If there are NHS staff who wish to find more about the better way then they are invited to come to the Lean London session on 25th May 2010. More information and registration here.

Best,

Rob

“We’ve had nurses reduced to tears. We’ve had very senior consultants in emergency medicine threatened with a disciplinary process.

“This is an outrageous misuse of the standard.”

That this is being said is no surprise, the thing that causes one to wonder is that while similar things are said so often, by so many different people, that still the people in power don’t listen.

Though the College of Emergency Medicine still has a way to go since it says that it still ‘supports targets in principle’.

I have noticed that it is the people who are close to the work that put up the biggest case against targets. There is a correlation between those who study the work and those who disagree with targets. I have never met anyone who has properly understood the work done in their organisation that subsequently still thinks that targets should stay.

It is interesting to note the comment from the Department of Health spokesperson:

“Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary.”

Surely it shouldn’t need a doctor to believe it to be necessary. I would hope that from the Chief Executive of the trust right down to the rookie cleaner, that care would take priority over administrative targets. In fact, care should take priority over everything.

The fact that they feel the need to make these statements and then still show the whole world that they haven’t got the focus right is what is holding back government from freeing the NHS to make its own local innovations that would give world class patient care but would also improve performance and save money. The first step to doing that is replacing all targets with measures that patients care about.

I have written about A&E targets before:

Targets in A&E make people cheat
A&E targets distort behaviour
More on 4 hour target in A&E

Best,

Rob

…we haven’t combined all of these tools and management methods in more than a few organizations.

Trouble is that the reasons why Lean hasn’t been taken up as much as Jim and I would both like is hidden in that very sentence. Also from the e-letter,

It seems to me that we have already achieved several things of lasting value:

• We have transferred and adapted lean process tools for production, product development, supplier management, and customer support to a wide range of industries in a wide range of countries.
• We have experimented with all of the management tools – policy deployment, A3 analysis, and standardized management with kaizen – that are needed to introduce and sustain these process tools.

Again, the reasons for the low take up compared to the potential of Lean, are right there in those two very telling paragraphs.

The problem is the tools.

The best thing Womack and Jones ever wrote was the title of the book that came after The Machine That Changed the World. That book was called Lean Thinking. The title emphasised thinking (more than the book, I might add). This is the thing that people need to focus on. The tools are a red herring. It is the way that management and staff think that determines how they see they systems they work in and so how they try to change them.

Looking at work through a filter of a set of tools means that is what you see. If all you know is 5S, kanban, heijunka, poke yoke, work cells, supermarket pull systems, value stream mapping etc., then every problem is seen as an opportunity to apply one of these tools.

Every problem is instead an opportunity to learn. Every thing that is working badly is an opportunity to understand better how to improve.

Taiichi Ohno, the father of the Toyota production system, said, “don’t codify method”. He meant don’t give things names, don’t invent tools. When people ask me, “Which tool should we start with?”, I ask them to guess which tool Toyota started with. The answer is they didn’t start with a tool because they didn’t have any. They started to understand their system and to develop solutions to the problems they encountered. These solutions have become codified as the Lean tools. Even the book Learning to See by Mike Rother, which has another promising title, is simply another description of how to apply a set of tools. It should be titled Learning to See Which Tool to Apply.

Jim Womack is in a considerable position of power in the Lean community and the trouble is that instead of reflecting and coming to the useful conclusion that he needs to drop the tools approach instead he is actually trying to extend it by inventing Lean Management Tools to patch up the poor effectiveness of the original Lean tools.

When the tools don’t work, using more of them won’t help matters.

Best,

Rob