British NHS Executive Talks About Lean

Lesley Doherty, the Chief Executive at NHS Bolton in the U.K. was recently interviewed by IQPC as a precursor for her being a keynote speaker at a conference IQPC is sponsoring in December (Zurich). In the spirit of full disclosure, IQPC had invited me to participate in a “blogger’s panel discussion” (along with Karen Wilhelm, author of Lean Reflections) earlier this year in Chicago.

The Chicago conference turned out to be very Six Sigma centric – in spite of having Mike Rother as a keynote. But that is history.

I want to reflect a bit about this podcast. I invite you to listen yourself- it is an interesting perspective from a senior executive who discusses her own learning and discovery. I will warn you that you may have to “register” on the web site – though you can uncheck the “send marketing stuff” box. I will also say that the interview’s sound is pretty bad, so it is hard to hear the questions, but I was able to reconstruct most of it from context.

What is interesting, to me a least, is that the methods and experiences are pretty standard stuff – common to nearly all organization undertaking this kind of transformation.

A summary of the notes I took:

They have to deliver hard budget level savings on the order of 5% a year for the next several years. That is new to them as a government organization.

They started out with an education campaign across the organization.

Initial efforts were on increasing capacity, but those efforts didn’t result in budget savings. In one case, costs actually increased. They don’t need more capacity, they need to deliver the same with less.

They have identified process streams (value streams), and run “rapid improvement events.”

Senior people have been on benchmarking or study trips to other organizations, both within and outside of the health care arena.

They are struggling to sustain the momentum after the few months after an “event” and seeing the “standard” erode a bit – interpreting this as needing to increase accountability and saying “This is how we do things here.”

“Sustaining, getting accountability at the lowest level is the biggest challenge.”

In addition, now that they are under budget pressure, they are starting to look at how to link their improvements to the bottom line, but there isn’t a standardized way to do this.

They believe they are at a “tipping point” now.

There is more, having do to with Ms. Doherty’s personal journey and learning, and knowledge sharing across organizations who are working on the same things, but the key points I want to address are above.

Please don’t think that this interview is as cold as I have depicted it. It is about 20 minutes long, and Ms. Doherty is very open and candid about what is working and what is not. It is not a “rah-rah see what we have done?” session.

As I listened, I was intently trying to parse and pull out a few key points. I would have really liked it if these kinds of questions had been asked.

What is their overall long term vision? Other than meeting budgetary pressure and “radically reviewing” processes, and “transformation.” What is the “true north” or the guide point on the horizon you are steering for?

What is the leadership doing to set focus the improvement effort on the things that are important to the organization? What does the process have to look like to deliver the same level and quality of care at 5% lower costs? What kinds of things are, today, in the way of doing that? Which of those problems are you focused on right now? How is that going? What are you learning?

What did they try that didn’t work, and what did they learn from that experience?

When you say “local accountability” to prevent process erosion, what would that look like? What are you learning about the process when it begins to erode?

The “tipping point” is a great analogy. What behaviors are you looking for to tell you that a fundamental shift is taking place?

As you listen, see if you can parse out what NHS Bolton is actually doing.

Is their approach going to sustain, or are they about to hit the “lean plateau?”

What would the “tipping point” look like to you in this organization?

What advice would you give them, based on what you hear in this interview?

One Reply to “British NHS Executive Talks About Lean”

  1. Thanks for sharing that, Mark.

    Interesting to see there’s one of the blanket “thou shalt cut 5%” environments – that’s usually a very challenging environment for a lot of reasons, especially if Lean is being pushed as a “cost-cutting” idea.

    We know, with Lean, that quality and process improvement leads to lower costs, but not with cost as a primary goal (or having hard ROI targets).

    I’ve always argued against starting with organization-wide education. You can waste a lot of time and money doing that. Plus, if you get people excited about Lean and the org. doesn’t have the resources to help coach people and to help follow up on implementation of ideas that come up, people are rightfully going to be frustrated.

    I’ve argued for starting small, in one value stream, or one “model area” to demonstrate proof of Lean concept rather than starting with a big bang organization-wide effort.

    Will comment more later and will follow the discussion.

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