Lean is often associated with big improvement events, such as an Rapid Process Improvement Workshop (RPIW). There is no magical quality to an RPIW, however – it is an efficient way of bringing people together to undertake concentrated work on a service problem, but not all change happens in an RPIW, and it is not always the best way of tackling the problem. Staff can and do make changes to their own services using Lean principles and, in some cases, shorter pieces of work targeted at different stages of a process may be more effective.
Recently, I visited a service to help them collect information for a report out one year on from an RPIW. It was almost nine months since I had been in the unit, and I was struck by how much had changed since. The staff had taken the principles from the RPIW, and the general acceptance that it was in their power to change how they delivered their service, and had continued to make changes. They were surprised when I commented on how much had changed since my last visit, as they no longer noticed it. They had become accustomed to a fluid service that they adapted as they went along. One nurse commented, ‘oh, we’re always talking about what we can change when we have meetings’. I was delighted to hear this as it suggested that the staff had taken ownership of the quality of their service, and did feel free to make continuous improvements without feeling the need to seek outside permission.
In other cases in my organisation, RPIWs have been followed by smaller Kaizen events lasting a few days to tackle a particularly thorny problem. We have also returned to some areas to undertake work somewhere else in the Value Stream.
There is a good example of both these approaches, of continuous improvement and of smaller targeted events, in a report published by the American Society for Quality. The report, from Dennis Delisle at Thomas Jefferson University Hospitals in the USA, is available at the ASQ site. To read the report, you have to register with the ASQ. This is free, and so far I have not been deluged by e-mail after registering.
The report provides a high level summary of a four year project to improve flow in a surgical service. They used the DMAIC structure – they understood the issues, identified improvements, and introduced new ways of working to control the problems. In order to do this, they conducted seven separate improvement events over the four year period, working on different parts of their value stream. These events sound as if they were shorter events than the usual week long RPIWs. The approach – to support staff to identify the issues in their service, to understand how service users see value, and to then structure a response to tackle the problems identified – is identical.
The solutions sound familiar – they introduced standard work, increased visual controls, reduced waste, matched supply to demand and came closer to one piece flow. All of these are frequently used Lean approaches. In this case, the changes arose from multiple events aimed at different parts of a value stream and undertaken over a four year period. This is far from the common ‘one week burst’ approach. Their results – decreased time in pre-operative assessment, decreases in waiting, and having more surgical procedures start on time – demonstrate that the principles can be useful however you use them.
Photo by Petr Kratochvil.