Where do we start?

I was with an NHS Trust earlier this week who were interested in making improvements in the way they deliver services (specifically around the 18 Week Target) and the discussion was revolved around the previous improvement programmes they had led and how they had gone about selecting the first place to start.

I was relating stories from manufacturing companies who have tried to start an organisation wide improvement programme simultaneously and then found almost immediately that they cannot provide the required amount of management support and individual mentoring required to generate the momentum. This had quickly exhausted their ability to make progress and although a few areas ended up making isolated improvements, the overall impact was minimal.

I also related some stories from the service sector where they started with a small pilot project in one area that was 'low priority' for the business and almost disconnected from the main 'hub' of activity. The result was a very slow start and even though they did achieve something it did not generate the organisation wide response that the organisations were looking for.

My belief from various programmes of activity is that to make a successful decision about where to start an improvement programme you need to first understand why the organisation must change (specifically creating a Compelling Need for people to participate) and then look at an area that is creating 'pain' in the organisation (else it will be hard to generate excitement when something is achieved). A third issue is concerned with also ensuring that which ever area is tackled first is also looked at in the full organisational context by looking at the impact of changes upstream or downstream of the area.This latter point is normally tackled through something like a Value Stream Mapping Event or similar activity, but can also be achieved through a Risk Management exercise.

Anyway, it seemed to answer the question for the clients - what do you think?