Radical Organisational and Service Improvement

1. Radical Organisational and Service Improvement Lean Thinking and Service Process Redesign

2. Lean A philosophy – not just a set of techniques Embedded in culture Not a ‘cuts’ methodology Done by (or with) but not to people Holistic and sustainable Works well with an appreciative approach Links well with commissioning ‘Lean is a business strategy based onsatisfying the customerby delivering quality products and services that are just what the customer needs, when the customer needs them, in the amount required, at the right price,while using the minimum of materials, equipment, space, labour and time’. Natalie Sayer and Bruce Williams: Lean for Dummies

3. Lean thinking - what is it? 5 S’s Lean Six Sigma Lean tools Six Sigma SPC BPR Systems Thinking Process Mapping Black Belt Green Belt Too much jargon!

4. Lean - aspects • Seeing it from the perspective of the user/ customer • Looking at the whole system – not just what you do – and the flow that creates value • Empowering people to know that they can make improvements and provide the solutions • Taking a long term view, and learning from what happened & what didn’t • Getting and keeping top level commitment to change • Demonstrating quick wins

5. Specify value from customer perspective Analyse ‘value’ steps in process Make value flow Let customer ‘pull’ the service Pursue perfection Five lean principles Improving Resource Management through ‘Lean’ Key references for ‘pure lean principles’: Toyota Production System; Taiichi Ohno; Deming; James Womack; Dan Jones; John Seddon/Vanguard

6. Adult Social Care – push/pull examples Push Style Higher pull Pull Individualised budgets Create support system…. Pay client when need is assessed Very high variable to total cost ratio Drive to achieve low average package and support unit costs Home Care Create management system…… Recruit staff Pay on as & when basis High variable to total cost ratio Drive to achieve low total unit cost Residential Care Create capacity…… Design and build home Staff and equip etc High fixed to total cost ratio Drive to achieve high occupancy and low total unit cost

7. Five lean – approaches and outcomes As a project As a project Outcomes and mapping Mapping Risk… doing the right thing, efficiently for a while… Risk… doing the wrong thing, efficiently for a while… As a culture Doing the right thing, efficiently forever…

8. Specify value from customer perspective Analyse ‘value’ steps in process Make value flow Let customer ‘pull’ the service Pursue perfection Five lean principles - techniques Value stream visualisation Process mapping Value chains Ishikawa Diagrams Benchmarking 5S Creativity techniques – reversal, brainstorming, brainwriting etc Problem solving techniques - cause and effect diagrams, but why? etc Ishikawa diagrams ‘Gemba’ walks Statistical process control Customer feedback, complaints & suggestions Surveys, focus groups & other forms of engagement Advocates Creativity techniques – wildest dreams, synectics etc

9. Provider Desired Outcomes Intended Outcomes Outcome matching Stakeholder Service designed to achieve Has needs and seeks Degree of satisfaction

10. High level of match and satisfaction Service is relevant but only partially meets stakeholder need Service appears to be aimed at some needs not identified by stakeholders Poor match - unmet stakeholder needs and a service aimed at some needs not identified by stakeholder Outcome matching Performance Generally value for money increases with the extent of match between needs and ingredients But … This depends on context, other stakeholder needs and the service involved

11. Value chains A “chain” of people and processes……… Stakeholder Need Satisfied Stakeholder Need Identified each depending on the strength of all the others to create value

12. Value chain process Identify the “value” you want to track Draw a simple “chain” Examine each link and each join in the light of the chosen value Identify issues and set priorities Develop proposals or an action plan Keep checking and monitoring

13. Value and waste VALUE AND WASTE W A S T E (what customer does not pay for) V A L U E (what customer pays for) Time Get paid/ complete transaction Receive request

14. Types of waste Overproduction (printing paperwork too soon or duplication of data) Mistakes (order entry errors or unclear information) Unnecessary work (Designed in or differences in how people work) Excessive movement (walking to copier or moving paperwork) Storage Underutilised people (or opportunities lost) Delay or time spent waiting (or system downtime)

15. An Example: Mapping OPM’s Value Stream Our typical customer/user is: large public sector organisation We add value to them by: helping make a difference through providing a service that improves lives The value stream below shows how we do it: Report & Get Paid Receive Enquiry Scope Out Do Action Identify Design How do I improve it?

16. Example: OPM’s Value Stream 2 The Process Identifying the time spent adding value and the non productive time and how this can be maximised. In this example, the exercise suggested greater value for the customer by conducting a case study which reduced the non vaue added time and more clearly produced the benefits the customer was seeking. Report & Get Paid Receive Enquiry Scope Out Design techniques Do workshops – (change culture)? Identify What public & patients need Action How Patients can make it work better Test out – case study? 20 Days 30 Days 10 Days 18 Days 8 Days 30 Days 30 Hours 8 Hours 10 Hours 20 Hours Is a case study the best thing I could do for my customer? Value Adding for 8.5 days 116 days = 7.3% of time

17. Key attitudes • People matter - people make processes work • The future can be changed • There is always a better way • The service users and local communities are what really matter • Measure and aim for results • Patient impatience • Think outside boxes • Be bold - anything is possible!

18. Selecting a process for improvement • High strategic importance • Low effectiveness • Low efficiency • High opportunity to make a change • Good fit to workload • Benefits will outweigh the costs

19. Radical redesign ideas and techniques • Redesign Challenge questions • IT enablers • Bureaucracy elimination • Cycle time reduction

20. 3 Simple things for Leaders to do • Go See. • Senior managers must spend time in the workplace – • listening and observing • Ask Why. • Use the “Why?” technique daily • Show Respect. • Respect your people – and people’s time!! • Learn how the work gets done by getting involved and doing. • Focus on the work and staff and ask questions • Learn and revisit Standard Work. • Use Value Stream Maps to expose the WASTE Think of yourself not as a firefighter, but as a teacher/coach and process owner/designer.