Improvement is easy. If you take a team, or even people from a few teams who work along a Value Stream, and give them time and space to work on quality problems, they will identify ways of improving services and reducing waste. Almost always, the solutions are sensible, and help resolve the problem. Sometimes the solutions that arise from teams, for example in Rapid Process Improvement Workshops (RPIWs), are brilliant, and contain entirely new insights into the nature of the problem, and ways of addressing it.
The challenge is in embedding gains, and maintaining them over time. It is common for organisations to find that applying Lean methods works well in projects, but mysteriously fails to yield the major benefits they want. Womack and Jones discuss this in ‘Lean Thinking‘ – this is not just a problem in health and social care, it happens across the whole spectrum of manufacturing and service industries.
The Virginia Mason Medical Center, one of the flagship examples of the application of Lean in health care, reported the same thing. They reviewed their first few hundred RPIWs, and concluded that their patients were not experiencing the maximum benefit possible from them, because they were having difficulty maintaining gains over time (the details are in the book, ‘Transforming Health Care‘).
Womack and Jones, and in turn Virginia Mason and other organisations, concluded that the reason was that isolated improvement activities can never gain maximum traction – you need to move your whole organisation towards a Lean Management system.
Components of this include a hoshin kanri, or World Class Management process, of identifying key organisational priorities, checking them out with staff (a process called catchball) and agreeing how to tackle them. This is accompanied by the pursuit of key transformational (or ‘breakthrough’) objectives, together with the use of daily management. This is discussed in greater detail in this post.
Accountability Walls are part of this approach. Some authors use the term interchangeably with Production Boards. More commonly, Production Boards are used to describe boards providing information on live systems, usually very close to the workplace (or ‘gemba’). Accountability Boards, by contrast, are used to monitor metrics on a series of related improvement activities across a Value Stream, or even across a whole organisation’s improvement activities.
Accountability Wall Walks are held, as the name suggests, in front of the Wall, using the information on the wall as the focus for the discussion. These stand up sessions are generally brief – no more than 30 minutes – and occur weekly. My own organisation has held its own equivalent for the best part of two years. At Virginia Mason, the sessions have occurred weekly for well over a decade.
I attended two sessions in the UK recently, where Diane Miller, the Executive Director of the Virginia Mason Institute, provided coaching on her experience of this process. In a wall walk, the relevant senior team looks at up to date information on progress in improvement activities. The staff who lead the relevant unit or department speak to the work.
This sounds as if it could be punitive, but Diane was very clear that the focus is on identifying and overcoming problems, ‘the whole reason for the conversation is to remove barriers to progress …and to reflect on what has happened’, she commented. Diane also noted the accountability element – commitments are recorded, and where expected actions have not happened, the reasons for this are explored then and there.
This could be an uneasy conversation, so while RPIW report outs, for example, are very public, Accountability Wall Walks, by contrast, tend to be undertaken with the relevant leadership team, with frank discussions both expected and appreciated, but with an emphasis on improvement andf progress.
The thread between this arrangement and workplace production boards is that data on process, performance, and local improvement activities will feed in to the work displayed on the Accountability Wall. The Accountability Wall, however, is a place where oversight of linked processes comes together, and a strategic perspective applied.
Thanks to ensarija at openclipart.org for the illustration.