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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Mark Eaton

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

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

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

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

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

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

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

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

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

There are three truisms to healthcare improvement:

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

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

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

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

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

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

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

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

Welsh health board plots merger with council

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

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

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

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

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

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

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

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

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

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

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

PRESS RELEASE 

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

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

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

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

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

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

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

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

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

PRESS RELEASE

The specialist healthcare quality, innovation and productivity improvement enabler, Amnis, has outlined plans to transform the quality and productivity of Community Services.

Amnis’s Mark Eaton explained: “Community Services are less well prepared for any reduction in funding than many other healthcare sector organisations, so they will need to develop their procedures and processes in order to enhance their productivity and patient care levels.

“In addition, Amnis’ recent research has discovered many opportunities to innovate and improve efficiency within these services,” he added.

“The transformation that has gone on with primary care over the last few years, from mergers to the separation of commissioning and provider arms, has created a number of challenges for community service organisations. Moreover, it has meant that their investment in building robust and efficient processes has slowed in many areas.

“Now is the time for community service organisations to transform the way they deliver services if they are to be ready for the expected funding squeeze,” Eaton stated.

“Some of the success will be driven by the creation of an effective improvement strategy that focuses on the identification of needs and opportunities for efficiency gains,” he pointed out. “However, this will have to be coupled with the effective implementation of change – and all of this must be done in the same time that is being taken to create these new organisations.”

Eaton believes that it is also important for Community Services to begin to address effectively the inefficiencies and patient experience issues that occur at the interface between primary and secondary care. This is because it is at these points that competition is most likely to occur – through new community based services or services that were once undertaken in a community setting being moved into an acute setting – he explained.

For more information, visit Amnis at www.amnis.uk.com, email info@amnis.uk.com or call 0870 446 1002.

PRESS RELEASE

Improvements in quality for patients, along with improvements in service productivity, can be achieved at the same time as improvements in staff morale. This has been the experience of the specialist healthcare quality, innovation and productivity improvement enabler, Amnis.

“In one example in Emergency Care from a single ‘Improvement Event’, a team released some 11,500 hours a year of time, under guidance from Amnis’ professional transformation and Lean team,” revealed Amnis’s Mark Eaton.

“Of course, this time was reinvested in care – with resulting benefits for both patients and staff.”

The team also managed to reduce admissions into an assessment unit by 65 per cent.

Three months later, this new performance level has been sustained and staff absence rates have also dropped by 45 per cent.

Agency staffing costs have dropped by 42 per cent and the number of adverse incidents has also fallen. In addition, a recent staff survey has shown a steep rise in overall job satisfaction.

According to Eaton: “Our considerable experience of enabling change in the healthcare sector leads us to conclude that any improvement activities that are not focused on both staff and patients are liable to fail.”

While it is vital to have a health service that is focused on patients and service users, Eaton believes that it is impossible to make that health service effective without the cooperation and input of front-line staff.

He further believes that many services that don’t work well for patients also don’t work well for staff.

“Effective processes are ones that not only engage front-line teams in their design and transformation, but also where the benefits are realised by staff as well as patients,” Eaton explained. “The knock-on effect of this can be seen in reduced absence rates, labour turnover rates and agency spending – as well as in an increase in patient and staff satisfaction.

“Through engaging staff in the redesign of services and giving them the capability to lead the changes for themselves – both in terms of time and skills – it is possible to transform both the efficiency of front-line care and also the morale of staff.”

For more information, visit Amnis at www.amnis.uk.com, email info@amnis.uk.com or call 0870 446 1002.