Wide support for government health plan: poll http://uk.reuters.com/article/idUKTRE55K00220090621?feedType=RSS&feedName=healthNews

NHS end of life care changing for the better http://www.hc2d.co.uk/news/article/NHS+end+of+life+care+changing+for+the+better/

NHS end of life care changing for the better http://www.hc2d.co.uk/news/article/NHS+end+of+life+care+changing+for+the+better/

Amnis News: Andy Burnham promises to overhaul NHS targets: Health secretary Andy Burnham has promised.. http://bit.ly/cfDvy

Amnis News: Service Improvement Presentation to the NHS Medical Board: Janet Williamson, NHS Improvem.. http://bit.ly/B0AYt

Amnis News: Senate to vote on FDA power to regulate tobacco (AP): AP - A tobacco control bill set to .. http://bit.ly/Xse1o

Amnis News: Best primary care trusts to get franchise on rest: Top primary care trusts will be able t.. http://bit.ly/huWlP

Amnis News: NHS finance squeeze must not put quality aside insists health secretary: Raising the qual.. http://bit.ly/5dXDn

Amnis News: A new objective for MRSA: National Quality Board stakeholder engagement: A stakeholder en..

Amnis News: Health Tip: Choosing Baby's Changing Table (HealthDay): HealthDay - (HealthDay News) -- A.. http://bit.ly/CDbba

Amnis News: Summary of responses to the 2004 public consultation 'Proposals to exclude overseas visit..

Amnis News: Quarantined New Orleans mayor still stuck in Shanghai (AFP): AFP - New Orleans Mayor Ray .. http://bit.ly/cepYe

Amnis News: Protecting Protected Mealtimes: With a report this week on malnutrition on the wards in t.. http://bit.ly/18TopD

Amnis News: Warning signs for diabetes detected: Changes in blood glucose and insulin sensitivity sta.. http://bit.ly/80Law

Amnis News: Is your hospital as safe as your bank? Time to ask your board: There are striking similar.. http://bit.ly/106zFZ

Amnis News: What to know before buying supplements (AP): AP - The federal Food and Drug Administratio.. http://bit.ly/2m53c0

Amnis News: It's official: NHS productivity is rising: NHS productivity rose by 1.2 per cent in 2007 .. http://bit.ly/OAtP7

Amnis News: The Patient Safety First Campaign: The Patient Safety First Campaign twelve months on. http://bit.ly/jazp0

Amnis News: Nicholson’s Efficiencies: With the CMO David Nicholson’s statement ‘all bets .. http://bit.ly/bUA2I

Amnis News: Leanpad for Healthcare Workshop: Amnis, in partnership with Process Master (www.processma.. http://bit.ly/wVbnK

Amnis News: Leanpad for Healthcare presenting at the Process Mapping, Redesign & Analysis Conference:.. http://bit.ly/qh9pH

Amnis News: Leadership Impact at the frontline: By Mark Eaton When the news came in yesterday that Al.. http://bit.ly/IMzyo

Amnis News: Obama outlines health care reform goals (AFP): AFP - President Barack Obama urged Congres.. http://bit.ly/ikTbE

Amnis News: Flu severity key for pandemic phase decisions: WHO experts (AFP): AFP - The World Health .. http://bit.ly/AtNCe

Amnis News: WHO flu alerts to reflect severity as well as spread (Reuters): Reuters - The World Healt.. http://bit.ly/4fJzs

Amnis News: John Denham 'to replace Alan Johnson': Innovation, universities and skills secretary John.. http://bit.ly/Gji8i

Amnis News: Girls and Math: Blame the Culture, Not Ability (HealthDay): HealthDay - THURSDAY, June 4 .. http://bit.ly/OzrMC

Amnis News: How doctors see the European working time directive - a podcast from doctors.net.uk: The .. http://bit.ly/M1zNh

Amnis News: Health Tip: Reduce Environmental Waste (HealthDay): HealthDay - (HealthDay News) -- With .. http://bit.ly/4c4n8

Amnis News: Emergency Services Review: The Emergency Services Review aims to provide focus and suppor..

Amnis News: Whistleblowing doctors in the dark over safety fears, says BMA: Nearly half of hospital d.. http://bit.ly/HiGIa

About to chair a telephone conference for the Institute for Engineering & Technology......fingers crossed the technology works!

Amnis News: Chile swine flu cases jump to 276 (AFP): AFP - Chilean health authorities confirmed 26 ne.. http://bit.ly/cXILY

Amnis News: Bausch & Lomb settles 600 eye fungus lawsuits (AP): AP - Contact lens maker Bausch & Lomb.. http://bit.ly/vz4dr

Amnis News: Collaboration is key to effectiveness (and equity): This is the final post in a series of.. http://bit.ly/tTt27

Amnis News: Efficiency is not about cutting budgets: This is the third in a series of posts that have.. http://bit.ly/zW6j2

Amnis News: Lessons Learnt about Quality Improvement in Developing Nations: Presentations from the In.. http://bit.ly/9EwQ3

Amnis News: UK Healthcare League Table: This is the second in a series of posts that have been inspir.. http://bit.ly/vzNf4

Amnis News: Health Innovation: the future's bright: As spending is reined in the NHS must find ways t.. http://bit.ly/MUh5z

Amnis News: Managing safety in the process industry: Our partners at DNV (www.dnv.com) and the IET (w.. http://bit.ly/13aW2c

Amnis News: CORRECTED: Health system discourages innovation (Reuters): Reuters - Countless workers in.. http://bit.ly/xwjGq

Amnis News: Designing to overcome failure: This is the first in a series of posts that have been insp.. http://bit.ly/aloag

Amnis News: Youth diabetes in Europe set to explode: study (AFP): AFP - Incidence of Type 1 diabetes .. http://bit.ly/Z7QuI

Amnis News: Experience with a trigger tool for identifying adverse drug events among older adults in .. http://cli.gs/eN3Djs

Amnis News: David Nicholson sticks by NHS quality cash claims: NHS chief executive David Nicholson ha.. http://bit.ly/mh44m

Amnis News: U.S. health system discourages innovation: WASHINGTON (Reuters) - Countless workers in th.. http://bit.ly/zP1Fu

Amnis News: Patient safety could be at risk from immigration change: A union warns patient safety cou.. http://bit.ly/zLltG

Amnis News: Rescuing People from PRINCE2: Have you experienced going on a PRINCE2 training programme .. http://bit.ly/14LS7Q

Amnis News: Quality Improvement – delivering the Darzi vision: Quality improvements and performance i.. http://bit.ly/XOwDZ

Driving to Liverpool tomorrow evening for an early start on Tuesday and then heading to Wolverhampton for an early start on Wednesday.

Benefits of an integrated NHS http://leanhealthcare.wordpress.com/2009/05/24/benefits-of-an-integrated-nhs/

Lean Problem Solving Tools Workshop http://leanhealthcare.wordpress.com/2009/05/24/lean-problem-solving-tools-workshop/

Consistency & Persistency http://leanhealthcare.wordpress.com/2009/05/23/consistency-persistency/

Lean Training Workshops http://leanhealthcare.wordpress.com/2009/05/23/lean-training-workshops/

Improving Health Outcomes with Andrew Lansley MP http://leanhealthcare.wordpress.com/2009/05/23/improving-health-outcomes-with-andrew-lansley-mp/

Improving Health Outcomes with Andrew Lansley MP http://leanhealthcare.wordpress.com/2009/05/23/improving-health-outcomes-with-andrew-lansley-mp/

Amnis News: Consistency & Persistency: At a meeting yesterday, the event leader was talking about rai.. http://bit.ly/T9gMU

Playing with Ping FM to link Twitter, Friendfeed, LinkedIn etc together

Have you seen our new Lean Healthcare Video?

Hopefully you will already have switched to viewing our new Lean Healthcare Blog but if not, you should now as we have posted a new Lean Healthcare Video.

Whilst you will have missed the window to download our new book 'Sustaining Lean Healthcare Programmes' you can still get a copy if you email us with details of your Lean Programme and the problems you have encountered. Just email info(a)amnis-uk.com for further details.

Are you sure that something is happening?

I was once told a story about a man who has a puncture as he was driving down a road. In the distance he saw a farm and set out to it to see if the farmer has a car-jack. On the way he started 'playing' the conversation in his mind; "I will say hello do you have a car jack" and the "Farmer will reply, yes" the driver thought as he walked.

As he got closer, he started to think to himself, "What happens if the Farmer says no?", and his mind began to race as he mentally played out different scenarios getting more and more angry in the process!

Eventually, he arrived at the door of the farm and knocked and when the farmer opened the door, without waiting the driver shouted, "I don't want your bloody car jack anyway" before storming off.

The moral of this story - well, what it meant to me was that you cannot guess how situations will play out - whether customers are avoiding you because they are busy or because they are genuinely avoiding you? The act of going round and round the loop of 'playing out' scenarios has the effect of increasing your stress and reducing your ability to think straight - perhaps a better approach would be to go and ask rather than continuing to worry about it because you do not want to shout at the next customer you speak too "I don't want your bloody order anyway" before storming off do you?

Find us in more places on the web

To find out more about my views on Lean in Healthcare you can now also find us at our dedicated Lean Healthcare site.

I will continue to post here on relevant topics to the broader issues surrounding improvement.

See you soon!

You Don't Know What You Don't Know

I did a short course yesterday about making a bigger impact with your blog and found it fascinating as I was introduced to topic after topic and site after site which I had no idea existed.

This workshop has led to some fundamental changes to the things I write in the 'virtual world' and in turn this will make my efforts more effective and it set me thinking about all the things that people don't know (or don't know how to find out about) which are holding them back........quite worrying when you think about it!

What do you feel you don't know enough about that you would like to know more of?

Management Involvement

Having facilitated eight improvement events over the last week I was able to compare the differences between the teams. We were focusing on one group (Medical Secretaries) across two NHS Trusts - so technically the same types of people doing the same time of activity.

In one trust the managers were deeply involved in the process, attending the opening briefs and helping set the scene for the team. They also helped overcome any emotional blockages felt by the team. The teams therefore made leaps forward and improved the service significantly.

In the second, of the four teams involved two were led by an exceptional manager who provided inspirational leadership whilst the other two teams were led by a manager who I only saw in passing - and they did not even arrange for their deputy to attend despite being insisted. As such, two teams achieved great things and two achieved next to nothing - and I bet you cannot guess which two failed to deliver anything!

I cannot believe that organisations invest so much time in organising improvement activities only to see them fall by the wayside because of poor management decisions.

If you would like to find out if your organisation is ready to make a significant improvement in performance drop me a line and I will mail you back a free diagnostic. My email is markeaton(a)amnis-uk.com.

Helping the drowning man

A colleague and I were working with a group of organisations who are in desperate need of making improvements about 10 days ago. The following is the background to this exercise......

1. We have been brought in because the main body responsible for these organisations has recognised they need help.
2. The people who attended were asked to rate how important making improvements their organisation were on a scale of 0-10 (0 being completely unimportant and 10 being the only way of avoiding disaster) and no-one scored below 8.
3. The team admitted they had tried many things to improve performance in the areas concerned.

Now, putting these three things together should give a really good picture that the lead organisation wanted it, the team felt it was important and it was time to try something different.

However, when we started to try to help them to think differently the resistence grew to a crescendo and in the end they agreed to do nothing (well actually, to commission a report to look into setting up a project that would consider options).

The lead organisation representative was horrified that they had (as a group) agreed to do nothing and that nothing would happen - and we had to reassure her that it is impossible to help a drowning man (or team) if they do not want to be saved.

What do you think?

Is every organisation unique?

I was chatting to a potential client earlier this week and they were talking about all the things that made their organisation unique. From the specific 'cultural' issues to legislation to client needs etc etc

Now, I have met many, many people who believe that their situation is absolutely unique and that no one else has the same set of issues and I was wondering why this was the case and propose the following answer.

We know our organisations very well - every lump and bump, every problem, opportunity and threat. Therefore, we can speak with authority about our own organisation.

As for everyone else, even closely aligned or similar organisations we have to make broad generalisations about them and in this process of generalisation much of the detail about the problems and issues faced by others are forgotten. This makes us believe that our activity is unique and that the situations faced by others are different.

This is then used to explain why our performance varies from someone else, it also explains why we feel more stressed than others 'appear' to be and it also explains why something that has worked in thousands of other organisations won't work here.

Perhaps this sort of behaviour is needed - especially if it helps to reinforce how 'good' the organisation is and therefore motivates staff, but for many it just acts as a barrier to making changes.

What is it like in your organisation?

Groundhog Day

I was watching the 1990's film Groundhog Day today whilst at the same time reading the book 'We All Fall Down' by Russ King and Julie Wright.

The story of both are about people trapped in a repeating cycle, working very hard to stand still and failing miserably, until a 'major event' or step change in their behaviours or environment occurs.

For many people working in the public and private sector every day is just about 'coping' and whilst people want to improve they find themselves unable to commit any additional time to the problem.

For some (the Firefighters) this way of working becomes a way of life and they find great professional pride in being seen as the person who 'sorts out the mess' when the 'chips are down.'

However, for the majority it is a tiring, stressful existence that many wish could be made different.

But what if the world tomorrow was not the same as today? What if things were not as chaotic as today and more importantly what would you be prepared to give to make it happen?

If you could see a way out of the hole, the Groundhog Day situation, is that something worth investing just a little more effort in?

It is fair to say that doing the same thing over and over again and expecting different results is the epitomy of insanity!

Delay what you don't understand?

I had an email today from a client asking if we could postpone some activity we were going to start in early September because there was nervousness amongst the team that they would not have the time to invest in turning their lives around.

Most of them are swamped by work and cannot afford to lift their head up and therefore the thought of even giving up a WHOLE DAY (let alone the full programme of activity planned) was beyond them.

Instead, they wanted to replace the proposed focused and high impact programme with some work to create a PID (Project Initiation Document), recruit and appoint a Project Manager, develop an implementation plan and really look to get going 'sometime in Quarter 2 of 2008' with a series of bi-weekly hour long meetings.

Now, I know that this is natural reaction to stressful situations - we are so busy firefighting we have no time to turn off the gas - but there is also a lack of understanding implied by the response. They seem to forget that the investment of time in an appropriate, targeted and (most importantly) quick implementation will generate better returns (by several orders of magnitude) than 'death by a thousand cuts' (this being my latest term of weekly/monthly meetings that go nowhere!).

However, there is a lack of understanding implied by this (typical) response which is that the previous programmes have required lots of time investment (admittedly in hour long chunks) and achieved nothing so the thoughts of investing (maybe) 200 hours over several months would not seem a good return when compared against the old model of improvement.

Therefore, the art of bringing this programme back on track (which it now is) was to stress that the approach is different, the results are different and most importantly the returns are different.

What do you think?

http://www.amnis-uk.com/

When is the right time?

A common question I hear when dealing with clients is 'When is the right time to schedule in to do this project?'

The answer is simply that there is never a right time!

Some organisations know they need to make a difference to the way they deliver products and services but cannot or are unwilling to make the time investment required to make it happen.

There is always a reason not to do a project; a new building, service changes, a new contract, someone has left, someone has joined, someone has failed to join, a customer has complained etc etc etc

These are the realities of business - whether you are a Healthcare organisation or a Manufacturing business - there will always be something that makes this 'not the right time.'

In my former role running change programmes for the public sector we were often approached by organisations who were facing the abyss (they were about to close, go to jail or something similar). The common strand was that most realised there was a problem a long before the end came but were so tied up 'dealing with the critical issues' that they did not take time out to deal with the important issues that would have saved them pain, money or damage to customers.

If you truly believe that something needs to be done then it probably does need to be done, and if something needs improving then you had better get on with it.

There are two quotes that I think are great at this point, one is from Henry Ford and the other is from an unknown source:

Henry Ford - "I realised that when I needed a tool, if I did not get it I would end up paying for it anyway but not having it"

Anon - "Madness is doing the same thing over and over and expecting different results each time"

I will close by challenging you to make the first step towards improving the long-term health of your organisation today. It may be disruptive, it may be unpopular, it may just save your organisation or the life of your customers. Delay it at your own peril!

What do you think?

http://www.amnis-uk.com/

The inquisitiveness of children....

Have you ever noticed how children ask the 'daft' and obvious question that exposes gaps in your knowledge?

My six year old son was watching the news with me on the day that Gordon Brown became Prime Minister and he asked me what a Prime Minister was. I started to reply that the PM was the leader of the main parlimentary party when he interupted me and asked me why groups needed leaders and whether or not the people in the political party were capable of making decisions for themselves.

This was a slightly more complex issue and stopped me in my tracks for a few seconds. Of course, everyone in a group has intelligence and is capable of making decisions for themselves but they needed a guiding hand to set the overall direction of the party and to act as a mediator in the event of a dispute.

His questions set me thinking about the usefulness of asking questions from the viewpoint of a child and how it forces people to examine why things are they way they are, why certain decisions have been taken and whether there might be another way of doing things. You often find someone involved in an improvement project will ask what appears to be a simple (or even daft) question that unexpectedly exposes a real issue, threat, risk or opportunity.

Perhaps we should encourage child like questioning for our organisations as it will challenge whether the organisational paradigms are valid or could be improved.

Are you brave enough to try?

Management Commitment is key!

Is it enough for management teams to delegate improvement responsibility to others and then wait for the benefits to roll in?

I think not!

Active support for your change agents, active interest in the progress and achievements of your front line teams and on-going interest in the allocation of improvement resources (making sure people turn up for meetings and that the communication of what is going on is effective), make the difference between success and failure.

On a scale of 1-100, where is your level of commitment to improving your organisation?

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?

A New Understanding

In the related blog to this one (here) we have been exploring the reasons why improvement programmes fail, and particularly why so many Lean improvement programmes fail.

Originally our work led to the uncovering of nine categories of failure and these were outlined in an article which can be downloaded here. However, later research undertaken systematically within Manufacturing and which we have tested in Healthcare has identified that a number of these reasons for failure can be combined or changed and that at least one area was missed in our original research.

Specifically, our original research identified the following nine categories of failure:

• Plans
• Reactions
• Ownership
• Training
• Operation
• Communication
• On-Boarding
• Leadership
• Systems

However, the later research has identified that a number of amendments need to be made and this has changed the sequence of Lean failure causes from spelling the words PROTOCOLS to spelling CRITICAL as detailed below:

• Communications - this remains important and is the same as that found in PROTOCOLS
• Resources - this combines elements of the former Plans and Operation and has been brought out as a seperate topic because of its importance
• Involvement - this combines the old Reactions & Ownership as these were found to be too closely related to seperate
• Training - this remains and actually has grown in importance
• Implementation - this replaces parts of the old 'Operation' but includes failing to apply a structured methodology
• Compass - this was grouped with Leadership during the first research process and brings to light the importance of setting the scope for the improvement process
• Achievement - this was originally missed and includes the need to make a movement from discussion into action quickly
• Leadership - this remains from the old PROTOCOLS model

You can download a copy of a detailed article which explains the research materials that have been used to support this approach here. If you have any comments then I would be delighted to read them either posted here or emailed to me at markeaton(a)amnis-uk.com.

Purist v Hybrid

Organisations looking to improve their performance often latch onto a particular methodology - such as Lean, Six Sigma or Concurrent Design etc - and although they might rename it the 'Performance Improvement Programme' to disguise the origin of the programme (which happens particularly in organisations which have tried a variety of improvement activities and failed) it remains at heart a pure approach to improvement based on the experience of the organisation and any advice they take.

However, given that situations vary and that even similar departments can have widely differing cultural and operational problems, and also given that many problems in organisations need to be linked to their strategic issues, I propose that it would be better to use a flexible, hybrid approach to improvement which draws the best from a wide range of disciplines.

Whilst this places a requirement on the management team to have a broad understanding of different improvement approaches, as well as being experts in whatever their organisation does, it will result in a more flexible, more customised and ultimately more sustainable improvement programme.

What do you think?

Is 50% good enough?

One of the common sayings I like to make about Lean projects is that it is 'better to achieve 80% now than 100% never'.

What this is meant to show is that if you wait until you have a 'Future State' that addresses every scenario and every situation you will never move forward. Whilst this may seem a strange statement for those who are aware of my stance on the impact of Lean on organisational Risk, it is really a call to action to organisations who are trapped in cycles of discussion and review and are finding it difficult to move to action - although you still need to assess the risks that the implementation will bring and put in place suitable controls.

The reason for this blog is that too many organisations that I worked with have previously experienced problems and delays in moving forward as they tried to assess every eventuality, even though the action may only occur once or twice in a lifetime!

I propose that it is better to have properly structured solutions that address 80% of the problems than to wait for ever for a solution to every solution. Using simple Pareto Analysis, an 80% solution would cover all of the most common activities - leaving more time to spend dealing with the minor occurrences (that you have to deal with anyway).

My closing point on this post brings me back to the title of this blog - in that whilst 80% now is better than 100%, I suspect that a properly structured improvement that makes a 50% improvement is still worth having!

What is your view?

Is success an issue of alignment?

I was discussing why partnerships and business relationships breakdown today and found myself referring back to some thoughts I had a while ago.

Given that so many business relationships breakdown (leading the stresses in the business and possibly leading to actual business failure) I realised how important work in this area might be.

In discussion today, we were reviewing all the relationships that had gone sour that we knew of and found it came down to three key reasons:

1. Breakdown in the alignment of personal values
Friendships in business are often based on shared personal values, or at the very least a mutual respect for each other, and if this is broken then it becomes very difficult for people to work together - starting often with an inability for individuals to listen to each other, which leads to bigger problems. This is about TRUST

2. Breakdown in the alignment of business values
The second biggest reason for failure in business relationships we felt were a breakdown in the business values - the way that people wanted to run the business. If one person wants to focus on selling 'anything the customer wants' - working with someone who wants to sell a 'quality and focused product' can be difficult. Also, the way they want to run the business (say, one wanting to sell and run and the other wanting to build long-term relationships), this leads to communication problems and ultimately to a breakdown in the relationship. This is about FOCUS.

3. Difference of Opinion about the Future of the Business
Having a shared vision for the business is the next most important reason for success, and breaking it is the third reason for relationship breakdown. One partner/director who wants the business to grow 20% per week will not be able to work successfully with someone who only wants to achieve a 'lifestyle' and therefore does not see growth as important). This leads to stresses in the business and ultimately to relationship breakdown. This is about VISION.

I am not putting this forward as a scientifically vigorous researched answer, only something that is based on some difficult experiences and I would welcome your thoughts on these issues too - what is your experience?

Compelling People to Change

Whilst you can never force people to change, in fact it is a sure fire way of getting very short term results, there is a need to compel them to change.

By this I mean creating a reason for why the change needs to happen and then 'making it real' for people so that they get over the immediate problem of 'so what' (as in 'So what? Why should I change what I am doing?')

Of course, even a compelling need will still encounter the problems of WIIFM (when people think 'what's in it for me?' - will it improve my life or make it worse?) but that is all about mentoring people into an improvement programme.

If you would like to see some examples of compelling statements that organisations have put together to inspire their people to change, drop me an email to markeaton(a)amnis-uk.com.

Kindest Regards,

Mark

How can you claim to be an expert when......

....you have done whatever it is only half a dozen times?

We expect Doctors, Firemen, Policemen, Teachers and others to know what they are doing - and it is clear when one of them is a beginner, but in terms of business transformation consultancy I found myself talking to a group of so called 'experts' when I discovered that they had hardly any real experience (and certainly no verifiable training in terms of qualifications or accredited training) and were pushing very low grade product direct to clients in the NHS - and some were buying it - in fact, quite a few were buying it!

Now - firstly I have to say, well done to the 'team' for selling a product like that, but I worry about the impact this sort of 'cowboy' behaviour has on the wider market for consultancy in the longer term.

In as much as one swallow does not make a summer, one or two 'Lean Events' does not make an expert!

Any thoughts?

The impact of emotions on performance

I have been putting off a job I have been asked to do for some weeks because I do not feel very happy about working on it.

In between, I have run (and enjoyed) workshops for the NHS, a consulting programme for tro trusts, a series of activities to support a Regional Development Agency and also finalised a book. I have approached all of these tasks with my usual degree of gusto - but for some reason I cannot get excited about the job I have been putting off.

The job in question is something which is not 'core' to what I want to achieve (it is about business planning rather than transformation), I am missing a lot of the background information that I need, it will be contentious - however I do it (!) and lastly, it has the potential to let others down by not being an exact fit with their requirements.........and this is preventing me from working on it.

The fact that I have felt so bad about this (relatively) small piece of work, whilst feeling so positive about other work I have been doing around it, shows the impact that emotions can have on performance.

If I were positive about the work, if I felt it would be beneficial to all those I am doing it for (rather than just some) and if I felt I had all the information required to do the job properly, I wonder how successful it would be?

What is your experience?

Gerry Robinson & the NHS

Having spoken to a wide range of people involved in the NHS about the Gerry Robinson programme of two weeks ago, I am aware that it has generated a lot of debate.

My own opinion, based on similar work in acute care, is that the problems he identified were typical problems and the solutions that were identified were typical solutions - no surprise there!

However, where I believe Gerry went wrong was in failing to provide a structure to enable incredibly intelligent, yet busy people, to move quickly from seeing the problem to implementing the solution. This is why it took so long and generated so much stress.

The role of a Change Agent in the NHS is to provide specialist structure, guidance and support to enable teams to see the problem and then see how to quickly implement a solution, and by providing this structure the results that Gerry achieved could have been achieved with fewer tears and much faster!

I also propose that his approach would have failed completely (because it would have run out of steam) without the pressure of the TV Cameras - but I would welcome your views........

Are electronic mistakes acceptable?

Today I made a mistake - not a big one, probably not even an important one, but a mistake none the less.

As I sit here reflecting on this minor hiccup, I begin to wonder whether making minor mistakes - 'Humanisms' - is becoming more or less acceptable in business. Typical, and common, mistakes in an electronic age include sending emails to the wrong person or sending something to someone 'in the clear' when it should have been in the BCC section (sent blind). These are two of a thousand different mistakes that are now possible to make, yet difficult to withdraw, through an electronic medium.

Less obvious problems occur with the transmission of emotion electronically with people misreading innocent text as aggressive because they put their own interpretation into it. Until we can find a way of transmitting sentiment along with sentence then it will be the cause of unneccessary arguments and broken relationships.

Given that the probability tht everyone will make an electronic mistake over the year, I wonder whether it is more acceptable to forgive someone who has made a mistake of this fashion in the knowledge that you will make the same mistake in the future.

I don't know the answer, but it is one hell of a question! What do you think?

Responding to requests

I am increasingly asked by clients and potential clients for simple guides that explain about the different approaches to improvement (which I generally view as Lean, Six Sigma and Risk Management).

In responding to these requests, I have completed three e-books as follows:

• Lean for Practitioners - a guide for practitioners and those tasked with leading Lean Improvements to the secrets of Lean and how to implement it in the service sector and NHS
• Introduction to Lean, Six Sigma & Risk Management - a beginners text on each of the three approaches to improvement and how they can be integrated
• Sustaining Lean Improvement - looking at the four aspects of successful Lean and how to engage the team, transform cultures and sustain improvements, this guide is for advanced users of Lean and for those who's Lean Improvement Programmes have stalled

For further details and an order form, drop me an email via our website (www.amnis-uk.com).

I look forward to hearing from you and wish you a Happy New Year.

A balanced approach to consulting

I was reflecting during a discussion with a client this week about different approaches to consulting.

At the one extreme is complete 'facilitative' Consulting - which is all about helping the team to work together to find the way forward but not providing much in the way of structure. In some environments this is a very valuable approach to consulting, normally where the team has a known outcome and they have the skills to get there and need a neutral chairman to sort it out. However, in most improvement environments this approach is far too passive as the team often need guidance on how to move forward and the next steps to take.

At the other extreme is the 'directive' approach to consulting, what is often termed the 'Screaming Sensei' who instructs the team what to do and then makes sure it happens. In some extreme environments (such as a high risk environment when safety is at risk and the Sensei is an expert or where insurmountable obstacles are being presented to improvement) but generally the Screaming Sensei will be far too directive for sustainable improvement to occur and will normally lead to quick gains that disappear just as quick as soon as the pressure is removed.

Life needs to be in balance between these two extremes. Successful consulting, where improvements are to be sustained, need to provide the support of a facilitative approach and the expert guidance of the directive approach, but without the extremes of behaviour of either end.

What are you looking for in your consultant?

From products to services

I was chairing a meeting of the IOM's Operations Development Panel (ODP) this afternoon at Cranfield University. The ODP aims to shape thinking in Operations Management across a range of sectors and one of the topics we were exploring was 'Product Servicisation' which is where companies look to stop selling products and start selling competences.

The classic example is Rolls Royce who sell 'power by the hour' on their aero-engines, so clients have access to the value (a working engine) but avoid the liability. For many companies trying to compete on price, this approach offers the option to differentiate themselves in the market, although it requires careful planning on cashflow and having a robust model.

Cranfield are working on a two year research programme to look at the most effective way of helping companies to 'servicise' their operations and also helping service sector companies to develop products that sell and I look forward to supporting them in this research.

Making that final investment decision

Even though many organisations are seriously unhappy with their organisational performance there is always a certain level of doubt about making an investment to make it better.

For most organisations investing in a physical piece of equipment seems to be much more palatable - yet investing in expert consultancy or training support at a fraction of the cost is often subjected to more scrutiny. I know the argument that if you have a piece of equipment it has a residual value - but that is the folly of many purchases as it is often extremely difficult to realise the value that second hand equipment have on the books!

I suppose the concern comes from whether or not you are buying quality support and consulting, unlike many commodity items, is not the same irrespective of the price. I will explain this point - you would expect a TV you purchased for £50 to work as much as you would a TV for £5,000 - the picture and features might be different but fundamentally they will both work. In consulting terms the same is not true - you can pay £50 and get a 'non functioning product' - much the same as you can for a £5,000 consulting project!

This does not make it easier to buy consulting, it actually makes it harder! Coming back to the first point I made, it is very difficult to make a decision about consultancy and many, many organisations have been caught out by being sold the 'corporate package' by a well dressed partner only to have the service delivered by a poor quality graduate.

To make the right decisions I would suggest the following five points:

1. Ask who will deliver the project - and meet them to ensure you like them
2. Buy in stages (with get out clauses) so you can terminate if you are not happy
3. Understand exactly the process/methodology they will follow
4. Ask for references - they don't all need to be directly relevant but they do need to 'stack up'
5. Get 1st hand feedback from the people working with the consultants on a regular basis

Of course, you could always go and spend £500,000 on a machine - but I would always say pay £5,000 on consultancy to identify whether you need to actually buy the equipment at all!

Repetition and (no) Deviation creates Hestitation

Stealing shamelessly from BBC Radio 4's 'Just a Minute', I have modified the rules for the game to highlight a problem that came up in a workshop I was attending today at Earl's Court.

Doing the same thing over and over again makes people an expert at undertaking that task, but in the longer term - when variation is required - this repetition creates a 'furrow' into which people channel their energies - making it hard for them to create the new patterns of working that are needed.

In the worst cases, the desire to continue doing what has been done before (without deviation) delays the organisation's ability to react to the changing circumstances and prevents improvement. This hesitation can be devastating to the long term health of the organisation.

The cure is often hard bear for some people in that it requires them to accept (and perhaps even value) failure, errors and divergent thinking - something that people normally get fired for in many corporates!

But to be clear, this disruption is different to devastation - which will be the topic of a later post!

Strategy Drives Improvement?

Earlier this week I was due to run a workshop but because of a mix up I had to allow someone else to do it for me.

The topic was to explore the linkage between Strategy and Improvement and in planning for the event (which ultimately I did not undertake), I was given the time to reflect on another reason why improvement programmes go wrong - this being that the various areas improved have no impact on the organisational trajectory and therefore the net effect is like the proverbial 'arranging the deck chairs on the Titanic'.

An example I was made aware of was given me by a friend last night who had worked with one of the 'Big 5' consultancies and had been tasked with transforming the administrative processes in the business's headquarters in Switzerland. Very quickly he realised that the real problems lay with the root and branch sales activities which were spread out across Europe. However, he diligently worked through the improvement programme, charging some £500k, and the overall effect on the bottom line was nothing as the company ran out of cash and closed.

This demonstrates that if you choose to improve the wrong thing, you will improve nothing! Therefore, being clear about the Strategic Issues facing the business is almost more important that rapidly moving to action and actually doing something!

Increase in Productivity or Increase in Intrusion?

I am writing this on a train coming back from a business development weekend in Scotland - the train is moving and I am sitting here wondering whether the fact that I have cleared my emails, dealt with a client proposal for the NHS and am now writing a blog entry is an increase in productivity or just an increase in the levels of intrusion into my 'personal space'.

At present, I am feeling quite good about the experience in that I know when I finally get home at around midnight tonight that I will not have to deal with any emails and can just go to bed -but if I were here with a friend, had a good book to read or just did not feel like working, I would probably feel that the ability to access WiFi/Emails during the journey would be an intrusion, nagging away at me - asking for me to deal with issues.

In business, having a clear delineation between 'work time' and 'play time' (the latter which could include creative time) is vital - but the line between the two is disappearing. On Tuesday I have a meeting which we have had to book a room in a hotel to avoid being disturbed, but even there we will probably be interupted by mobiles and the occasional message at the hotel.

I worry that this blurring of work and play will have a serious impact on organisational performance as individuals have less and less time to themselves and less time to be creative - but for now I am just enjoying the ability to travel and work!

Success in Healthcare

Last Friday I was delighted to host a meeting of one of the Ecademy clubs I belong too (CEN). The event focused on issues relevant to Healthcare and we had a great mix of people, including some with extensive 'in house' expertise of working in the NHS.

What we discovered is that (not unsurprisingly) the opportunity for improvement is great, especially in the area of sustainable improvement (using a variety of tools such as Lean etc). It is perhaps one of the best environments for leading change - you have motivated and skilled people who share a common aim (delivering patient care).

However, the issues of 'improvement fatigue (IF)' and changing public priorities will make it a long and slow process to implement (and sustain) the benefits that individual trusts can realise.........fancy joining us to help make it happen?

Loyalty in Adversity

When things start to go wrong in relationships (whether personal or business), loyalty becomes a very important issue.

If you have built up relationships with your network, when things start to go wrong they will support you - whether you are right or wrong - but when you haven't built the relationship, or if you use up all of your 'emotional credit', the loyalty and support is not there everything becomes much harder.

In change, it is important to have a relationship with the people you are working with so that when things start to 'get sticky' (and they will), they support the change.

The Duke of Wellington had a great saying which emphasises the power of loyalty and training and went something like, "When other Generals make a mistake they are beaten, but when I make a mistake my troops pull me through."

When things go wrong, who will support your change programme?

Buzzword Bingo

It is a very worrying fact that a lot of consultants use very complex language. Well, it isn't even limited to just consultants, but to pseudo- academics and pompous people of all persuasions!

Is it because they like the sounds of the words or because they do not really know the answer and need to use complexity to mask stupidity? In my time, I have worked with both groups of people, some of them even believing that they were really impressing others by using 'complex interactive knowledge processes' when in reality they were boring the others rigid and demonstrating quite the reverse of what they were hoping - instead of appearing intellectual, they appear confused and instead of appearing dynamic they appear boring.

I was prompted to write this entry by a good friend emailing me the link to Buzz Phraser which is, I am sure, where these people get their words from!

Every experience is unique

If you think about it, everything we experience is completely unique.

Where we are sat in a room of people is unique and therefore the acoustics at that point is unique. The way our brain processes the sound and then our conscious and sub-conscious analyse the sound into concepts we can understand is completely unique.

Two people sitting side by side listening to a speaker on a training workshop will both experience different events, take different learning and have different emotions.

This makes communicating such a fascinating topic for a consultant such as me - how do you ensure that the message you are transmitting is the message they are receiving - and how do you ensure that the activity you are leading is the activity they are needing.......

I don't have the answer, I only pose the question......

Random Connection

I realised yesterday that all the important people in my life (other than brothers, uncles, aunties and children) I have met because of a random connection.

In a family context, I met my wife because she happened to be at a mutual friend's house when I was and in a business context, one of my business partners I met because I decided to try a different form of networking event.

Subsequently, these random connections lead to a wide range of things such as children, contracts, further introductions and friendships, but the root of all success comes from a random connection.

In analysing why this is an important message, it is because the more random connections you make, the more success you will have - but the real issue is pushing yourself to go and make those connections!

On a different issue, have you seen my other blog on Lean Sigma (called Flexiblean - pronounced Flexible Lean)

20 Year Complacency

I was preparing some materials for an event that I am speaking at next week (download the brochure here) and realised that we are possibly heading toward another period of complacency in the UK.

In the 1950's, there is a lot of historical evidence about the fact that UK industry were complacent about the impact that the rising quality and productivity of Japan would have on us and in the 1960's/70's it killed off our motorcycle industry (for all intents and purposes) and a lot of our electronics and automotive industry as well.

In the 1970's we were complacent about the Asian revolution, joking about the quality of what they were capable of and in the 1980's and 90's they stripped our manufacturing and are now advancing on our service industries.

In the 1990's we were complacent about the rise of China saying they would be become the 'low cost but low tech' outsourcing centre of the world and today they are encroaching upon our high tech industries and sectors.

As we move toward the 2010's, I am beginning to wonder whether we are facing another period of complacency in the UK....perhaps because of the impact of Eastern Europe, the BRIC nations (Brazil, Russia, India & China) or even the Middle East or Africa - maybe it will not happen at all but history seems to be against us on that!

Stress + Depressed = No Success

Individuals who are stressed under-perform - everyone knows that - hence the growth in stress coaches, but have you considered that organisational health and levels of stress also affect performance?

Organisations which are feeling the squeeze find it difficult to focus on the longer game and it permeates through to the individuals working in the organisation, which in terms affects their performance and hence the results achieved by the business.

This is not about 'benchmarking', but is purely a matter of fact that organisational stress is a real phenomena and has a major impact on the results achieved - any comments?

Innovation?

I was invited to an 'Innovation Dinner' this week at which some 150 people had booked and paid to attend.

The dinner had a good keynote speaker, but the topic was less about Innovation and more about how they had grown their business from scratch.

The problem for me is that the whole affair seemed to be a 'ra ra' session about innovation without any practical advice or information for the participants - the typical 'Innovation: Its a good thing' type approach.

For many, Innovation means developing a new product, whilst others think of it as a new creative design for a brand, but if we take the government definition of Innovation it is about 'the exploitation of new ideas' - meaning that it is equally relevant to the improvement in a process as it is too the development of a completely new process.

To find out more, read my article on INNOVATION at Ezine Articles.

Changing Direction

I have decided to split my ramblings into two seperate blogs.

This one will change to be about the activities I am involved in, the people I have met and what I have heard, whilst my blog FLEXIBLEAN will evolve as the main site for comments on making change sustainable, flexible and high impact.

I hope you enjoy the journey!

Are you completeLEAN mad?

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I was speaking late last week to a real 'Lean Jockey' with a well known American consultancy who are building a presence in the UK.

I found the conversation both interesting and a little disturbing on the basis that the approach being followed appeared to be 'tools only' - a quick 'Value Stream Map' and a series of Rapid Ram-Raids on the business, with no focus on sustainability.

One of the worrying things about the approach they are adopting is that the consultancy concerned it is growing nicely with an impressive range of new clients - and this fact made me challenge what I believe to be true - namely that the 'tools approach' is not sustainable in the long term.......so why were these guys being so successful?

Having spoken to a couple of people last week, including one of whom has been a current client of the consultancy concerned within the NHS, my fears have been allayed - it appears that whilst the price is high and the benefits good in the short term, the results last as long as the consultant is on site, creates bad feeling in the team and does not create an optimal solution.

We are about to extend our research into the sustainability of Lean, the first phase of which led to the development of our PROTOCOLS(tm) approach which assists organisations to prepare for Lean (or any form of transformational change). We will be speaking in depth to up to forty organisations from the service sector who have tried Lean to correlate our findings - although initial feedback says that the same bunch of cowboys who saddle their Lean tools outside manufacturing companies are now putting on their boots and striding into the service sector!

Beware the 'tools only' approach to Lean - unless your people bed it in and believe in the change, it does not matter how good the consultancy presentation is, the project will fail!

Public Profile

I was delighted today to receive a report about the growing use of Lean and related techniques in the public sector.

Having spent a number of years working in the public sector on transformation programmes, including with the RAF, NHS, Public Agencies and Local Authorities, I have seen many of the pitfalls that can behalf public bodies embarking on a transformation programme.

It was a long time ago that I gave up being a 'Tools Jockey' - partly because I realised the damage it was doing to organisations when I was leading programmes of support in the private sector. Luckily I was able to take this knowledge of sustainable lean into the public sector.

Sadly, for many public bodies, it seems they are going down the route of a 'tools approach', using 'drive by kaizen' which makes a quick improvement and collapses even quicker, unless you pour an ever increasing amount of money into supporting it (normally ever increasing consultancy fees).

True sustainability of change (and particularly Lean), relies on employee engagement, a vision of the future and development of internal capability. These are hard learnt lessons which it seems that many public bodies are going to learn the slow and expensive way.

Ho hum..........

Your Attitutde Affects Your Performance

For some, this might be a statement of the blindingly obvious, but I think it is an important point to make.

My attitutde at the current time is based upon a range of external influences such as my relationships with my colleagues, clients, friends and family. It is also influenced by some internal influences, such as my energy levels and levels of confidence.

Now, my current attitude is based on the combination of these (and other) internal and external influences, and this attitude affects my performance. Obviously, as the influences change (perhaps after a good nights sleep, or receipt of some good news) so does my attitude and in turn my performance.

When you are the manager or leader of a change programme, the attitude you have makes a significant difference to the performance of your team and therefore the success they achieve.

Being aware of the affect external and internal influences have on you is an important step to maintaining an appropriate attitude - which in turn is essential to the success of your team in leading change - and the bigger the change, the more the attitude of the leaders affects the result.

Several development processes exist to assist leaders of change to manage the effect influences have on them - and these include NLP and Emotional Intelligence - and for further information please feel free to contact me about them.

Sustainable Does Not Mean Forever

An interesting concept that has raised its head this week is the idea that some organisations are looking to 'fix' their change - and are turning to the concepts of Sustainable Change as a way of achieving it.

Whilst Sustainable Change does ensure that organisations get the most benefit out of their improvement activities, motivate their people effectively and also ensure they maintain their position in there market, it is different to 'fixing' change in place.

To fix change would imply a rigid system - a winning formula that once developed was never changed. But what would this mean when the circumstances changed and the world, the market or individuals moved on?

Look at McDonalds, for years they had an almost winning formula; Burgers, Beverages & Breakfasts, but over the last few years they have recognised that society has moved on and demands more variety - especially healthier options.

Sustainable Change ensures an organisation remains 'best' for a period of time, but also leaves them with the capability to move on when circumstances change.

So, the idea is not to 'fix things forever', but to fix them and flex them as the requirements change - and this is the basis of Sustainable Change.

By the way - our new book entitled 'A Beginners Guide to Continuous Improvement' is now available.

Visit my Ecademy profile and then drop me an email for further details.