lean london sep_09_web
TRANSCRIPT
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Lean London Forum
30 September 2009
Royal College of Surgeons - Holborn
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Confidential not to be used without consent
We have several broad aims
• To create the environment where Lean Solutions in the NHS are shared, discussed and acted upon by practioners in the Health service
• To engage in a debate about strengths and weakness of lean in the current NHS climate
• To network and with new colleagues and friends
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia, kinetik solutions
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practionersFacilitator - Rob Worth
• 1930 - 2000 Networking and Drinks
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Confidential not to be used without consent
Ground Rules
• Suspend assumptions
• Act as colleagues
• Spirit of enquiry
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Confidential not to be used without consent
Quick Introduction
• Name
• Organisation
• One thing you like about Lean
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Confidential not to be used without consent
What is Lean
• Focus on Value from a Customer (Patient) point of view on every step of process
• Passion for removing waste within the ‘whole system’
• Bottom up approach in identifying value and waste – assumption that much of waste and value is hidden
• A true lean system would “flow” and need little command and control
Leads to sustainable change ingrained in the ‘DNA’ of an organisation
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Confidential not to be used without consent
“Lean’s focus on delivering care is a refreshing antidote to benchmarks, targets and the traditional approach to performance management. The emphasis it puts on looking at the whole system is valuable.”
Nigel Edwards, Policy Director, NHS Confederation
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practioners
• 1930 - 2000 Networking and Drinks
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Radiology Lean review The journey has begun
Carole DarnellSeptember 2009
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400 approx bedsServing 270,000 population
2,000 staff
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Radiology plc
80 staff
All diagnostic modalities (except PET)
130,500 examinations per annum
£3 million budget
8.5% increase in activity 08/09 when cmp with 07/08
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Radiology Lean review
A threat???
We know what’s wrongWe know how to run
our department
An opportunity!!!!
Radiology is important to the TrustRadiology is worth
investment in (time & money)Radiology is core to
the majority of patient experiences
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Which way were we heading
2005 – promised new department
2006/07-Turn around/CIP 2007- New RIS/PACS 2007 –PACS redundancies 2007 -New manager/deputy
manager 2008 – 6 week targets 2008-New Clinical lead
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Steps on the journey Scoping
& initial data collection
Process mapping
Project identification
Data collection, KPIs defined
5S exercises
Project implementation
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A just do it! Zero wait plain X-rays
2 weeks 2 days
2 days2 days1.5 days1 day0.5 day2 minsStart
Patient X-rayed
Request Attended
Pt arrivesIn dept
Appt sent to pt
Appt made
Card returned to recept
Dr vets request
Card taken to Dr
Request pended
Pt arrives with request
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12mins2 minsStart
Radiographervets request & x-rays pt
Request attendedPt arrives with request
Leaned!!!
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10 steps → 3 steps 28 mins→12 mins
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It all adds up!
Savings for reinvestment
16mins x 10 appts = 2.6hrs per day
2.6 hrs x 5 = 13.3 hrs per week
13.3 hrs x 48 = 639.9 hrs per year
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Where do we re-invest?
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Project 4 – Centralised appointments/admin
Dedicated appointments centre in X-ray back office
All appt queries dealt with centrally
All Admin/appts work done outside clinical areas → releases clinical capacity
Choose & book, reduces cancellations, reduces DNA’s
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Oh dear – our waiting room/reception
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What do we have here? a 5S opportunity
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That looks better!!!
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Good about lean
They are our ideas
It puts you in the patient’s shoes
Staff morale
Pride in the department
Belief that the department has a future
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Bad about lean
Time (too busy being lean to do lean)
The rest of the Trust a’int leaned yet
Other parts of the Trust think we are sorted
You can’t do it all at once (things have a natural order)
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Would we do it again? Would we recommended it?
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practioners
• 1930 - 2000 Networking and Drinks
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Lean Solutions in the NHS: London Forum
Recruiting for the Lean & Service Transformation
Daniel McDonaldLean Executives
Executive Search & Selection ‘Managing the talent pipeline for Lean Enterprise’
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Applying Lean Methodology into Search & SelectionLean Defined• A strategy for maximising value to customers both internal and external• Relentless pursuit of the perfect process through Waste Elimination
Context• High Process Variation / Long Lead Times / Significant Re-work / Increasing Administration
Burden / Specialised and demanding arena with sought after skills
Scope• Change Leaders to Service Transformation Directors • Job Specification to Employee Starting Successfully
Objectives• Absolute Process Transparency • Greater Client Engagement• Reduced Lead-Time• Reduce Total and Average Cost Per Hire
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The Journey – Lean Applied
• Mindset• Behaviours• Ownership
• Start with a thorough VSM exercise looking at entire recruiting, assessment and post-hiring process
• Bespoke ‘Standardised Worksheets’ created detailing the specific timings, search and assessment process to assess key technical and behavioural competancies
• Detailed Assignment Brief constructed
• Joint Research / Advertising campaign
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Real Impact• Developed a robust recruitiment solution to deliver maximum effectiveness whilst
minimising waste, adding value and reducing clients spend.
• The Assessment Centre (Hiring Cell) yielded an average of 2 hires per 5 candidtes.
• Total recruiting cycle time reduced sigfnificantly from 93 days to 58 days that included candidates notice period. Our search process reduced on average from 45 days to just 19 days.
• Cost per hire reduced by 20%
• Real-time management information.
Key Learnings
• Transformation achieved through Accountability, Trust and creating a Forum for Input
• Think Customer Back! Focus on the fundamentals and Imagine a Better Way!
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practioners
• 1930 - 2000 Networking and Drinks
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Lean vs. Systems Thinking
Rob Worth
kinetik solutions
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Confidential not to be used without consent
Lean vs. Systems Thinking
Lean Systems ThinkingHistory Interpretation of Toyota
Production System by Womack and Jones
W. Edwards DemingRussell Ackoff
Outline •Customer•Value•Value Stream•Flow•Pull•Perfection
•Whole systems•Interactions between parts•Outside-in•Purpose
Qualitative Differences
Set of tools, e.g. 5S, VSM, Kaizen
•Less defined•Whole system
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Lean vs. Systems Thinking
Systems Thinking
Toyota Production System
Lean
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practioners
• 1930 - 2000 Networking and Drinks
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Confidential not to be used without consent
Lean Solutions in the NHS: London Forum
Starting afresh with LEAN
September 2009
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The scenario
• 550 bed DGH
• Estates-led project
• Replacing critical infrastructure
• All wards and departments
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Limitations
• Decant for at least 30 months• Major disruption to fabric and services• Large, but fixed budget (£50m)• Should have been complete in 2004• Some failures occurring• Organisation in midst of reconfiguration
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Why use LEAN?
• Disruption to current processes• Disruption to critical services• ‘One-shot’ commissioning• Short timetable• No loss of operational efficiency
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Key processes
• Developing the principles– What are the critical priorities?
• Process map – How will we do this?
• Value stream mapping– Is there anything we don’t need to do?
• Next step : Engage operational staff
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Benefits…..on paper
• Direct revenue cost reduced by 15 - 20%, – freeing resource to….
• Reduce the decant phase by 20%– And to…..
• Save 25% of capital– Which has allowed us to look at…..
• NEW OPPORTUNITIES– Ward improvement & consumerism
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Confidential not to be used without consent
Agenda
• 1800 -1805 Introductions to Speakers, Agenda and Ground RulesKetan Varia
• 1805 - 1830 Radiology Lean Review – the journey has begunCarole Darnell, Bedford Hospital Trust
• 1830 - 1840 Recruiting for the Lean & Service Transformation Daniel McDonald, Lean Executives
• 1840 - 1850 Lean and Systems ThinkingRob Worth, kinetik solutions
• 1850 - 1900 Don't water your weeds - starting afresh with LeanIan Greggor, Cyril Sweett
• 1900 - 1925 Questions and Answers from practionersFacilitator – Rob Worth
• 1930 - 2000 Networking and Drinks
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Confidential not to be used without consent
Your Questions on LeanYour Questions on Lean
Why don’t we succeed in our
department?
Can Lean fail?, and for what
reason?
We have no budget to start
Lean – what can we do?
We have low morale and no one
is willing to change, what can I
do?
What the one thing that makes the
biggest difference?
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Network LEAN
Sue WhittakerSeptember 2009
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…just another Network? – NO!
• Forum for like minded organisations and individuals to meet• Opportunity to share and address the challenges of service
transformation in the NHS• Reduce the barriers of scale/size and complexity within the
NHS• Finding time for learning, support and to stimulate business
creativity and innovation
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Network LEAN provides…opportunity
• To listen to key note speakers and presentations• To practise creativity techniques,• For creative swiping and to share best practice, and• To stimulate creativity and innovation
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£££££s – 0!• Time
– up to 6 network meetings a year
– 2 - 3 hours duration
• Cost– Nominal e.g. travel,
refreshments etc
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Confidential not to be used without consent
WHATS NEXT?
• Today’s presentation and feedback survey sent out by email
• The Next Lean London Form will be on 27 January 2010 – We will send out reminders to all participants from today
– If you’d like to take up one our presentation slots, please do let us know
• Kinetik solutions is running a one day ‘introduction to lean course’ on the 26 of November – for further details please contact [email protected]
• We have set up a twitter account – this will be used to send short interesting messages that can be of use to lean practitioners. To join please go to http://twitter.com/leanlondon
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BIG THANKS TO OUR PRESENTERS
Carole Darnell
Daniel McDonald
Ian Greggor
Susan Whittaker
Rob Worth
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Confidential not to be used without consent
FINAL THANKS TO OUR SPONSORS
Assisting with Lean Transformationsin the health sector and beyond
Managing the talent pipeline for Lean Enterprise and Service Transformation
network lean