In a recent post “With Lean, how big is too big?” Cameron discusses the problems of a large-scale Lean implementation in health care provision in Saskatchewan. He suggests the issues are about context, preparation, style, scale and sustainability. I think these categories are applicable to most if not all Lean implementations, regardless of size.
Take my own recent (and ongoing) experience in delivering a roll-out of “5S” method in the eight hospitals in rural Argyll and Bute. These hospitals cannot be described as ‘massive’ by any means – the smallest has only three beds, the largest operates with a modest 74. This project would qualify as minuscule compared to the Saskatchewan ‘big-bang’ approach. However, the oppositions and criticisms levied by healthcare staff at the project, especially in the early days, sound very similar to those raised in Saskatchewan.
Let’s begin with context. People already under pressure, with existing heavy workloads, may easily view the introduction of any Lean work as yet another pressure, something additional that has to be done on top of everything else. It’s therefore important to ensure everyone understands why we are doing it, what our objectives are, where it ‘fits’ in the organisation, and therefore ultimately why it will help rather than hinder their day-to-day work. It should not be a one-off exercise, but part of an ongoing organisational culture, focusing on improving quality, eliminating waste and delivering better value services.
As with many things, preparation is key. You have to ‘know your stuff’, be confident, have all the right tools readily available, i.e. practice what you preach. Find out in advance about the department you are working with, and how they operate – what are their day-to-day difficulties, what are their strengths? Then use pertinent examples that will demonstrate the resulting well organised workplace will actually save time and money, by enabling staff locate those vital pieces of equipment as and when they are needed (right place, right time, etc.). And probably most important of all, ensure you have their line managers and their line manager’s manager on board before you start – essential if this really is about organisational culture. “5S” is recognised as a fundamental building block for Lean. If the preparation isn’t right, the longer term success of Lean working is compromised.
To sum up style, think firm but fair. Meet resistance with encouragement and make suggestions. Be clear that the “5S” work must be done, but be aware that “5S” and Lean cannot be ‘done’ to people. There’s something here about ownership. Staff must feel enabled to make the changes for themselves. We must avoid the ‘militaristic’ approach reported in some accounts from Saskatchewan. Be visible, be available, be supportive – and be first to acknowledge where improvements are made.
On scale in “5S” implementations, my advice is ‘start small’. Identify one small area such as a stationary cupboard, a treatment room or an office where there is an obvious need for improvement and tackle this first, then build on it. Success in the first small area motivates people to carry on in other areas until it becomes ‘normal’ standard working practice across the department and ultimately across the organisation.
Finally, sustainability is about maximising the benefits and ensuring the process does not become burdensome. If the system (the standard benefits will dwindle and the improvements will unravel. Therefore, there is a requirement for ongoing support. Going back six months or a year later, and saying, “Do you remember what this area looked like?”, or “Look at the savings you’ve made on your stock levels,” or “See how that process of service delivery flows so much better than it used to”, reinforces the achievements, provides the opportunity to ensure the changes are sustained, promotes continuous improvement and serves as a reminder that this a Lean organisation.