A survey of 148 council boroughs across the UK reveals that they have raised the cost of skip permits by as much as 650% over the past five years, rises that have corresponded with increases in illegal dumping.

and

Experts suggest there is a clear link between the costs of rubbish disposal and an increase in fly-tipping.

But right at the bottom,

Last month the local government secretary, Eric Pickles, criticised councils that introduced charges at recycling centres, saying they would be “utterly counterproductive”.

Pickles said: “People already pay £120 a month in council tax for local services”, and warned that the move would create “perverse incentives” to fly-tip rubbish.

Maybe Eric Pickles understands that concentrating on costs means that total costs go up.

I hope so.

Best,

Rob

“The system will suffer”, they cry, “help our bit of it, but not theirs.”

Every service, region, council, lobby group and association will be calling on the government to treat them as a special case in the near future and from their point of view they are right. The important thing is to take a different point of view. When genuinely looked at as a system, public services need to do two things

1. See themselves as part of the whole system that is the economic and social complex of the country.
2. While bearing that in mind, look to their own systems of work to see how they can improve and save money.

I believe that focusing on purpose (what they are there to do) and improving the service they give is the best way to save money. It is not a direct route but doing what the service user needs, with no waste, errors or rework, as quickly as possible must be the cheapest way to deliver every service.

Most public services are nowhere near that state. So they need to look to themselves to solve their problems.

The only problem will be is if either the service managers don’t see this or the cuts come so fast that they can’t implement it. Though implementation can be surprisingly quick when people put their mind to it.

Best,

Rob

About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Using the figures further on in the article of 549 surgeons questioned and 19% seeing harm, that means that in two weeks, 104 surgeons saw a patient harmed. I wouldn’t even like to start extrapolating that figure to all the surgeons and all year long.

Apart from the fact that

When asked about what gets in the way of patient safety, many said they did not feel in full clinical control, because of pressure from managers to get through operating lists.

The report author said that

surgeons often come under pressure to “slip in” extra patients on their lists

These are systemic problems. The management are putting pressure on the individual surgeons to make up for the lack of systemic thinking about how patients are treated. “Slipping in” patients to surgery lists means that not only are the lists tampered with but so is the whole patient flow. There is probably a lack of understanding of demand and little or no flow of patients or continuity of care which is leading to these comments.

Many [surgeons] complained of having to operate on patients they had not seen before

If patients came to see a surgeon and their surgery was scheduled quickly, then this would occur much less frequently.

The bottom line is that surgeons, managers and all staff involved in the care of patients having operations need to be aware of and contribute to the end-to-end system that patients experience. No one section of the flow should start blaming the others, they all have a responsibility to get together to improve. The problem is that there are currently no structures in the NHS that assist them to do that. Combining GPs, PCTs, SHAs, hospital trusts and the other agencies that affect these flows is a mammoth task that is not being addressed yet.

We shall continue to see these kind of articles until something brings these systems all together.

Best,

Rob

I wanted to break it into two since the first part is quite positive, I was very impressed with the enthusiasm of the attendees to firstly come in their own free time on a Saturday, but secondly in their wish to improve things generally in how local authorities deliver service. Which brings us to the last session of the day…

Get Over Yourself

The last session was suggested by Emma Langman and was called ‘Get Over Yourself’. I didn’t really have any idea what this would be about, but I do know Emma so I knew it would be interesting and it was, but not for the reasons I thought.

Emma was posing a question about why we project school models into the workplace. “Teacher knows best, pupil learns from them”, is translated as “Boss knows best, employee will do as they say.” I would agree with the sentiment of this, that for many managers this is actually a desired model except for the fact that many bosses don’t know best. I thought this was an interesting question and a nice opportunity to discuss it in a quite open environment, but it went a bit ugly for me. The challenge came, “We have been going over this for 50 years, why are we talking about this again?”. I have thought the answer to that was plain, we still don’t have a really good answer and a good answer is well worth searching for.

It got worse. The group descended into a blame fest. “Fifty percent of councillors are rubbish.”, “There are too many fat, lazy b*****ds.” and so on.

I was very disheartened by the general feeling. There were a few positive voices who noted that if you give people a good job to do then they will do a good job and that there is potential in everyone, it just has to be tapped by management.

I was quite surprised since I had pegged the attendees of Local Gov Camp to be quite hopeful, forward thinking folk who would go above and beyond to find better ways to do things and here we were slinging mud at our colleagues and fellow man.

I think that this attitude is the thing that we have to knock down first. The idea that people are fat and lazy who do everything to avoid work and spend their time raising grievances is an interesting observation since it actually takes quite a lot of thought and planning to avoid work and a knowledge of procedure and a considerable tenacity is needed to raise a grievance in a modern council. I think that the potential is there in these people but we just have to channel it. We shouldn’t give up on them or write them off. They want to do a good job, same as the rest of us.

I sincerely believe that everyone wants, down deep, to contribute to a meaningful purpose. It is just that management often does their level best, not always deliberately, to block them. It is the enlightening of staff at all levels, from councillors down to street sweepers, that will open up thinking and wipe away prejudice. It is in the work that purpose is achieved and I think that the propensity to focus on individuals as things to be fixed when broken and used when performing that is wrong.

The reaction of staff to a bad system of work by withdrawing and rebelling is a natural thing that should be expected. Management are responsible for creating the system that creates the bad staff member and it is management’s responsibility to fix it. Another attendee noted that management hired “good, intelligent, self-starters with new ideas”, so if they are not like that any more, either management are incompetent at recruitment or they are incompetent at designing a system of work to keep new hires the way they were when they arrived.

But lest I fall into my own trap of starting to blame management. I am not. I don’t think it is their fault. They learned what they know from their managers, who learned from their managers. Like a cycle of abuse, it needs to be broken and it only with optimism, belief in people and an open mind that this will change.

All in all I am glad Emma ran that session since it is clear that we need to keep airing these issues until it becomes a non-issue by virtue of us fixing all the problems.

Someone once said, “The most depressing thing in life is to have hope.” Well I hope he was wrong, since I think things can change for the better we just have to look to ourselves, to the system of work and stop blaming others.

Best,

Rob

Local Gov Camp Review – Part One

Before the election in May, the three health spokesmen for the major parties debated on television. Obviously the question of targets came up and Andrew Lansley said he would scrap “politically motivated” NHS targets but keep those that were “clinically justified”.

The problem is that there is no such thing as a clinically justified target. The reason is that targets are arbitrary and make performance worse. That is never clinically justifiable.

A target to have every suspected cancer patient seen within two weeks has behind it a laudable goal – that patients with serious conditions should get the best treatment possible. There is nothing wrong with that goal but everything wrong with having a target.

Study Demand

To achieve the goal you would start by looking at demand. “How many suspected cancer patients do we get every day/week/month?” You would then look at the current system to see how this demand was dealt with and you would measure it from the patients’ point of view. They want to be seen quickly, they want to get the right treatment and have the best outcome possible. Also they want dignity, respect and to be treated like human beings.

If you are thinking of hitting a target your mind is filled with resources, measures and reporting. I went to Exeter to help run a workshop on how to meet the 18 week target from diagnosis to treatment. One of the questions from the floor was about what monitoring should be put in place to spot when patients are just about to breach the target and so fast-track them so they won’t breach. If you put that monitoring in you are moving resource from the core flow of diagnosis and treatment and over to monitoring. If then you add a fast-track expediting of patients just about to breach you add a further complication to the system where suddenly certain patients jump the queue to make the trust’s figures look better. But remember that patient has jumped over other patients who are now delayed and so more likely to get close to breach. If they get close to breaching they will jump the queue and so the cycle continues. You are in effect increasing the variation in the system while at the same time reducing the resources available to the core flow.

Measures of Purpose

The correct approach is not to have monitoring of near breaches but to measure the end-to-end times of patients from diagnosis to treatment, while also measuring the type of treatment given. You will see that the end-to-end time will vary. This variation is normal in any system. Your first job is to remove any abnormal variation until the system is stable (which is not to say it is yet effective – just stable) then work on the flow of the patient through the system to remove the batching, waiting, errors and rework so as to reduce the variation and improve the system to get the time from diagnosis to right treatment as short as possible.

This method will leave any target setting in the dust. Why 18 weeks? Why not 18 days? Why not 18 hours?

Why two weeks for cancer patients? Why not two days?

Method Not Targets

Targets don’t help you to improve, in fact they distract from improvement. People set targets when they have no method. When they have a effective methods, they get results that would be seen as ludicrous to set as a target.

Best,

Rob

I bet the light works in your kitchen and you don’t even think about it. Well the strip light in this kitchen hasn’t worked properly for ages. For the want of 99 pence worth of a new starter, we have both been getting up on a chair to fiddle with the old starter to make the fluorescent bulb flicker and come on and stay on. We just hadn’t quite got round to going to an electrical shop to get the starter. So up on a chair every time we wanted to turn on the kitchen light. We even took to leaving the light on all evening when we left the kitchen so that if we popped back to make some tea, we didn’t have to get on the chair again to turn the light on again. Talk about a work-around.

The thing is we got used to it. After a while, getting up on a chair to make the light come on didn’t seem so much trouble. We forgot that it was a bother. It became the way things were done.

I recall way back when, working for an investment bank as an analyst messing with dozens of Access databases and Excel spreadsheets. One day I had to add an extra calculation to the daily work which would have meant a couple of days effort to update the Access database. Instead, because the trader wanted it that day, I exported the data to Excel, wrote a quick and dirty calculation in an hour, ran the calculation and then reimported the results to the database to continue the day’s work. This extra procedure added 90 minutes to my day, every day.

I continued that extra step for months. I forgot that it was slow and cumbersome. I got used to it.

It took six months before it started to bug me and I got so bored of the extra step that I spent the two days implementing the calculation in Access. After that the calculation whizzed along in the blink of an eye. Those two days spent right at the start would have saved me 24 working days over the six months I waited. In fact the two days of work would have paid for themselves in only eleven days.

In order to implement change, big or small, you need some negative emotions. You need to be dissatisfied, bored, shocked, appalled, angry and critical. If you are tolerant, accepting, placid and content with your lot, nothing will happen. This is why change agents are always searching for the “burning platform” so they can get people to jump instead of having to push them off a “quite comfortable thank you” platform.

For an evening, the newly fixed light was a revelation. “Wow! We don’t have to climb on the chair to turn the light on! Amazing!!” How sad that we take joy in things working as they always should have done. I recall my boss at the bank giving me a pat on the back for rewriting the calculation to save that 90 minutes a day.

A vision of a better way is nice and shiny, but how about a bit of tedium and rage to get us not just to where we should be, but beyond, to where we couldn’t dream of? If only we could stop being so accepting of the messy, awful, boring, infuriating status quo.

Get moving. Get some dissatisfaction.

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