ‘factors’ upon which the doctors’ decisions to get involved in change programmes appear to be based; 4) Barriers/enablers’ associated with each of these factors: a. Barriers (red), when present, seem to prevent doctors from engaging. b. Enablers (green), when present, seem to help persuade doctors to engage.

Most of the elements within each level are directly related to ‘evidence’, as would be expected given the research focus. An interesting discovery was the number of elements that came out of the research data, which were not directly about evidence, despite the focus in interview questions on the topic of evidence.

The data suggest these elements are important in shaping the role of evidence in respondents’ decision-making as well as potentially in their own right, although this would need further investigation as was not the primary focus of this study.

The model shows how all of the elements described in each of the levels above appear to be ‘weighed up’ by the doctors to shape the way that they make the four decisions as identified on the right hand side: 1) Is it worth my effort? (i.e. do I believe it will work?)

2) Will it benefit patients?

3) (related to no.2) Do I agree with the motive(s) behind the change?

4) Am I involved early enough to influence the course of the change programme?

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Evidence was found to be the second most important factor that influenced the doctors’ decision to get involved in change programmes

Whilst this research does not claim to have identified all of the key decisions, the role of evidence has been explored further than in previous work; the four decisions highlight how evidence is used to determine whether doctors will engage in change programmes.

In reviewing the research findings, there are four key topics for discussion that would be relevant to those trying to engage with doctors in change programmes. First of these is the element of ‘medical training and background’, which appears to lead to attitudes of scepticism and a desire for a scientific approach, both of which may drive the need to see

evidence. The type and presentation of evidence as well as the method of data collection is also linked to their medical training and background, and is depicted above as either an enabler or a barrier to engagement. These can be differentiated due to descriptions the doctors made about what methods they would more readily accept in relation to evidence. There is a different tradition in management, which is less prescriptive about the method employed and begins to highlight a potential reason why there is a perceived gap between managers and doctors in change programmes.

Secondly is ‘measurements and data’, which was mentioned by all six interviewees and was the most frequently mentioned theme from the questionnaires. The doctors’ views of measurement and data were notably deductive, seeing ‘before’ and ‘after’ measures when constructing a concrete answer about a specific change. However, in lean thinking, the measurement of the whole system impact is more longer term, therefore the simplistic question of “has it worked?” when analysing the specific initiative before and after implementation may not be wholly suitable when assessing longerterm lean-style quality or efficiency improvements’ success. The doctors’ view may therefore not be naturally compatible with lean-style change programmes, which the Royal Surrey County Hospital is looking to implement – the changes here are system wide, with reviews of interactions between departments. It may not therefore be appropriate to measure these types of improvements in the same way as doctors might do in Randomised Controlled Trials.

During the process, there was a slight contradiction found with regards to measurement and data: whilst all expressed a desire for this type of evidence, another element that encouraged engagement is for the respondents to see the change for themselves through ‘best practice’ visits. A comment was that this could be ‘enlightenment’ for people who have been working in the same

PROCESS FO C U S

environment for many years. On the other hand, a clear barrier in terms of type of evidence is the use of solely anecdotal stories to try and influence doctors to get involved – this is likely to come up against resistance as it is unsubstantiated.

The third topic worthy of note is being able to show that the change is going to benefit the patients. The

With the current economic climate, many of the changes that take place appear to be motivated by cost-cutting.

As such, it is perhaps no wonder that doctors are sceptical and wary about engaging with changes that they cannot directly see as benefiting the patients

doctors interviewed and surveyed were consistently interested in making sure that any improvements actually benefited the patients and were often wary of the motives behind changes instigated in the hospital. With the current economic climate, many of the changes that take place appear to be motivated by cost-cutting. As such, it is perhaps no wonder that doctors are sceptical and wary about engaging with changes that they cannot directly see as benefiting the patients – even if these changes will enable the long-term sustainability of the services for patients.

The final interesting conclusion from this research is not directly related to evidence as such, but is an element that appears to be a mediator in the role evidence plays in engaging doctors in change programmes. It is that of early involvement of doctors and it appears to be important in shaping how the doctors respond to the evidence that is presented to them. For instance, even if strong evidence is presented after the decision has already been made to go ahead with a certain approach, it may be seen as being presented merely to persuade (or manipulate?) them, which appears to instantly lead to resistance.

The findings from this investigation have begun to explore how evidence can be used by doctors in their decision-making, not only for clinical decisions, but also when deciding whether to get involved and support a service improvement activity. This was a small study and further work needs to be done to expand on these findings and develop our understanding, to help ensure doctors are involved in all kinds of change programmes. An important point to end with is a message that came out clearly in the findings: all of the doctors were definite in their desire to make improvements that would benefit both patients and the hospital.

All wanted to see their service improve and develop. It would appear managers need to harness this attitude earlier in the process of change to secure the involvement of doctors, equipping hospitals with the engagement they need to deal with the challenges the next few years will bring.

Further Reading 1. Gollop, R. and Ketley, D. 2006. Shades of resistance: understanding and addressing scepticism. In: Buchanan, D. A, Fitzgerald. L. and Ketley, D. eds. The Sustainability and Spread of Organizational Change: Modernizing Healthcare. USA: Routledge 2. Parand, A., Burnett, S., Benn, J., Iskander, S., Pinto, A. and Vincent, C. 2010. Medical engagement in organisationwide safety and qualityimprovement programmes: experience in the UK Safer Patients Initiative. Quality and Safety in Health Care 19, pp. 1-5.

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S P E C I A L f E A T U R E A P E X S U P P LY C H A I N T E C H N o L o G I E S

A new asset to get a leaner supply chain Thousands of lean and six sigma companies have implemented Apex Supply Chain Technologies solutions in the US – with the firm opening its European headquarters and demo centre in Worcester, these products are expected to sell big in the Old Continent too.

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ending machines are popping up in manufacturing and distribution facilities all over North America. What’s unusual about that? They’re not vending soft drinks, or sweets, or salty snacks.

They are lean, green, point-of-work tool stores – industrial vending machines that are saving companies tens of thousands of pounds annually while allowing them to increase production.

Every month, hundreds of companies install their first vending machines, and the companies that already have them install many more at their manufacturing and distribution sites as their savings continue to add up, day after day.

These solutions are the focus of process improvement not only in companies that utilise lean

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and six sigma principles, but in all companies that see the benefits of easy to use, easy to implement, and easy to afford solutions. Apex solutions quickly, easily and substantially reduce or eliminate companies’ waste in production, inventory, over-processing, transportation, waiting, and motion.

Apex arrives in Europe The supply chain automation solutions that have taken North America by storm – already utilised by over 160 European-based companies – are now available in Europe. The global specialist in pointof-work automation technology, Apex Supply Chain Technologies Ltd., recently opened its European headquarters and demo centre in Worcester, UK. In just a few years, thousands of Apex industrial vending solutions have been installed in sites throughout the U.S., Canada, and Mexico – by 162 Fortune 1000 companies and 125 Forbes Global 1000 companies – and from the largest manufacturing and distribution plants to small job shops to schools, offices, and medical facilities.

These companies have discovered the benefits of automating the distribution of MRO supplies, PPE, medical and health care, and both high-use and mission-critical tools and supplies. Firms using this technology include Associated British Foods, BAE Systems, Astra Zeneca, Weir, Procter & Gamble, GE, and PepsiCo. Apex develops and supplies simple, easy-to-use realtime enterprise software, industrial vending machines, RFID cabinets, and other sensor-driven solutions to help manufacturing, industrial, healthcare, and government and institutional users reduce costs, streamline and automate processes, and become more productive.

SPECIAL fEATURE

“Adding control and automation to the distribution of MRO materials typically drives cost savings of 20 to 30 percent of the cost of tools, supplies, and critical materials,” says Apex CEO Kent Savage. “Now, this technology is easily affordable for all businesses.

Many suppliers of industrial products now offer Apex solutions as part of their supply agreements.”

Apex solutions are also being utilised to dispense medical, hospital, and laboratory supplies and equipment, office supplies and assets, school supplies, fleet maintenance supplies, and computer and diagnostic equipment.

Apex’s Connect n’ Go™ technology provides easyto-use industrial vending systems at the point-ofwork in manufacturing and distribution facilities.

There is no software to purchase or to install: users just plug into an electrical outlet and connect to the Internet. The systems provide 24/7/365 dispensing, decreasing downtime while end-users control each employee’s access to each item while monitoring inventory, and saving on usage.

The vending solution is seen as a durable, reliable, proven system for dispensing supplies, replacing standing and handing at tool stores or traveling to a central distribution site while providing automatic inventory usage tracking reports and re-ordering.

Apex provides a variety of bespoke cost-saving solutions for many industries and products.

For example, its Tool Ninja series of vending machines for the metal-cutting industry safely dispenses indexable inserts, packages of inserts, and round tools.

Megastore will soon be unveiled, a sensor-driven point-of-work vending system that can combine cabinets, shelves, and drawers to accommodate individual application requirements. Megastore can change in case more drawer space or extra storage for larger items is needed, for example. It will be able to detect even the lightest items, even screws and small fuses, being taken and then put back into place. MegaStore will allow a wide range of items to be dispensed in a very compact way, making restocking fast and efficient and delivering greater value than ever before.

The evolution of Apex’s lean revolution Historically, materials, tools, parts, components, kits, and other critical assets have been retrieved by the workers who use them from stores and warehouses. Workers leave their workplace, travel to the location where the needed items are stored,

and then request an item at a counter or window.

The requested item is retrieved and the transaction is recorded.

The result is a costly, inefficient process that is the antithesis of lean workflow. Data collected in these counter-type transactions is often incomplete and/ or inaccurate. When storemen are not available, creative “workarounds” frequently emerge.

These may include open access to storerooms for off-shifts, weekends, and bank holidays, supervisor management of storeroom keys and accompaniment of personnel retrieving tools by plant security services. These “workarounds” provide a way for workers to get needed materials, tools and the like, but they result in unrecorded and inaccurately recorded transactions which, in turn, lead to higher costs in the form of out-of-stock situations, emergency and expedited orders, and production delays.

Some industrial sites have developed alternatives to the traditional tool store model.

Among these are: Unattended, uncontrolled storerooms These open storerooms provide easy access to inventoried materials and assets. The cost of attendant labor is eliminated, but the uncontrolled

www.leanmj.com | January/february 2012

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S P E C I A L f E A T U R E A P E X S U P P LY C H A I N T E C H N o L o G I E S

consumption typically results in increased usage levels of 15-30%. Restocking becomes problematic as recordkeeping for stock removals and replenishment is inconsistent at best. Unreliable inventory information leads to excess inventory (safety stocks), out-of stock conditions and frequent emergency or expedited orders.

Free-issue at the point-of-work For many commonly-used items, free-issue bins or cabinets are placed at or near the point-of-work.

Workers can take items as needed from the freeissue point. Although this approach may provide convenient access for workers, it creates other problems such as: Consumption increases; High cost to monitor and replenish ; Increase in inventory levels; Vulnerability to out of stock situations.

Items commonly provided as free-issue may include: Gloves and safety supplies Medical and health care supplies Tools Electrical components and parts Welding Supplies Fasteners Fittings Shop supplies

No record of inventory levels or transactions is maintained at these free-issue drop points, so inventory management and reordering are fraught with challenges and burdened by wasteful and unnecessary costs. To compensate for lack of reliable inventory and demand data, buffer inventories or safety stock frequently builds up both at the point-of-work and at various midpoints in the supply chain.

In these cases, users gain the benefits of controlling and automating transactions and inventory management at the point-of-work. Additional operating benefits also include: 1 Elimination of waste and inefficient manual processes; 2 Collection of process data for six sigma and lean initiatives; 3 Automated replenishment processes; 4 Support for integrated supply programmes.

The elevated control and demand visibility provided by automated point-of-work technology produces direct cost savings such as reduced consumption; reduced reordering costs; reduced inventory levels; reduced material/part/tool retrieval time and cost; and elimination of out of stock situations, downtime, and delays.

Users also receive many indirect benefits including: automated collection of accurate, actionable data for process improvements; improved compliance with procurement, process, quality and safety standards; and increased inventory turnover rates.

Direct labour In most historical models, production time is lost when workers travel to and from the tool store or storeroom to retrieve the materials, supplies, and tools they need to do their jobs. This process is also disruptive. In some cases, a “lead person” or supervisor retrieves materials on a “batch” basis for his entire team.

This leads to uncontrolled, excessive use, localised stockpiles or hoards, and a second handling of materials as they are redistributed to workers who actually use them. The control and automated replenishment provided by point-of-work technology eliminates out of stock situations and improves worker confidence that tools and supplies they need will be available when they are needed. The improved confidence levels result in a reduction of the hoarding of supplies. This, in turn, has a positive impact on waste, spoilage, and obsolescence.

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SPECIAL fEATURE

In most cases, hundreds of hours of direct labour can be reclaimed for production each year. To calculate the potential amount of direct labour subject to reclamation, the following factors should be considered: Travel time for tool and supply retrieval; Distraction, socialisation, and disruption occurring during tool and supply retrieval; Waiting time; Put-away, picking, transaction processing, and data processing.

Indirect labour Workflow processes for reordering replenishment stock will be digitised, automated, and streamlined.

This will result in greater accuracy; elimination of out of stock situations; and improved efficiency.

Management will be relieved of redundant paperwork and manual approval processes.

Areas where improvements are typically realised include: Reduction in number of requisitions; Reduction in number of purchase orders; Streamlined reconciliation and payment processes; Eliminate need for management involvement in routine processes, expediting, and tool and supply searches.

Reduced material costs due to decreased consumption The use of industrial vending systems to manage point-of-work tools and supplies has historically produced a sustained reduction in material cost of between 10% and 30%.

This is driven by greater accountability for material used and control over access and quantities issued. Workers are given the materials required for their particular jobs in the quantities specified. Benefits of the increase accountability and control include: Waste reduced; Shrinkage reduced; Maverick and non-compliant consumption monitored and controlled.

As workers become aware that their individual usage can be tracked and monitored, abuse and waste is reduced. Usage levels tend to go down. Limits can be set for both access rights (authorisation for particular workers to access particular items) and quantity levels (set quantity limits for the number of particular items workers can access over time - hour, shift, per day, etc).

Improved visibility to usage patterns helps management to quickly identify abuse, waste and other opportunities for improvement. Because granular information is readily available across the supply chain, management can implement corrective actions quickly and effectively.

Finally, the ability to control access to particular items and to link those items to particular jobs or processes (machines, cells, jobs, etc.) dramatically reduces noncomplaint or “maverick” usage. Materials, tools, parts and the like are used for the intended purpose in the specified quantities.

Inventory reduction By introducing accountability, tightly controlling inventory usage, and automating replenishment, inventory levels can typically be reduced to less than one month on hand, thus “virtualising” the inventory.

This will result in a one-time savings as the excess inventory is burned off. The amount of the burn-off savings can be calculated by comparing the currentand future-state inventory levels. Additional benefits of reduced inventory levels include: Lower inventory carrying costs; Reduced storage space (valuable space can be reclaimed for production); Reduced damage; Reduced obsolescence.

For more information, go to Apex’s dynamic website – www.apexsupplychain.com – which includes case studies, white papers, a benefits calculator, demonstration videos and podcasts, and success models, or call 01905 388 194.

Saving ranges are typically 10 to 50 percent. Each item or category should be considered individually.

Items with unique utility within the plant typically yield reductions towards the lower end of the range while items of high value and ubiquitous utility outside the plant (leather gloves, batteries, hand tools) can yield savings at the higher end of the range.

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We want to hear from you!

As the Lean Management Journal progresses on its own continuous improvement journey, we understand how important it is for us to listen to the voice of our readers.

So we have set up our own suggestions box and would like you to tell us what topics we should cover in the journal and at our events this year. What are the questions you want answered? What are the issues you are facing that you would like to read about? We will always welcome your suggestions and feedback, and we will try our best to address every request by providing helpful, thoughtprovoking case studies, interviews and features.

Don’t forget that our Letters and comment section is open to anybody in the lean community who wants to share an opinion or an experience with their peers.

Your feedback is important to us as we strive to improve our publication, services, and overall reader experience.

If you have any suggestions for topics you would like the LMJ to feature in 2012, please send an email to the commissioning editor, Roberto Priolo, who can be reached at r.priolo@sayonemedia.com or +44 (0)20 7401 6033.

IT’S A LEAN woRLD

IN PA R T N E R S H I P WITH

Made in lean Italy Arnaldo Camuffo, professor of management at Milan’s Bocconi University and scientific director of the Lean Enterprise Center of Italy, CUoA foundation, introduces this country special talking about the status of lean in Italy.

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he principles of lean thinking aren’t new to Italian firms.

Companies like Snia Viscosa experimented with quality circles in the mid-1970s, and Fiat started implementing its own version of the Toyota Production System in the early 1990s.

That was the first “lean wave” in Italy, which mostly involved larger groups or the Italian subsidiaries of multinational corporations (like Electrolux-Zanussi, Pirelli, SKF, Alenia and others). Its effects were sizable, especially for the diffusion of lean practices among suppliers, but did not really permeate the structure of the Italian industrial sector, which is dominated by small and micro firms often embedded in local clusters.

In the second half of the last decade, however, the Italian lean movement has regained strength, focusing on SMEs and services. The competitive pressure caused by globalisation and the changes in the structure of mature industrial sectors (such as textiles, apparel and furniture) brought Italian SMEs to understand the need to change their operations and management systems. The adoption of lean has become a powerful competitive weapon that has driven dramatic changes in the way these firms are managed. This is the second wave of the lean movement and it promises to be more structural and longer lasting than the first one.

Last year, we conducted an extensive research, Made in leanitaly: how Italian firms are undertaking lean transformations to survive and thrive, to assess the status of lean in Italy.

We observed that large Italian groups, as well as the Italian subsidiaries of multinationals in Italy, have revamped their lean efforts. Moreover,

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I T ’ S A L E A N w o R L D M A D E I N L E A N I T A LY

Italian medium sized enterprises, the most solid component of the Italian industrial sector, have taken lean seriously, promoting change and achieving significant results in their industries and market niches. Furthermore, a selected number of small firms, led by visionary entrepreneurs and solidly converted to the lean gospel, have also become benchmarks in their local business communities.

The research shows a lively lean movement, with many initiatives in place (including conferences and training centres), numerous experimentations going on, but few serious, committed and sustained efforts towards lean transformations.

Apart from the lack of knowledge and culture (no Toyota plant in Italy) and the scars left by some wrong lean applications in the past, the major factors hindering further positive developments are: a) the small size of firms, which often makes investment in lean prohibitive; b) the role of the unions, which often impede lean experimentations; c) the industrial clusters in which Italian firms are embedded, which require, in order to get sustainable improvements, the involvement of several companies across supply chains thus making lean transformations more complex.

Within this scenario, the emergence of Lean Clubs, local groups of firms engaged in collaborative learning about lean practices, is probably the most innovative and interesting phenomenon.

The future challenge for the Italian lean movement is to keep the experimentations going, to help firms interested in lean transformations to find the financial support needed to embrace or continue their efforts, to promote lean education and to start implementing lean systematically in services and, more urgently, in healthcare and the public sector.

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what the dottore prescribes

Maria Teresa Mechi is a senior executive in the health department of Tuscany’s regional government. Here she explains the lean journey florence’s local health trust is taking, and the plan the region has to promote the expansion of this model.

I

n 2007, we set off on our lean journey at the ASL (Azienda Sanitaria Locale, a local health trust) in Florence, starting by reviewing our processes. In 2010, the regional government saw the results we achieved in Florence and asked me to join the board to try to apply to other local health trusts those same principles.

In Florence, with the help of the Lean Enterprise Academy, we undertook a six-month educational programme. In 2011 we were ready to expand and involved three more ASLs (in Prato, Lucca and Pisa), all under the same project, Net-VisualDEA. The aim was to remove obstacles to flow and ensure alignment in all processes, from radiology to transportation within the end-to-end cycle of the patient.

The difficulty to access funding in Italy convinced us of the necessity to save by reducing waste rather than simply asking for more money: we are at a very early stage, but we have already started managing replenishment using kanbans and reorganising nurse stations using 5S. We are supported by a very engaged regional councillor, Daniela Scaramuccia.

The regional government has now launched a Tuscany-wide programme to optimise patients flow in hospitals by adopting lean thinking. It will award incentives to trusts that decide to embrace Net-VisualDEA, and it will support them as they take their first steps in training their medical directors and operations professionals.

In Florence, we have concentrated on redesigning processes, identifying the value stream in both emergency and elective surgeries. We have achieved a 20% increase in capacity keeping in mind the different types of operations. By analysing the work of nurses and identifying waste we halved the length of transfers, doubling the time in which a patient receives direct care.

To improve the flow of patients from the ER to the wards, we looked at the schedules of both and noticed that most discharges took place between 2 and 4pm, just because this was the most convenient time for people in the wards. We realised, however, that this created huge bottlenecks in the ER. After intercepting the issues, we applied PDCA to free up beds. We tried to plan our work rather than acting on a day-by-day approach. By looking at what we plan and what we actually achieve we can correct the gap. We have seen a 10 to 20% reduction in the percentage of patients waiting in the ER. Of course you need to have strong support from government. With roles coming and going, the risk is to have new councillors who are not as engaged. These projects require long-term support. The staff are also definitely on board. After overcoming some initial resistance, we have seen everybody very appreciative of the value of this new way of managing work. Doctors are usually more difficult to convince than nurses, but we eventually have buy-in from them as well, when they realise that, if anything, this is a way to solve problems that are vecchi come il tempo (as old as time).

IT’S A LEAN woRLD

The fiat way

P

erhaps the most iconic of Italian companies, Turin-based car manufacturer Fiat has operations in 61 countries and 223,000 employees. It owns brands like Alfa Romeo, Lancia and Maserati, and a 90% stake in supercar powerhouse Ferrari.

Under the leadership of Sergio Marchionne, the company has pursued new markets, become majority shareholder of Chrysler and dramatically changed its structure and culture, which is leading to growing profits.

fiat and its subsidiary brands, including Alfa Romeo, have certainly not enjoyed the strongest reputation in the European car market. Some perceive the company as a dinosaur of a car maker that is no longer competitive.

But fiat’s profits and global presence are growing, and lean is playing a role in its renaissance, says LMJ’s editor Roberto Priolo.

Marchionne is often viewed as an “Americanised” boss that doesn’t care much about the group’s Italian operations.

His promise to invest in the Pomigliano plant in exchange for worse working conditions like longer hours and shorter breaks was commonly regarded as blackmail. In December 2011, a new contract with the unions (except Fiom-CGIL, Italy’s largest) extended the “Pomigliano model” to all Fiat sites in the country (86,000 employees in total): it changes work structure, allowing for more overtime, shorter breaks and a different rhythm on the production lines, but also prevents unions that haven’t signed the contract from being represented in the company. The decision to close the Termini Imerese plant, which made over 1,000 people redundant, didn’t help Marchionne’s image either. Although in a recent face-saving development at the site, Fiat has agreed to sell the plant to fellow auto manufacturer, Dr Motor, who will invest €110m and employ 1,312 staff, many of whom will be former Fiat workers.

Despite the conflicting relationship with the unions and several difficult decisions, Fiat is doing well, thanks to its acquisition of Chrysler, its agriculture and construction equipment unit Case New Holland, truck manufacturer Iveco and Fiat Powertrain Technologies – the 2011 Engine of the Year was awarded to Fiat for the 875cc Fiat TwinAir powertrain.

And these successes have been supported by the company’s continuous improvement programme.

Launched two years ago in three plants (Melfi, in Italy; Tychy, in Poland; and Bursa, in Turkey), the Fiat Advanced Production System is based on Total Industrial Engineering, Total Quality Control, Total Productive Maintenance and Just in Time, and it’s already reporting progress according to World Class Manufacturing criteria.

Like Toyota, Fiat employees are trained to do several jobs rather than sticking to one task. All aspects of work are measured through cost deployment, in order to identify root causes, tackle inefficiencies and reduce waste.

Chrysler has adopted the system as well, which is further proof of the consistency with which Fiat implements its CI programme. In 2010, a year after the introduction of the FAPS, Chrysler recorded a 10% increase in productivity, an 8% reduction in costs and a 30% reduction in injuries.

www.leanmj.com | January/february 2012

37

I T ’ S A L E A N w o R L D M A D E I N L E A N I T A LY

This is how it’s done

k

imberly-Clark is a primary health and hygiene company that has a long history in people care. The consumer division manufactures and sells well-known branded products amongst which Kleenex, Andrex and Huggies.

The North-Atlantic organisation, which Europe belongs to, decided to perform a lean transformation four years ago with the aim to improve the way we do business. I started my lean journey in early 2008, when I was manager of the Alanno plant, in Italy. The facility was selected as one of five North-Atlantic pilot plants.

The journey started with an executive training of the senior managers involved with the first wave of lean: four one-week sessions with the right balance of classroom and on-the-floor activities. The implementation in the plant started immediately after using the same approach. Since the beginning people in each department and function were involved, including unions’ representatives.

Giacomo Pica, lean manufacturing director for kimberly-Clark’s family Care operations in Europe, talks about the transformation at the Alanno plant, which is now a model for the company’s other sites. Passion, a focus on the reasons behind the need for change and discipline are a recipe for success, he says.

The first outcome was the identification of a True North for the plant and four A3’s aimed to improve asset efficiency, energy cost, lead time and people engagement. This last item was the enabler of the other improvements, in our intentions.

The lean journey had a successful start-up, but after a few months the progress slowed down, especially with regards to people engagement. We decided to run a problem solving initiative to address the issue. The root cause was determined: lack of confidence, skills and mind-set of the leadership team to engage people on the floor. The countermeasure we adopted was a very rigid development plan for all leaders. First of all, I personally assessed their capability. I later set a minimum capability level objective for each of them. Then I included a weekly 1:1 development meeting for all leaders in my own standard work.

These meetings were mandatory.

I used a simple notebook to track progress and record agreed next steps. Every month I did a capability assessment of each leader by means of a simple spread-sheet that was posted in the office hall, so it was a public document. This approach worked very well: leaders quickly improved their capability and, more importantly, changed their approach to problems. They abandoned the mindset of a super-expert that knows the solution to embrace the concept that a good leader is first of all a good teacher. As leaders started to ask proper questions to the floor people, these started to feel valued and become key contributors to the plant’s success.

They now come to work not only with their mind, but also with their heart.

If you come and visit Alanno these days you will find a different mill compared to 2008. Production flow is smooth, assets are like brand new, all materials are managed with kanban system, inventories are low, lead-time is shorter. Alanno is now a lean model within Kimberly-Clark. We achieved important financial results, but these are the consequences of how our people are engaged. Our leaders are better people, and this is what I am more proud of.

38

IT’S A LEAN woRLD

In the mood for solutions

I

n 2008, lean entered the agenda of Modulblok’s operations management, and it soon became part of our every day vocabulary. We didn’t start because we had to, but because we realised the status quo wasn’t acceptable anymore. We questioned our structure and identified opportunities we hadn’t seen before. Three years down the line, we are already reaping benefits.

CoMMENT

Modulblok is a logistics specialist based near Udine, in Northeast Italy. It provides solutions, like the magazzini automatici (automated warehouses), to companies ranging from shoe manufacturer and retailer Geox to refrigerator maker Incold Italy. Here operating director of logistics fulvio fregonese and plant manager Mario di Nucci share an intimate portrait of the company’s lean journey.

We immediately realised that anything can be questioned in the name of change, but too often personal views prevailed over holistic ones. Communicating to our workforce the importance of acting with improvement in our minds is something that sits at the core of our mission as an enterprise. The main difficulty we have is creating a selfsupporting business where everybody at every level understands that their actions must be part of a system where improvement is the norm, where data becomes information and where there is nothing more than what is needed.

Lean has helped Modulblok accelerate and simplify the movement of goods and documents, but also to define what the next steps should be.

On our journey, we have been supported by a consultancy: on the first year, we worked with TPM, SMED and 5S. In the second year, we concentrated on flow and activities integrating lean with ergonomics.

Finally, in 2011, we concentrated on order management.

We haven’t taught our men many Japanese words, but we have encouraged them to use words in their own language with courage, trying to promote concepts like “We can do this” and “I’m on it”. It hasn’t been easy and took a lot of time and effort. We have tried to be hard on issues and soft on employees and as a result have instilled a great deal of trust in our staff which has resulted in a marked increase in employee engagement and loyalty.

We haven’t brought a Japanese revolution within Modulblok, but instead we have focussed first on the team and secondly on the techniques.

PRofESSoR DANIEL JoNES of THE LEAN ENTERPRISE ACADEMY CoMMENTS oN THIS SPECIAL oN LEAN IN ITALY It is 25 years since we presented the first lean benchmarking results to the board of Fiat Auto. They and other large Italian companies have had many different lean programmes since then as the competitive challenges got harder. The spread of lean in Italy has been region by region as pioneering organisations have embraced this methodology as a survival strategy and shared their learning with neighbouring organisations.

The lean hospitals cluster that began with the oldest hospital in Europe, in Florence, is a remarkable but typical

example. This was triggered by Luigi Marroni, a former Fiat executive who became the hospital CEO. He was determined to use lean to significantly improve the performance of the hospitals while renovating their ancient buildings into an ultra-modern hospital. Maria Teresa Mechi has gone on to spread lean to other hospitals in Tuscany.

This regional focus is not a surprise to anyone who knows the importance of regional and extended family networks in Italy. Rebuilding new lean organisations out of old family-owned small and medium sized businesses is the next challenge as so called “low cost” sourcing come back from China to Europe. As always the spread of lean depends on both having the vision of what is possible and the courage to do it in practice.

www.leanmj.com | January/february 2012

39

written by John Bicheno

The fifth Column This is the first of a series written by John Bicheno that will appear in every issue. The aim is to foster discussion on lean-related topics where, it is felt, reexamination is called for. why so? Because, although lean and its predecessors have been around for over 100 years, many uncertainties with regard to implementation remain.

Also, the scope of lean is widening horizontally into (for example) health care, public service, ‘green’ and sustainability, customer service, construction, and less repetitive operations, and vertically into accounting, design, HR, and IT. In these areas, conventional TPStype lean may need adaptation. And, of course, the world moves on and new insights develop. future topics include standardised work, variation, six sigma, value, capacity, kaizen events, pull and push, PDSA, oEE, lean audits, strategy deployment, rewards, systems thinking and measures.

Readers are encouraged to submit their comments in advance on these topics, but also on any other topic considered relevant. General acknowledgement will be given in the form of “contributions have been received from”. The ‘Letters and comment’ section can be used for comments in arrears.

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This issue contains a superb article that relates to the assumed benefits of a 5S-type housekeeping exercise. It should give pause for consideration.

5S has become a widely accepted foundation for lean implementation. It appears at the base in many ‘House of Lean’ illustrations.

But, like ‘obvious’ things to do there should be caution. Consider: The much publicised 5S implementation at HMRC. ‘The £7m tidy desk’ said The Times.

‘Ah, yes’, said an employee, ‘Lean is about not allowing a banana on your desk.’

How many times have you done 5S? Quite a few? You are not alone!

Is 5S 5S or is it 2S?

THE fIfTH CoLUMN

The experience of one company where, after much effort had gone into launching 5S, a cell layout exercise took place negating much of the earlier work, and drawing workforce criticism of the consultants who were paid ‘for nothing’.

One company that continues to make good profits, even exporting to China, but where there is no 5S programme.

The parent company in Switzerland has hospital-like appearance, but makes a loss.

Several well known companies have ‘tidy desk’ policies. But take a look in drawers and cupboards, and at computer file organisation…..

The story of Sir Alexander Fleming, whose notoriously untidy lab led to a petri dish with fungus. Penicillin resulted from Sir Alexander’s questioning culture (literally!). By contrast, Don Dennis’ fanatical attention to cleanliness and detail certainly has been instrumental in McLaren’s F1 success.

5S Corporate Japan style: Daily at 5 p.m. a bell rings and an announcement comes over the tannoy to remind office workers to leave their desk tidy. On Friday, at 4:30 a bell rings, and the tannoy announces the half hour for office clean up. There are no cleaners. Now that’s what I call sustainability! Or not.

So, SHoULD 5S AS A LEAN foUNDATIoN BE CHALLENGED? SoME THoUGHTS: 5S sustainability can be a problem when it is seen as just ‘housekeeping’.

Do the real benefits come in the earlier stages of Sort and Simplify or the later stages of Scan and Standardize?

Is 5S pushed or pulled? Pulling 5S means that a specific gap is recognised that 5S aims at closing. Perhaps the gap is high variation, or productivity, or safety.

What about multiple shift responsibilities for 5S? A big one for 5S is flow. Should 5S be delayed until flow is thought through (and then implemented simultaneously)? In other words, runner routes, cells, inventory presentation, kanban, tools and dies, are all part of 5S. Should 5S be part of Leader Standard Work?

Is 5S required in offices? Should you begin with tidying the desk or the computer files?

Conversely, pushing 5S means (typically) a big announcement because 5S is ‘obviously’ a good thing to do.

What about 5S with your suppliers?

Should they be sorted, simplified, scanned, standardised, and sustained?

Many 5S programmes are called 6S – adding on safety. Think about this one.

Should safety be the sixth S or should safety be integral to the other S’s?

You may have an audit process for 5S. If so, does it encourage ticking the boxes at the expense of continuous improvement? And, do you audit once per week, like a Queen’s visit?

And, putting yourself in the shoes of those that are audited, have you asked ‘What’s in it for me?’

If the place is a mess, should you begin with a ‘cleanup’ programme, not calling it 5S? In TWI Job Instruction (JI), workstation layout is integral to the JI process.

Thus, 5S becomes the natural way of working, and may not even be called 5S. So, what can be learned from the vast TWI experience? Should 5S be extended alongside JI?

So, the bottom line is, is the need clearly articulated and understood?

Please note: The Fifth Column does not advocate. It aims to provoke.

www.leanmj.com | January/february 2012

41

L E T T E R S

LMJ

& CoMMENT

The need for a global strategy on lean healthcare Jane Bishop, senior clinical lead with the Leading Edge Group, outlines the role that lean can make in a hospital Emergency Department and the urgent need to develop a national consensus amongst medical professionals, Government and academia.

E

mergency Department overcrowding is a global issue which has been linked to increased mortality and morbidity for patients. Attempts to solve the issue have focused on the streaming out of patients with minor injuries, and more recently, a hospital wide systems approach. With neither method having yet provided a sustainable solution to ED overcrowding, some institutions are utilising a new approach by adopting lessons from manufacturing. Lean processing as a continuous improvement methodology has been gaining support in healthcare in recent years, but globally still remains in its infancy.

Many congestion issues within the ED are not due to the volume of patients attending, or to inadequate staffing levels, but are in fact attributable to poorly designed processes for patient throughput.

This perpetuates a mismatch in capacity and demand. In real terms this means that no matter how hard the staff work, there will always be the potential for the ED to become overcrowded and for waiting times for patients to lengthen. Identifying

42

which processes are causing congestion and realigning available capacity within the ED can alleviate some of the congestion experienced on a daily basis and assist you in achieving your targets.

A report issued in February 2002 (Report of the Committee on Accident and Emergency Services) stated that the design of ED does not always maximise patient flow. Design limitations can prevent maximum utilisation of ED facilities, compromise patient safety and confidentiality and lead to inefficient staffing and work practices within the department.

The committee recommended that design and flow elements be considered when building new EDs in the future.

Increasing in-patient capacity and maximising the efficiency of diagnosis and discharge for in-patients are commonly cited as potential solutions to ED overcrowding. However ED could be made considerably more efficient and effective with the application of lean.

Some notable hospitals in the UK, USA and Australia have begun to explore how lessons from manufacturing can be applied to the ED in a bid to increase efficiency, while maintaining or improving quality of patient outcomes.

The application of lean and six sigma methodology from disparate industries to healthcare has been gaining increased momentum across the United States, and to a lesser degree in the UK and Australia.

New ways of thinking about how healthcare is designed are beginning to emerge, and some hospitals have begun to apply the principles of process design and lean thinking into their everyday operations.

While research has suggested a whole hospital approach is needed to solving the ED crisis, more recent studies are suggesting that looking only at efficiencies in the ED will also pay dividends.

The Institute of Healthcare Improvement suggests that all work is a process, and advises looking at processes internal to the ED to elicit inefficiencies that could be eliminated. The practical application of this principle is that complex systems such as ED work better when the processes that comprise them are designed with fewer steps and fewer people.

No clear national strategy exists that could incorporate lean into healthcare as a means to improve quality while driving down costs due to errors and rework.

While formal qualifications in lean can be attained, places on these courses to date have been dominated by engineers with a background in manufacturing or IT. In the past three years, however, healthcare students have started to study lean and are benefitting from exposure to practitioners in manufacturing and other industries who practice it on a daily basis in their workplace.

All hospitals need to improve the quality and safety of patient care they deliver, while reducing the cost of delivering that care. The taxpayers also need to be assured that the healthcare budget is being used as efficiently and effectively as possible. In the current political and economic environment, the importance of efficiency in the ED is not only about patient safety but also the need to improve quality of care despite diminishing resources.

Leadership is crucial. Driving the values of quality and efficiency strategically across all sectors of the healthcare system will require healthcare managers to engage in lean thinking and to visibly support programmes that attempt to improve quality and drive down costs. Frontline staff needs to be empowered to change and to champion quality initiatives.

It is in the country’s best interest to ensure that all healthcare workers are competent and efficient, and there is a need for general consensus between the medical profession, Government and academia to pursue this ideal. I contend that the application of a lean methodology will significantly contribute to a more efficient delivery of service.

LETTERS & CoMMENT

Start from the basis try to: provide a checklist to make sure all bases are covered when looking for opportunities to save and improve; make the point that transformational change starts with demand analysis and creation of flow, not waste reduction or improved procurement; and conceptualise a model which is based on sensing, responding to, and shaping customer demand.

For us, shaping and analysing demand and creating economies of flow are the most appropriate starting points.

Operational reviews might undertake basic analysis of value and failure demand, but not understand real customer needs, as their data is already corrupted by being forced into transactional categories. We seek to bridge the gap between ‘customer

Ben Taylor, of Red quadrant, a consultancy operating in the public sector, explains the company’s model to save and improve, which starts with demand analysis and the creation of flow.

o

ur clients are mostly public sector bodies, all facing reduced budgets and massive savings targets. Cuts, rebranded as savings, have more recently been rebranded as transformation, and the more thoughtful authorities understand that lean can offer a way to achieve savings while protecting (or improving) service quality.

However, the tendency is usually to have a quick look at the big book of lean,

1. All work is triggered by some external demand...

2. which hits a contact or touch point in our organisation...

Shape demand

Create economies of flow

chapter 1 (‘Create flow’), and skip forward until they find the familiar-looking chapter 2, ‘Reduce waste’.

“Aha! This is something we understand,” they think. “We’ve been making cuts for years.” Lean is pigeonholed as a process improvement approach, focused on finding and removing waste.

We’ve developed a model called ‘Seven ways to save and improve’, to

3. which triggers a process or project to deliver results.

Cut waste

4. These processes require the use of organisational assests...

5. Which have to be structured in our organisations...

6. ...and which have to be procured or sourced from somewhere.

Resource optimsation

Gain economies of scale

Better procurement

5 Organisational structures 2

3

Contact

Process/ Project

1 Demand

7

4 Source

6

Resources

Policy

7. And what is offered in response to demand is determined by policy.

RedQuadrant Savings Framework™ © RedQuadrant, 2010-2011

www.leanmj.com | January/february 2012

43

LETTERS

LMJ

Start from the basis CONTINUED

world’, ‘service world’ and ‘manager world’ with some simple analysis which looks not only at demand and failure, but also at restorative and innovation demand.

There are two useful principles concealed within these two points: 1. If you build a system responsive to demand, you had better be sure that you can respond when that demand changes. We’ve seen many ‘lean processes’ that operate brilliantly for a time, but, when demand changes, the capacity no longer matches and chaos ensues.

2. Customer demand in the public sector will come at you whether you like it or not, through the channels and in the ways and for the things that the public actually wants.

Once you are capable of understanding what demand is, you can ignore it (but know the consequences), shape it to better meet your needs or put the capacity to deal with it at the actual point of customer contact.

We then come to familiar territory – waste within the project or process, and optimisation of resources. These can be effectively addressed with a set of tools.

Most of this is to the good, especially if done well – do you really need levels of sign-off? Can a single hefty form adequately cater for all procurement, from the purchase of postage notes to a new IT suite?

Let’s look at resource optimisation: buildings, people, IT and ‘sweating’ organisational assets in general. In many ways, this is an even easier target, but

44

without prior demand analysis, work economies of flow, and reduction of process waste, resources are optimised to service systems full of waste. The effects are two-fold: first, they lock in the waste at the transformational levels above by building structures that are not fit for economies of flow. Second, they can generate additional cost by forcing optimisation at the cost of inefficiency elsewhere.

Nevertheless, because you are freeing up real concrete resources, if done right, this step generates significant cashable savings. For example, mobile and flexible working allows organisations to identify their staff’s working patterns and tailor provision around them, implementing desk-sharing and working from home to free up the need for leased buildings.

Next, we come to economies of scale, addressing the fact that unit costs reduce as the size of an organisation and the usage level of inputs increase. This is particularly useful to local authorities considering shared services such as HR or Revenues and Benefits as part of their savings strategy, but, as our model demonstrates, this stage should only come after the previous areas have been thoroughly developed, as economies of scale often run directly counter to economies of flow.

These savings and improvements should only be sought very cautiously.

Sixth on our model is the optimisation of procurement, which involves creative and flexible thinking. This can include any or all of the following: procure volume, shape the market, reduce or standardise specification, share services, outsource, use the third sector, or multiplying effects. The London Library Consortium, for example, provides a shared Library Management IT system for twelve boroughs, with customer benefits including online access and access to stock, and significant financial savings.

Last on our list is the changing of policy, which wraps around the previous six recommendations as an enabler to future improvements. The policy might change a system by stopping, rationing, reducing

eligibility, delaying, or charging for a service, all of which could deliver significant improvements to the organisation. The councils with whom we work are political organisations and may change policy to determine which demand they respond to, thus ensuring a streamlining of the service they offer.

So, approaches which start with economies of scale, resource optimisation or waste reduction (often process improvement) can be delivered through more ‘technical’ change and, while these approaches realise real savings, they risk building ‘waste’ demand and activity into the system. Our ‘Seven ways to save and improve’ model links these as secondary to the more emergent, transformational, and sustainable systems thinking approaches of demand shaping and economies of flow, to create a coherent yet pragmatic framework that focuses on delivering value to meet demand.

Transformational change starts with demand analysis and creation of flow, not waste reduction or improved procurement

LEAN D I A RY

Identifying your I II III IV V VI VII VIII IX X

commandments We left SCGM very enthusiastic and full of good ideas to implement.

What happened in the last few weeks? Are they progressing in the implementation of the improvement activities? Are they facing obstacles?

How are they dealing with the new working system, The SCGM Way? Director Sandra Cadjenovic gives us an update.

I

n September, the company launched a continuous improvement programme named The SCGM Way, tailored on its specific needs. As mentioned in the previous article, the project is divided into four phases.

As of today, we are in the second phase, the Pilot Phase. As a first “exercise�, designed to let people in the company understand the approach to lean activities, we applied 5S all over the business. After one month we have the second S in place, so in almost every area of the company we have scrapped unnecessary items and now have a clear organisation of space. Naturally, there are some areas in which the activity is more visible and others where there is still room for improvement. During the Pilot phase, we have selected the assembly area and molding machines area to start with our improvement exercise.

T he assembly area The starting situation is a really good example of what batch production means, with a clear idea of the waste that this kind of approach generates. For any kind of assembled product there is the habit of overproducing as much as possible in terms of subcomponents, with the aim to not let people be idle. However, this generates waste, in particular overstock, and not value-added activities, especially

www.leanmj.com | January/February 2012

45

LEAN DIARY IDENTIfYING YoUR 10 CoMMANDMENTS

SCGM way VALUE ADDED ACTIVITIES vs. NoN VALUE ADDED ACTIVITIES ANALYSIS

No

Activity name and description

1

Bringing boxes with parts Parts are brought in boxes and spilled on table in unspecified quantity. Motors are delivered in boxes on pallets of 18 pieces, and are also spilled on the table.

2

Shopfloor:

Molded plastic production

Product:

Purple black adapter with electromotor

Activity name:

Motor preparation

overall - Value Added Activities (VAA), s:

4s

overall - Semi Value Added Activities (SVAA), s:

0s

overall - Non Value Added Activities (NVAA), s:

17 s

overall calculated activity time per piece, s:

21 s

Production time per piece (C/T), s:

? (? pcs/h)

Photography

Type

VAA’s

SVAA’s

NVAA’s

Notice

0

0

2

During measurements, there were some extremes like a worker speaking on the phone or taking more time to deliver the boxes.

1

0

5

There were various ways in which workers were shortening wires, thus making the number of parts done sometimes hard to define.

1

0

2

Difficulties can occur during the process of joining two parts and worker can be injured. Inadequate hands protection is applied.

2

0

7

Difficulties can occur during the process of joining two parts and worker can be injured.

Inadequate hands protection is applied.

0

0

0.5

0

0

0.5

Transporting

Shortening of electromotor wires Worker is scissor shortening ends of the wires and is leaving them on a pile.

Cut the material

3

Joining the motor with its top Motor is manually joined with the top

NVA 81%

Fitting 4

Joining the motor with its mount Motor is manually joined with the mount Fitting

5

Box packaging Prepared motors are packaged into boxes Transferring

6

Taking the loaded boxes away Previously loaded box with prepared motors is taken away to the warehouse.

VA 19%

Transporting

transportation. Before considering any technical analysis, the most important point the company is focusing on is to ensure the assembly people understand the concepts of loss and waste. They simply do not see the waste around them. “We are working very hard, that we know,” is a common sentence on the factory floor.

During the first meeting of the assembly team, made of five workers and one supervisor, together with the production manager and a consultant, people were asked to reorganise the assembly of one product. This product was previously assembled in several batch stations with a lead time of two days. Today, it is assembled in a new way: one piece flow,

46

with lead time of one minute and 30 seconds. The results may be outstanding, but this is only one activity that now needs to be engineered for standard production, maintained and extended to all the other products in the assembly department. More importantly, we have to convince people that our achievements are not the result of a magic trick but of a short analysis and of the elimination of waste. The problem is that they don’t have the habit to see waste yet, so they are not ready to drive improvement as part of the targets of the whole project.

During the second meeting with the assembly group, a NVA (Not Value Added) analysis was performed, considering,

LEAN D I A RY

explaining, and measuring the Value Added, Not Value Added, and Semi Value Added activities. This analysis was studied in depth and then shared with the assembly workers, in order to better focus their effort on the elimination of the NVA activities at first, or on the improvement of SVA activities or VA activities. The results of this first analysis are showed in the chart opposite.

As a conclusion on the assembly area, the remarkable fact is that the biggest effort the company is performing today is changing the way people are looking at the activities they perform, and the way we have chosen to do this is by working with management, the owners and the operators all together on the shop floor.

T he m o lding machines area For this pilot area, the first activity we undertook was to set-up a data collection system focusing on OEE (Overall Equipment Effectiveness) and losses. The molding area consists of seven machines: three of them were chosen as model machines. The equipment has no automatic data collection, so operators were given a sheet on which they are collecting good parts produced, scrap and seven other types of losses. Even if the data collection process is still ongoing and operators are still making errors in collecting the information, the main loss highlighted in this first month is set-up.

We have to convince people that our achievements are not the result of a magic trick but of a short analysis and of the elimination of waste

Based on this analysis, a SMED activity was started and a first video analysis has been performed. The first impression is that, with the first small and low-cost changes, a 20% in average set-up time can be reduced in the first months of 2012. This is a target we have now set.

T he steering c o mmittee The very first issue that is emerging during steering committee meetings is the overall difficulty of getting people involved with the lean project, and giving them time to perform the tasks assigned, especially during a time in which the company is facing an increased turnover in manpower, the task of implementing an ERP system, new products development and new customers management. The main root cause that emerged during the meeting is that The SCGM Way is still considered, by some of the top managers, something more similar to an extra activity and a standard lean programme than to a core philosophy that has to grow within the company until it permeates its every part.

The roots are not strong enough yet. Based on this assumption, the team has worked on a brainstorming activity called the Ten commandments, through which the ten main precepts of SCGM were identified: each of them now has a person responsible for its development and circulation throughout the company by means of practical activities.

The main target of this activity is to start creating a common philosophy and culture on SCGM, which will later be infused in the activities and projects that are part of The SCGM Way.

www.leanmj.com | January/February 2012

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oPERATIoNAL EXCELLENCE SoCIETY LAUNCH EVENTS Warsaw and Munich; November 8 and 10

IN CoNfERENCE This section features reviews of the events LMJ attends. find out what goes on in the lean community by reading about some of the most interesting conferences and seminars.

It is very easy to like Joseph Paris, and not just because he is a great entertainer. As chairman of consultancy firm XONITEK, founded in 1985, Paris is constantly involved with operations management and his idea to create the Operational Excellence Society is one that deserves praise and recognition. The inaugural meetings of the group were an occasion for him to explain his proposal: the creation of chapters based in different cities and formed by business leaders, practitioners and consultants who gather once a month to discuss the issues they face in their businesses and industries with the aim to find solutions.

It is certainly a valuable and ambitious undertaking whose main difficulty is likely to be keeping people engaged (we all know a thing or two about this, don’t we?).

Enthusiastically addressing, and entertaining, a crowd on the top floor of a skyscraper in Warsaw’s business district, and two days later in a business club in Munich, Paris told attendees of the potential of the OpEx Society and shared stories on the importance of concentrating on improvement (he prefers to call it “deliberate” rather than “continuous”) as well as stories on bad management.

He said that years ago he spoke with a client who was complaining about his business. When Paris asked him what was keeping the business from growing, the man replied: “The reason is that I am surrounded by the lazy and the stupid.” Paris then asked him: “Is that your policy, to hire the lazy and the stupid?” The man said: “Of course not, we hire the best people from universities and we poach the best staff from our competitors.” Good point: it is all too common to point fingers and blame workers, when the reality is that many times businesses struggle because of narrow-minded, short-sighted or simply inexperienced leadership. And this is an area where the OpEx Society can help.

After the presentations, both rooms saw people from different industries (including lawyers, manufacturers, consultants, service providers, students, lean coaches) share their experiences in a successful networking event.

Paris’ idea proves that it doesn’t really matter what sector we operate in, the problems we face are likely to be the same. In Munich, as I took part in a vigorous discussion on whether to reward employees for their achievements within a lean programme together with Paris, two guys from a manufacturer operating in the food sector and a couple of consultants, the potential of OpEx Society became clearly apparent. The access to a veritable lean brains trust has a tremendous potential value, and it will be interesting to see how this project evolves in the future.

For more information search for the OpEx Society on Linkedin.

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LMJ IN CoNfERENCE

MAkING LIfE SIMPLER foR CUSToMERS SEMINAR Cambridge; November 24

When I first checked out the agenda for this seminar organised by consultancy oee, I thought: “They must have some pretty good speakers lined up if they can afford to put Dan Jones up first.” I was right, as the contributions brought on stage by each of the speakers made for an impressive learning experience that left me both fulfilled and eager to further explore the adoption of lean within banking and financial services.

There was a good reason to invite Jones to be the first speaker. His engaging presentation looked at the current status of lean based on a changed customer base, and set the scene for the rest of the seminar. Jones discussed Tesco’s lean strategy (and how it led the retail giant to reach the number one spot in the online shopping market in South Korea thanks to the deployment of visual stores set up in subway stations where people can shop using their smartphones to scan the barcodes of products) as well as the use of lean techniques in hospitals – see the Process Focus section for more information on lean in healthcare.

It then was the turn of oee’s managing consultant Chris Hallmark, who gave an insight into a very bad customer experience he had with a telecommunication firm while trying to get back online after his phone line had been disconnected (we all have one of those stories). His enlightening presentation helped the audience understand what companies shouldn’t do, and offered several tips as to how they can actually make life easier for customers.

After lunch (discussion at tables inevitably focused on the debt crisis in Europe - after all, it was a room full of bankers), Joseph DiVanna proved to be the perfect antidote to what is usually the sleepiest slot at conferences, the one right after eating.

DiVanna gave a very interesting and lively presentation on how banks around the world are changing. He has been working with banks for several years and has a very good idea of what they think of themselves, of what customers think of them and what the examples of best practice in the sector are. He showed pictures of so many examples of customerfocused banks that we were all left with our heads spinning: an interesting case is m pesa, in Kenya, which transformed the way payments are delivered by enabling people to pay for anything using their mobile phone (it now controls 65% of all the transactions taking place in the country).

Closing the one-day conference was Alan Mitchell, strategy director of Ctrl Shift, a firm that is developing a new way to offer value, by giving information (and therefore power) back to customers. Its approach is based on the fact that consumer power is on the rise, and empowering consumers is a fast-growing business opportunity. To achieve this Ctrl Shift helps organisations understand and track the many different manifestations of the control shift (definitions of value, uses of information, etc) and find new opportunities within these shifts.

LMJ LEAN DIRECToRS’ SEMINAR London; November 30 – December 1

Get a bunch of business leaders, a couple of consultants and an expert in visual management in one room, and you can expect some serious brainstorming. This LMJ seminar provided a great opportunity for attendees to learn from the experience of successful companies, to share best practice and answer questions.

Jon Alder of Rexam, for example, explained how the consumer packaging company produces 60 million beverage cans a year, throughout its 80 sites where it employs 19,000 people. The task sounds daunting to say the least: so many different cultures, so many processes, so many people to involve. Yet, thanks to the Lean Enterprise programme and a committed leadership, Rexam is enjoying almost zero errors in its operations. It has four plants (three in Brasil and one in Austria) running for the Shingo Prize, and is hoping to have all of them competing in the future.

Alder’s humble attitude really struck me: he stressed that Rexam is “not there yet” and more work is needed. “Do we have engagement at all levels? If we walked away today, would lean stick around?” he asked before concluding his presentation.

It was then the turn of Bo Steffensen from FLSmidth, a supplier of systems and services for the global cement and mineral sectors. The company’s lean journey started six years ago, when China entered its market (today it has a 32% share). FLSMidth saw in lean the only solution to differentiate from competitors and create more value for its customers: it is concentrating on lead times, with the target to dramatically reduce engineering time. Starting with the pyro department, Steffensen explained how it once took the company 13 weeks to start working on a contract after it was received: he’s now asking his employees for two weeks.

Other presentations included consultancy TBM discussing the importance of standard work (which is one of the two most important principles taught to Toyota employees) and an interesting case study on PattonAir, presented by business excellence manager Phil Brown. The business, which supplies components to companies in the aerospace sector including Rolls-Royce, touches and manages 35 million individual parts per year, and has managed to reach levels of less than 100 defective parts per million, after starting a lean programme focused on strong leadership, careful selection of customers and suppliers and the development of people at all levels.

Concluding the event was an information-rich presentation by visual management expert Gweldolyn Galsworth. She said that without visuality (which she sees as a language) no company can ever hope to achieve alignment, empowerment and, eventually, excellence: humans are visual beings, and what we see changes our feelings and attitude. The workplace should be like a road, which is full of dangers and therefore full of signs.

www.leanmj.com | January/february 2012

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An abundance of riches T

his article is a celebration of the diversity and natural creativity of people determined to improve the organisations in which they work. It is also a ‘call to arms’ for leaders of change to avoid the simplistic adoption of standard approaches to business improvement and to think and experiment their way to the creation of change and improvement strategies that work for them. But first, the celebration.

… but M r L enin , w hat type o f rev o luti o n d o y o u w ant ?

Kevin Eyre, of SA Partners, shares an interesting analysis and comparison of lean, appreciative inquiry and work-out and urges practitioners to explore the plethora of different methodologies available out there.

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Of the many approaches to organisational improvement available to us, I have selected a distinctive set of three - lean thinking, work-out and appreciative inquiry (AI). All are formally defined, have explicit methods, deploy particular tools and can testify to having realised significant organisational benefits.

Lean thinking has benefitted from growing interest and notoriety since it first came to prominence with the publication by Womack, Jones and Roos of The Machine that Changed the World in 1990, and of its sequel Lean Thinking in 1994. In and of itself, the term ‘lean’ is a Western construct. The methods codified as such are generally regarded as having had their origins in the Toyota Production System (TPS). The development, integration and application of lean ideas

across industries over the past twenty years has led it to be regarded as an approach to organisational improvement worthy of very serious consideration.

On the other hand, criticisms of lean focus on its ‘tool-head’ status.

Indeed, Dan Jones himself has recently commented, “Many of us in the lean community have focused our attention on improving core processes… by deploying brilliant tools when we should have been focused on improving the management process itself.”

But not all lean thinkers have been obsessed with ‘brilliant tools’. Taiichi Ohno in 1978 referred to the Toyota Production System as having been “built on the practice and evolution of the scientific approach”; Steven Spear and H. Kent Bowen in their 2006 HBR article Decoding the DNA of the Toyota Production System describe the effect that the combination of ‘brilliant tools’ and ‘problem solving capabilities’ has in creating “a disciplined yet flexible and creative community of scientists who continuously push Toyota closer to its zero-defects, just-in-time, no waste ideal” and Jeff Liker in his 2004 The Toyota Way has re-enforced the centrality of the scientific method.

More recently, Mike Rother, Toyota Kata, has confirmed the trend in understanding TPS as a move away from tools towards systems or routines, of thinking and behaviour.

SPECIAL fEATURE

Toyota’s influence is ubiquitous. Katsuaki Watanabi, in Lessons from Toyota’s Long Drive, describes it thus: “We’re doing the same thing we always did; we’re consistent. There’s no genius in our company. We just do whatever we believe is right, trying every day to improve every little bit and piece. But when 70 years of very small improvements accumulate they become a revolution”.

Appreciative inquiry couldn’t, on the face of it, be more different from lean.

Lean’s insistence on dominant, rational, scientific, process orientated approaches to organisational improvement leaves practitioners of AI cold. Appreciative inquiry is based on the premise that organisations change in the direction in which they inquire. So an organisation which inquires into problems will keep finding problems (and be paralysed by the burden of these) but an organisation which attempts to appreciate the essential nature of itself, at its best, will amplify its ‘positive core’.

Amongst its sources, AI is influenced from personal positive psychology and its origins are generally credited to David Cooperider, who contrasts the notion that ‘organising is a problem to be solved’, with the appreciative proposition that ‘organising is a miracle to be embraced’. A number of sources support the beneficial outcomes that AI might produce. These include Jane Elliot’s work in labelling theory, Open Space Technology and the theories of Social Constructivism. But this evident idealism is also supported by a clear and pragmatic method which is capable of engaging large numbers of people in an enthusiastic and focussed search for organisational improvement and real results.

Detractors of AI have a relatively easy time ‘cocking a snoop’ at it. They point to its heavy investment in activity, to the preference given to social engagement and to the apparent subjectivity of its method: story collecting and telling may well be culturally important and may well give meaning and encouragement to people, but does it really and sustainably make my organisation work any better?

AI’s retort, however, is simple – we’ve had

decades of ‘rational-scientific’ approaches to change and most of it hasn’t worked.

As Whitney and Trosten-Bloom point out in The Power of Appreciative Inquiry, AI works because it liberates power. It unleashes both individual and organisational power, and generates unprecedented cooperation and innovation. It is a positive revolution that can’t be stopped.

Work-out is ballsy and explicit. Unlike lean thinking, it focuses little on detailed and sophisticated diagnostics; unlike AI, it focuses less on ‘what I need to become’ and rather more on ‘what performance I need, now’. Work-out has its origins in the problem of ‘busting bureaucracy and engaging the front line’ in GE under Jack Welch. Its notoriety has been somewhat eclipsed in recent years by GE’s reputation for six sigma. But work-out is generally credited with bringing about much needed transformation towards speed, simplicity and self-confidence inside GE

All these approaches are formally defined, have explicit methods, deploy particular tools and can testify to having realised significant organisational benefits

during the earlier years of Jack Welch’s stewardship and, as an improvement method, beyond its Crotonville origins, is capable of citing many examples of performance and cultural benefits.

Where lean has a reputation for focussing on the process, and AI a reputation for engaging the community, work-out is concerned first and foremost with results and with achieving these in very short timescales. Its own critique of other change methods is that they are slow, unfocussed and activity-centred. Who cares how many people might have been trained in quality improvement methods, it argues, if there is no sensible return on investment?

When organisational leaders invest time in defining the challenging improvements required in their operations, it becomes possible to work backwards from desired results and to make accountable, most usually, front-line people in working out how such results can be realised. This focus on results is an enduring one, as is the need to deliver them speedily, in usually not more than ninety days. By working in this way and by requiring managers to make rapid on-the-spot decisions regarding the implementation plans of their people, managers are compelled to delegate appropriately and to trust their people to deliver. This serves to create a dynamic leadership capability and to eliminate, as was its original intention, slow, bureaucratic and analytical behaviour.

Critics of work-out point to its intensity, arguing that galvanising the necessary stakeholder energy is sustainable only over short periods. In this sense, they argue, work-out merely represents a ‘shot in the arm’.

But work-out, say its advocates, is about developing leaders who have new expectations about the pace at which things can be done – busting bureaucracy means ‘taking it on’, not ‘having tea and biscuits’ with it. Work-out’s revolutionary garb merely re-asserts the natural, prebureaucratic order of things, moving improvement behaviour from being, in Steve Kerr’s words, “an unnatural act in unnatural places to natural acts in natural places”.

www.leanmj.com | January/february 2012

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SPECIAL fEATURE AN ABUNDANCE of RICHES

CoMPARING THREE DISTINCTIVE APPRoACHES To oRGANISATIoNAL IMPRoVEMENT Lean thinking

Appreciative inquiry

work-out

Method

Stabilises processes to enable daily improvement at front line level and strategically aligns at all levels. Eliminates waste, over-burden and unevenness

Identifies through narrative examples of the organisation at its best and seeks to amplify this ‘positive core’. Avoids ‘deficit thinking’

Leaders set demanding goals in challenging timescales and support their teams to ‘find a way’ of meeting the challenge

Tools and techniques

Many and various. Most notably, PDCA, Kanban, Visual Management, ‘Go Look See’

The 4 D’s cycle – (Discovery, Dream, Design and Destiny); The 8 principles

Simple and few - The art of framing the challenge; brainstorming; pay-off matrices; project planning

Role of leaders

Leaders are coaches who remain close to the work

Define strategic themes. Unleashes the energy of ‘the positive core’

Challengers who delegate responsibility and accountability well

focus on learning

‘Learning by doing’ philosophy for individuals and teams. A dominant emphasis

Around affirmative topic choices linked to strategic themes

Individuals learn by taking calculated risks to achieve stretch goals for which they are accountable

Defining improvement

Thorough attention to root cause of issue often with use of well defined and approved tools

A set of ‘provocative propositions’

The leader selects area for improvement and frames the challenge for others

Making improvements

Implemented at pace following thorough PDCA cycle

Implemented with the ‘whole (social) system’ at the pace of the system

Implemented at pace – a sense of urgency

Emphasis towards people

Respectful. Disciplined, continuous and creative

Integral. Emotional connectedness to the organisation

Challenging. Encourage the thrill of success

Unconcerned

A helpful input

The failure of ‘deficit-thinking’ change methods

The need to bust bureaucracy

Deep and unrelenting Emphasis towards process The crucible

Beat Ford but not with Mass production

THE RICHNESS of ABUNDANCE So, what conclusions might we draw from having compared these three distinct approaches to organisational improvement?

Firstly, each approach arose from real and deep seated problems - for Toyota it was the desire to compete with Ford on a platform other than unaffordable mass production; for GE, it was the need to reduce the bureaucracy of organisational practices; for the AI movement it was the dissatisfaction felt at the poor success rate of deficit-based change. So, perhaps, for improvement methods to stick, their need must be viscerally relevant; their design must have integrity and be anchored in the needs and culture of the organisation.

Secondly, each approach required, a priori, that the natural capacity

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Perhaps, for improvement methods to stick, their need must be viscerally relevant; their design must have integrity and be anchored in the needs and culture of the organisation

of people to manage risk, solve problems and realise opportunities, be leveraged. For Toyota, finding ways to make good cars with, in comparison to Ford, only a tiny proportion of the necessary resources, required the ingenuity of all of its engineering talents; for hierarchical GE, creating a leadership system which would bring front-line ideas to fruition and ‘bust bureaucracy’ required the deep involvement of people at all levels; for the AI movement, the failure of conventional change with its narrowly applied expertise and focus on ‘what doesn’t work’ required the perspective of the wider organisational system (all of the people) in identifying and building from the positive core of practices. So, perhaps for improvement methods to stick, there must be a deep and necessary requirement that people’s ingenuity be marshalled.

Thirdly, and perhaps most significantly, leveraging this natural capacity was

PRoCESS foCUS

made possible by surfacing and then resolving the many issues that sit inside the original (deep seated) problem. For Toyota, this is done through the design of processes that make front-line problems visible in real time; for GE, it is through the framing of challenging opportunities by leaders for improvement by their people; for AI, it is through the definition of strategic themes around which communities of people build on ‘the positive core’.

Perhaps, without this disposition to make the issues explicit, to surface them, there will be little progress; resolving is a matter of technique; surfacing, by contrast, is a matter of personal psychology. Surfacing requires leaders (and their organisations) to want to find issues, to have a liking for so doing and to be able to cope with the uncertainty that such uncovering engenders. It requires a shift in the emphasis of leadership discourse and practice away from a focus on the persuasiveness of advocacy and the control of admonishment towards the illuminating effect of inquiry.

Without this, no amount of tools based improvement will ever sustain.

DIffERENT MEANS of SURfACING AND THEN RESoLVING IMPRoVEMENT ISSUES Lean thinking

Appreciative inquiry

work-out

Surface

Structures the workplace so that problems and risks are made visible.

Uses standard tools for this purpose.

Operational plans allow time for problems to be surfaced

From selected strategic themes which define what we need to be better at, enlists people in discovering good practices that need to be emulated.

We surface what we already ‘do well’

Leaders take and explore a performance gap and express the need to close this as a stretch goal within a short space of time.

Resolve

Through structured methods such as, PDCA; Poka Yoke; 5 Why; Root Cause problem solving

Through the 4D cycle

In rapid improvement cycles of not more than 90 days with frequent reviews

Additional insights and questions may be yielded by further understanding of and comparisons between other improvement methods (six sigma, positive deviants, systems thinking, kaizen events and so on). Comparative analysis (at a level deeper than this article has been able to go) has a solid reputation as a research method and for practitioners is a viable way of thinking differently and thinking again about what might really work inside their organisations.

And so, our ‘call to arms’ is this: explore the diversity of thinking and experience on organisational improvement that exists; consider combinations of approaches which meet the deep issues that you need to address and run experiments which help you to understand what may or may not work. By all means, embrace the transformational potential of lean but challenge narrow and repetitive codification. Lean didn’t start as a package; why should it become one?

CoMMENT JoHN BICHENo CoMMENTS Kevin presents three approaches to improvement, claiming they are distinctive. No doubt, two of them (lean and AI) are widely known and practiced, with large numbers of references, but the third (work out) is much less known, with only one specific 2002 book listed on Amazon.

But why should lean and AI be distinctive? Certainly they have tended to be used in different fields – lean starting out in manufacturing and growing into service, with AI more or less the other way around, starting particularly with service.

AI now seems to be merging with lean. AI is strongly associated with organisation development, which certainly has a role in every lean transformation.

Both lean and appreciative inquiry share at least two characteristics – systems thinking, and management by asking questions. Moreover, are ‘people’ centred and future vision centred. But, certainly, lean is more focused on ‘logical’, closed problems whereas AI’s field is more open, where ‘the problem is the problem’.

Of course, both types are routinely found – that is why an awareness of both is useful. For readers of this journal, who will be familiar with lean but perhaps not as familiar with AI, I would recommend ‘The Thin Book of AI’ as a publication that will help in your change endeavors (it is recommended on the MSc in Lean Operations, when AI is discussed).

In the end, Mr Lenin, perhaps we get the revolution we deserve.

www.leanmj.com | January/february 2012

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Book REVIEw John Bicheno reviews Chris Cooper’s The Little Book of Lean: The Basics, Simpler, 2011

T

his is a short little book of 65 pages aimed, I would say, at the beginner to lean. It can be read in under an hour. Of course, that is not to say that experienced lean practitioners would learn nothing from the book – they certainly would.

The great strengths of this little book are the focus on ‘gemba’, people, and humility. A person new to lean would be reassured by ‘precepts’ such as ‘respect for people, society, and environment’, and ‘gemba wisdom that is valued over theoretical knowledge’.

About half the book is given over to explanations about waste.

This is good as an introduction, but a pity about no muri or mura.

The second part of the book is about the 10 elements of flow. The author suggests the following sequence: 1. 6S 2. One-item-flow 3. Right-sized equipment / changeover reduction 4. Takt – time driven standard work 5. Work is pulled, not pushed through the system 6. Visual management and Jidoka thinking 7. Team and Gemba-based problem solving 8. Cost management with job security 9. Total Productive Maintenance (TPM) 10. Leveling Each is explained in one or two pages, each with a question or two. Answers are not given, so one has to think (what would be your answer to ‘what law of mass production makes leveling so wrong?’ Presumably it is economy of scale. But then there is a full page of ruled lines to fill in your answer. So what would you write?).

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The final section is about ‘culture’. Here, there are six questions: 1. Are you dissatisfied with the status quo?

2. Do you have the required humility?

3. Is respect for people, society and the environment at the top of your agenda?

4. Do you believe that “Lean will work wherever work is done”?

5. Will you value Gemba wisdom over theoretical knowledge?

6. Do you have a leadership that believes these precepts and principles?

Again, short answers are given about each. But, who are they aimed at? A middle manager presumably. Up to this point, I was thinking the book was aimed at the shop floor. And what if the answer to the last question is ‘NO’?

Reservations, if any, would be the following: I am averse to books where people have to fill-in sections.

This is seldom done, to judge by quite a few ‘workbooks’ that we have used in the past. But I do like the questions, such as ‘What is the difference between discipline and habit?’ (No answer is given!)

The numerous cartoon illustrations do nothing for me, except perhaps enhance the presentation. Little VA! Manufacturing not service. I think to give the impression that the concepts can be easily transferred to service is misleading.

Maybe to some transactional services. But beware.

A focus almost exclusively on repetitive, assembly-line type work.

Maybe it gives the impression of being just too easy. Just get out there and do 5S or kanban.... This can backfire.

In short, a useful little book – and now the best news: It is apparently free from Simpler consulting!

foRTHCoMING

E V E N T S

EVENTS

There are currently an expanding pool of events available for the development of the lean community which offer both general and sector specific opportunities to renew your enthusiasm and gain new perspectives through communicating with lean contemporaries.

April 23 – 28, hosted at PepsiCo in Skelmersdale and Corin Group in Cirencester The Lean Management Journal invites you to a unique week of Visual Workplace seminars and visual benchmarking factory visits taught by visual thinking expert Gwendolyn Galsworth. Whether you are well advanced on your journey to enterprise excellence or just about to begin, visuality will transform your workplace and accelerate your improvement results and make them sustainable. LMJ readers can select one of two locations for the seminar and benchmarking visit: PepsiCo on April 23-24 and Corin Group on April 26-27. You will understand that a Visual Workplace is a compelling operational imperative, crucial to meeting daily production goals, central to a company’s war on waste, and fundamental to vastly reduced lead times and an accelerated flow. Seminar and Tour: £595+VAT – early bird £495+VAT. To attend please contact Benn Walsh on 0207 401 6033 or b.walsh@sayonemedia.com

CUSToMER EXPERIENCE IN fINANCIAL SERVICES March 20, The Waldorf Hilton, London Organised by Marketforce, this conference will allow delegates to hear from industry leaders including senior executives from across the retail financial sector (from companies like Ageas Insurance, Nationwide, Allianz Insurance and Hiscox UK) and network with peers. They will also debate the business case for customer experience programmes, and the key areas for investment, learn about the challenges and opportunities of social media and explore the possibilities for creating a customer-centric culture at the heart of their businesses.

LEAN SoLUTIoNS IN THE NHS: LoNDoN foRUM March 21, Royal College of Surgeons, Holborn

oTHER EVENTS INCLUDE:

LEAN CULTURE woRkSHoP January 30-31, Bristol Many companies advanced in their journeys have adopted the more visible parts of lean without addressing or keeping enough into consideration the people element. This advanced workshop, organised by SA Partners and hosted by Kevin Eyre, is for middle or senior managers. It will help them to understand how to tackle these issues and start developing a lean culture.

JoURNEY To EXCELLENCE February 8-9, London During this two-day course, organised by the British Quality Foundation, you will learn how to identify where you are on your journey to excellence, where you would like to be and how to get there.

Delegates will learn how to use self-assessment as an improvement tool; develop a roadmap for their organisation; discover how to prioritise improvement actions; recognise the cultural aspects of excellence and develop a plan to engage people; learn to use different tools and techniques.

Lean transformation has proved to be a sustainable and proven way of improving efficiency and effectiveness of NHS services without huge capital investment. Together with Kinetic Solutions, Lean Executives is hosting this one day free event for service improvement leaders, commissioners, operational directors and anybody with a role in improving service line productivity within an NHS Trust. Register via www.LeanLondon.org.uk

PRoCESS EXCELLENCE wEEk EURoPE April 23-27, London IQPC’s Process Excellence Network invites you join this 5-day event to discover the future of process centric management strategies and how you can leverage them to help sustain and accelerate your organisation in uncertain times. Speakers at the conference will include Steve Tower, founder and CEO of the BP Group, Pete Henderson of Bank of America, Soeren Ruskjaer of Vestas Wind Systems and Estelle Clark of Lloyds Register.

The event will see a plethora of roundtables, networking events and sessions taking place.

www.leanmj.com | January/february 2012

foR UP-To-DATE EVENT INfoRMATIoN VISIT www.LEANMJ.CoM

LMJ EVENTS INCLUDE:

LMJ’S VISUAL THINkING wEEk

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w w w . L E A N M J . C o M