Lean applied to healthcare and public sector service delivery in SA

Norman Faull*

Lean Institute Africa

*and his students/teachers

A note What follows is a plan. Some of the learning

informing the plan is in healthcare; some is from courts, mining, banking & manufacturing.

Rather than talking about the 10 year healthcare lean learning journey I will talk about a plan for

the future.

Undoubtedly we have not devised the perfect plan. But the actual implementation will speak

to us in the language of problems.

If we listen and respond to the problems,

we will improve.

Building blocks…..

S1

S2

S3

Strategic (What business are we in? What do we need to be good at?)

Systemic

Situational

Model line:

Natural work teams BoPs/std work Feedback (VM) Problem solving X

X Multi-disciplinary teams

X

The 3S model

Situational problem solving

Systemic problem solving

Strategic problem solving

S1

S2

S3

Strategic (What business are we in? What do we need to be good at?)

Systemic

Situational

*Pilots:

Natural work teams BoPs/std work Feedback (VM) Problem solving X

X Multi-disciplinary teams

X

Top management sets agenda as to a. What we must achieve b. Why c. How

Implementation steering group (ISG)

Situational task force (STF)

The 3S model

The implementation process

What we must achieve

(Purpose) informs

both

College Approach for time-phased training of ‘improvement cadres’

Pilots

Evidence to motivate and inform the training

Understanding of why the pilots ‘work’

S1

S2

S3

“Learning about”

“Building understanding

& skill”

S1

S2

S3

Strategic (What business are we in?

What do we need to be good at?)

Systemic

Situational

*Pilots:

Natural work teams

BoPs/std work

Feedback (VM)

Problem solving X

X Multi-disciplinary teams

X

Top management sets agenda as to a. What we must achieve b. Why c. How

Implementation steering group (ISG)

Situational task force (STF)

The 3S model

Assertion…

“It is easier to get people to act their way into a better way of thinking, than to get people to think their way into a better way of acting”

John Shook, How to change a culture: lessons from Nummi

Sloan Management Review Winter 2010

Informing threads…

Consider this:

The people in every organization acquire work habits. Those habits constitute the organizationʼs culture.

Consider this:

All managers are teachers, whether consciously or not. With their everyday

words and actions managers teach their people a mindset and approach, which

determines the organizationʼs capability.

© Mike Rother / Improvement Kata Handbook; 2013

Aims of this proposed plan

• Demonstrate impact on service delivery

• Ability to scale up across the public sector

• Ability to sustain the improvements and the ability to further improve service delivery

Practice-Performance Matrix

Pe

rfo

rman

ce

Practices

lo

hi

‘All’ e.g. Waiting time, Quality Service,

etc. e.g. Team Work, Problem-solving, Operator-centred

maintenance, etc.

‘None’

Dysfunctional

Unsustainable

Unpurposed

World-class

Efficiency Matrix*

*Modified from Modig & Ahlström (2012) This is lean

Re

sou

rce

eff

icie

ncy

Service efficiency

lo

hi

hi Actual output Rated output

Service time Journey time

Efficiency Matrix

Modig & Ahlström(2012) This is lean

Re

sou

rce

eff

icie

ncy

Service efficiency

lo

hi

hi

Increasing variability

damages both efficiencies!

Efficiency Matrix

Re

sou

rce

eff

icie

ncy

Service efficiency

lo

hi

hi

Mental pre-occupation of

senior & operations

managers is for service to

function here!

Efficiency Matrix

Re

sou

rce

eff

icie

ncy

Service efficiency

lo

hi

hi

Probably where most operations

actually are!

Efficiency Matrix

Modig & Ahlström(2012) This is lean

Re

sou

rce

eff

icie

ncy

Service efficiency

lo

hi

hi

We believe the improvement journey is via

stabilising operations and targeting flow through the

service channel

Service time Journey time

COMPONENTS OF JOURNEY

ACTION

RESEARCH

PREPARATION

CORE ELEMENTS P

REP

AR

ATIO

N

• Inform

• Recruit

• Prepare site

• Steer Coms

• Gvt

• Departmental

• Facility CO

RE

AC

TIO

N

• Rapid Improvement Events

• Sustaining

• Entrenching

• Develop facilitators

PAR

ALL

EL R

ESEA

RC

H

• Workbook

• Syllabus

• Best Practice

• Self-audit

• Improvement pathway

• Ad hoc academic

PREPARATION

Recruit phase

Brief Departments

• ‘Twinkling eyes’

• Next steps

• Leader Do’s & Don’ts

Pre- Recruit Cohort

Cohort Training

RPIW Preparation

CORE ACTION

PREPARATION

“Pre-” phase

Briefing dpt leaders as to

• ‘3S’ pathway

• First steps

• Leader Do’s & Don’ts

Recruit Recruit Cohort

Cohort Training

RPIW Preparation

S1

S2

S3 X

X

X

Do’s Show engaged & informed support to SteerComs and Facilities

CORE ACTION

Don’ts Disrupt Facility & P/D staff with fire fighting, transfers, etc

PREPARATION

Recruit

RPIW Preparation

Pre

CORE ACTION

Recruit Cohort

Cohort constituted of 3-4 Facilities:

CEO+3 3-5 P/D

Cohort Training

PREPARATION

Cohort Leader Training

• Intro to ‘lean’

• Stability issues

• Sustaining actions

• Provisional A3s

Recruit

RPIW Preparation

Pre

CORE ACTION

Recruit Cohort

PREPARATION

RPIW Site Preparation

Identify 3 projects & for each

Map process

Define current condition

Define target condition

Recruit

Cohort Leader

Training

Pre

CORE ACTION

Recruit Cohort

PREPARATION

Recruit Pre- Recruit Cohort

Cohort Training

RPIW Preparation

CORE ACTION

CORE ACTION

Entrenching Practice via Coaching & Mentoring

Year: Cohort II

Entrenching Practice via a Coaching & Mentoring

Year: Cohort I

Entrenching Practice via a Coaching &

Mentoring Year: Cohort III

Establishing Consistent Practice I

Establishing Consistent Practice II

Establishing Consistent Practice III

Establishing Consistent Practice IV

RPIW & Initial Sustaining

Cohort I

RPIW & Initial Sustaining Cohort II

RPIW & Initial Sustaining Cohort III

RPIW & Initial Sustaining Cohort IV

1 2 3

Months: 6 12 18 24

Two kinds of know-how & skill for each facility:

1. Process improvement 2. Improvement

sustaining

Scaling up

Months Cohorts Master Facilitator SDi’s ∑SDi’s

6 1 MF1 12 12

12 2 MF1 MF2 24 36

18 4 MF1 MF3 MF2 MF4 48 84

24 8 96 180

30 16 192 372

36 32 384 756

42 64 768 1524

48 128 1536 3060

54 256 3072 6132

60 512 6144 12274

THE BIG PICTURE 1 2 3

1 SERVICE DELIVERY

2 OPS CAPABLE OFFICIALS

3 STAFF ATTITUDE & MORALE

0

10000

20000

30000

40000

50000

60000

70000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

SIX MONTH PERIODS

COHORTS INTRODUCED • 4 CEO’s • 12 FACILITY LEVEL STAFF • 3-5 P/D STAFF

The 5 ‘coaching kata’ questions*

1. What are we trying to achieve?

2. Where are we now?

3. What obstacle is now in our way?

4. What’s our next step, and what do we expect?

5. When can we see what we’ve learned from taking that step?

*Mike Rother at http://theleanthinker.com/2013/02/24/mike-rother-overview-of-toyota-kata/ Or full presentation at http://www.youtube.com/watch?v=fYoppX3VHIY

Challenge or target condition

Current condition

CORE ACTION

Entrenching Practice via Coaching & Mentoring Year: Cohort II

Entrenching Practice via a Coaching & Mentoring

Year: Cohort I

Entrenching Practice via a Coaching &

Mentoring Year: Cohort III

Establishing Consistent Practice I

Establishing Consistent Practice II

Establishing Consistent Practice III

Establishing Consistent Practice IV

RPIW & Initial Sustaining

Cohort I

RPIW & Initial Sustaining Cohort II

RPIW & Initial Sustaining Cohort III

RPIW & Initial Sustaining Cohort IV

1 2 3

Months: 6 12 18 24

WORKBOOK & SYLABUS

DEFINE/DESIGN INTEGRATED IMPROVEMENT PATHWAY

SELF-ASSESSMENT & IMPROVEMENT PATHWAY

ACADEMIC PATHWAY

AD HOC “ACADEMIC”

RESEARCH

LEARNING COLLABORATIVES: SPECIFIC & SOCIAL

If you do nothing else as a manager...

In the context of purpose:

• ‘Go see’ (Develop “Good eye shop-side”)

• Ask lots of questions, with a sense of genuine curiosity

• Work respectfully with your people – have the intention of setting them up to succeed, first time every time

A note

We need to ‘co-produce’ the plan to improve public sector service delivery;

this presentation is an attempt to be specific and actual as to actions and outcomes,

so that your criticisms and suggestions can be specific and actual.

Undoubtedly we will not devise the perfect plan. But the acual implementation will speak to us in

the language of problems.

If we listen and respond to the problems,

we will improve.