Very simple equation for healthcare improvement:

Clinical Pathway + No Clinical Engagement =

No Improvement

NHS Confederation pushes manager/clinician collaboration http://ping.fm/bVs8Y

Don't give up on Lean in healthcare; http://ping.fm/DqmCe

Flighter simulator boosts performance:
http://ping.fm/SIQWk

Is Healthcare QIPP (Quality, Innovation, Productivity & Prevention) the new Lean in healthcare?

Patient safety still an issue http://www.hc2d.co.uk/news/article/Patient+safety+still+an+issue/

Patient safety is still an issue within healthcare http://ping.fm/616XS

Patient safety still an issue http://www.hc2d.co.uk/news/article/Patient+safety+still+an+issue/

Paul Corrigan: the future of foundation trusts http://www.hsj.co.uk/comment/opinion/paul-corrigan-the-future-of-foundation-trusts/5003214.article?referrer=RSS

New national director and Britnell replacement unveiled in DH reshuffle http://www.hsj.co.uk/news/workforce/appointments/new-national-director-and-britnell-replacement-unveiled-in-dh-reshuffle/5003442.article?referrer=RSS

Future fears http://news.bbc.co.uk/go/rss/-/1/hi/health/8124830.stm

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

NHS hospital ward shut due to poor cleanliness http://www.hsj.co.uk/news/acute-care/nhs-hospital-ward-shut-due-to-poor-cleanliness/5003284.article?referrer=RSS

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

How to use NHS leadership training to drive performance http://www.hsj.co.uk/home/clinical-leaders/how-to-use-nhs-leadership-training-to-drive-performance/5003143.article?referrer=RSS

Hygiene codes failed at health trust http://www.hc2d.co.uk/news/article/Hygiene+codes+failed+at+health+trust/

How to use NHS leadership training to drive performance http://www.hsj.co.uk/home/clinical-leaders/how-to-use-nhs-leadership-training-to-drive-performance/5003143.article?referrer=RSS

Reform of dental care proposed http://news.bbc.co.uk/go/rss/-/1/hi/health/8109679.stm

Darzi centre pay for nurses 'worse than Agenda for Change' http://www.healthcarerepublic.com/rss/news/article/914705/Darzi-centre-pay-nurses-worse-Agenda-Change/

Report due on dental care changes http://www.hc2d.co.uk/news/article/Report+due+on+dental+care+changes/

Reform of dental care proposed http://news.bbc.co.uk/go/rss/-/1/hi/health/8109679.stm

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/

Darzi centre pay for nurses 'worse than Agenda for Change' http://www.healthcarerepublic.com/rss/news/article/914705/Darzi-centre-pay-nurses-worse-Agenda-Change/

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?