Scottish Government

CHAPTER FOUR IMPLEMENTATION OF LEAN

4.1 This section considers the implementation of the improvement programme (the implementation of the changes which come out of the improvement activity is discussed in Chapter 5). By considering the implementation process, insights and recommendations can be given regarding the methodology, its replicability and embedding of continuous improvement.

4.2 Whether discussed as a Kaizen Blitz, "blitz" or Rapid Improvement Event ( RIE) the methodology used in most cases followed a similar pattern - although there was some variation in scale, scope and timescales. This chapter will reflect on the process of the RIE as well as issues affecting the implementation process.

A. Process of a Rapid Improvement Event ( RIE) or 'Blitz'

4.3 Section 3.12 mentioned that the favoured approach to Lean was the 'Kaizen Blitz' or 'Rapid Improvement Event ( RIE)'. The RIE approach was adopted by the three pilot sites in the study. The event usually comprised of three separate stages: preparation, workshop and follow up ⁹.

4.4 In the RAF case, the RIE was formalised into a seven week cycle in which the 'Blitz' week was essentially about trialling new processes which had come out of the Value Stream Analysis ( VSA). The 'Blitz' week was preceded by a three week data-gathering and planning phase and then followed by a three week sustainment phase to embed the new processes.

1. Preparation

4.5 The consultant's brief for one case was typical of the structure of the preparation phase:

4.6 In most cases, a short (1 day) training event for managers was held to establish the purpose, direction and methodology for the second phase. This event was used to link current managerial issues, strategy and the Lean thinking initiative.

4.7 In a number of cases it was the role of the change managers to collate information about the service to be reviewed such as current volumes, number of steps for a process, etc. In two cases the participants-to-be were asked to carry out this work prior to the change event.

4.8 In all cases, some time was spent trying to understand the needs of the customer. A common approach was a customer survey:

"The business change methodology works around the principle that processes can best be developed by designing around the needs of customers. To achieve this, each service review includes…a survey of recent customers." ( CS4)

4.9 In the pilot studies, the facilitators made efforts to ensure that RIE teams would have the necessary information at their disposal, by planning this at the preparation phase. However, the research noted that much of this information could not be readily obtained before or during the RIE week. For example, the hospital pilot did not have accurate demand seasonality information and struggled to obtain this in a timely manner.

2. The "Blitz" week

4.10 Although most events were referred to as an improvement week, some actually took less time than this (3 days) but 5 days was found to be the norm. This was to maintain momentum:

"If it had been five Mondays it would not have worked. We would have forgotten improvements. [Intensity] is part of the trick." ( CS3)

" The length of the event is short… In this short time cross-functional teams from the departments had to work together for achieving common objectives. A "just do it" attitude meant that change could not be postponed." ( CS1)

4.11 The sequence below represents a typical example of a Kaizen Blitz week:

• Monday was used to train on techniques and learn principles.
• Tuesday was used to observe current practices.
• Wednesday was to design and implement a new process.
• Thursday was to run in a new process.
• Friday was to report to senior management.

4.12 However in the RAF case the central purpose of the "Blitz" week was slightly different:

"The physical change is at the heart of the improvement event. Three weeks of preparation data gathering to make sure you get your facts and figures straight and then at the end of the three weeks you say we have a good idea of what we want to implement physically and then that's when it happens in the fourth week." ( CS8)

4.13 Most Blitz events carefully managed the degree of involvement of staff in the improvement week. It was essential that people who were not involved did not feel left out:

"The biggest problem has been a degree of resistance from those who did not participate - [it] is addressed by having presentations for them." ( CS3)

"From the service perspective all staff would be involved at some stage in the process - but usually with a small working group leading, facilitated by the Business Change Managers." ( CS4)

4.14 During the week an improvement plan was developed. The plan usually sets out some basic ground rules about objectives and resource requirements for the implementation. Most Lean improvements were cash neutral, and did not emphasise cost reduction to staff:

" But soon people began to realise that you can make change with no money" ( CS7)

"I think people very quickly got over that not having resources…[and] probably found the methodology was quite simple and straightforward." ( CS7)

4.15 In one of the pilots the RIE team said that they felt that a week had been too short a time to get to grips with the process through process mapping and to trial new processes, let alone to embed them.

4.16 The Local Authority pilot demonstrated the challenges associated with the inclusive nature of the RIE week. In this case, it was deemed necessary to include 20 people in the RIE. The facilitators were able to manage such a large group by dividing tasks and allocating them to smaller groups. Even so, there were concerns that not enough people had been included.

3. The Follow-up

4.17 Most implementations had a third phase to implement more challenging changes outside of the Blitz week:

"There was also the 30-day follow through where additional actions would be implemented." ( CS2)

4.18 In most cases, these were necessary where changes to physical facilities or other structural changes ( e.g.IT, telephones etc) could not be adapted in the Blitz week.

4.19 Feedback from one of the pilots indicated that there was not sufficient structure around the "Blitz" week to ensure that the momentum would be sustained and the changes implemented.

B. Management Commitment

4.20 Management commitment to the improvement events was identified by everyone as a key element of the implementation. Also, the survey results reported that managerial commitment to ongoing improvement was seen as the most important factor contributing to the success of the Lean projects ( Annex 2).

4.21 In one case, management responsibilities were made crystal clear with guidance stipulating that commitment must be demonstrated in the following ways:

"By giving your time for the planning and identification of projects
By having a vision and setting aggressive goals for your teams
By unblocking any problems around the arrangements for the Kaizen Week
By attending Blitz briefing sessions or delegating attendance
By attending the Friday Blitz Report Out
By ensuring those who need time to carry forward the implementation get it
By continuing to engage with the team leader post Blitz about the progress of implementation
By unblocking any problems around the implementation
By attending the Final Report (project closure) out session." ( CS3)

"Will it be implemented? We took ownership. The fact that the service director was there 3-4 times in the week was a good sign." ( CS3)

"I provided management support. - I attended built in slots during the week. I needed to give visible support." ( CS3)

4.22 It was also noted that few interviewees reported senior management involvement in the detailed work within the Kaizen week which is what would be expected. The implementation teams tended to encourage other staff to do the practical aspects of this work of which the outcomes would be presented to the senior management to generate their support and 'buy-in'. The commitment of senior management to be available during the RIE was seen to be important as it reflected a commitment to the improvement activity.

4.23 The pilot studies showed that management participation in RIE weeks needed to be managed carefully. Within the RIE process, managers need to be available to provide advice and expert opinion, to sign off decisions and to demonstrate commitment to the process. It was noted that some managers actually found it difficult to see their previous decisions being corrected by junior staff. In one pilot, a senior manager watched as the team withdrew a system he had championed. His lack of resistance (and indeed support) for the change reinforced perceptions of management commitment. However, in another pilot, senior management saw their role in the week as crucial to the staff empowerment aspect of the RIEs.

4.24 The pilots demonstrated the care that must be taken when management roles are determined for the RIEs. Too little involvement can create the impression of lack of commitment to the RIE, but too much involvement may stifle the team's ability to challenge existing practices. The style of involvement is also important. If managers are seen to act as gatekeepers for all decisions, however minor, this may convey that the existing top-down approach to management has not really changed. Employees may need unambiguous signals that their empowerment is real. In complex systems, such as healthcare, there was some evidence that senior managers need to have a better knowledge of the process behaviour, otherwise they may incorrectly overrule valid suggestions.

C. Scale and Scope

4.25 Attention should be paid to the management of expectations about the scale and scope of a programme, what should be included and what outcomes might be expected within given timescales. For example, in the case of one of the local authorities a number of respondents stressed the long term nature of their culture change programme which had been going five years and was well embedded (although this still met with some resistance). This supports the view from the literature that attempting culture change over short time scales can be problematic for a variety of reasons, not least, that constantly re-launching or renaming a change programme (in response, perhaps to changes in external drivers) makes people cynical about the "latest fad". In the words of one respondent:

"An 18 month programme is doomed to fail…" ( CS4)

4.26 Some case studies tried to control this by focussing more on small-scale, incremental, short-term process improvement which were reported as working well. In these cases, the methods used included Kaizen, RIE and Plan Do Study Act ( PDSA) which were seen to be better suited to dealing with "bite sized chunks" of processes. These processes included ones, for example 'administrative change' or a 'planning application process' which usually were in the power of the management to implement or had sufficiently high levels of volume and low levels of complexity to implement some quick structural changes.

4.27 Doubt was expressed as to whether Kaizen or RIE, for example, could cope with a more strategic problem such as the integration of social care and health services .

" quick cycle redesign rather than lengthy re-engineering." ( CS3)

4.28 In the case of the RAF, while they focused very much on process improvement they were consciously working towards a time when Lean practices are an integral part of an embedded improvement culture:

"Yes we do [talk about culture] and that's probably another year, two years downstream for us…if we can get the culture right in our people so that when they see something wrong they will fix it as opposed to just finding a workaround…that's a culture we are trying to generate with our people because they are all going to have to do this." ( CS8)

4.29 It was noted that there may be a difference between driving improvement across an organisation of a few hundred people mainly in one physical location and trying to do the same in an organisation with thousands of staff spread across a wide geographical area. One case study hoping to take it further by operating across networks spoke about a future of increased partnership working.

4.30 The analysis leads towards a conclusion that it is necessary to generate a vision of a fully integrated Lean organisation at the outset of Lean implementation. There needs to be clarity about the timescales involved in achieving this vision and an understanding of how the Lean approach may fundamentally impact upon the organisation. Although it is appropriate to start the implementation on a relatively small scale, it should also be made clear to stakeholders that the initial work is part of a longer journey towards the embedding of Lean, through a series of carefully managed steps that steadily escalate the levels of improvement activity and the pervasiveness of Lean. It is evident from the literature and from case studies that partial implementation of Lean is seen as a missed opportunity and risks reversal of the gains achieved. It is the relentlessness of lean that ultimately achieves sustainability.

D. Engagement

4.31 The case sites and pilot studies both demonstrated that a key challenge during the early stages of a Lean implementation is to engage ALL staff in the process as quickly as possible. Communicating among staff is also important in the engagement process (see section E below). Staff need to be engaged in Lean early on for a number of reasons. Staff not included in early RIEs can feel left out of the improvement process, occasionally resulting in a lack of commitment, resistance to the improvement ideas generated and failure to comprehend the different approach to improvement. Additionally, Lean improvement is intended to be "whole system" and there are both behavioural and technical reasons for requiring participation from all relevant groups or departments. Partial engagement may lead to sub-optimal improvement.

There is a clear tension between the need to involve all staff and the need to keep the scale of changes (and the inevitable short-term disruption) to manageable levels. The timing of the engagement of managers relative to RIEs is important, to ensure that the approach is both understood and supported.

4.32 In terms of delivering potential improvements the speed, intensive nature and design of the RIE/ Blitz possibly contributed to the ability to establish truly representative multi-disciplinary teams to implement the changes:

From the service perspective all staff would be involved at some stage in the process ( CS4)

4.33 Amongst those who have participated in Kaizen Blitz weeks, the response was broadly positive, once initial barriers had been overcome:

"The experience of Kaizen was very different. I was very sceptical at first about another improvement initiative - will anything change? My initial reaction was 'do I have to go on this?' " ( CS3)

"My first reaction was 'how do I get out of this? - no chance.' " ( CS3)

"I would like to see more of Kaizen. My initial reluctance has completely changed." ( CS3)

"I wondered 'could it work?' " ( CS3)

"You saw guys today in civvies deliberately to free people up - the guy who presented is a junior rank - at the beginning of the week - he said I'm just a junior in the rank and I said we want you because you are the guy doing the job - only you can tell us how to do it. By the end of the week he was impressive." ( CS8)

4.34 The change in attitude was not confined to the junior staff involved in the practical work. Senior managers also engaged in the concept:

"I was originally very sceptical. I was not a process person but [I'm] now learning the value of process." ( CS3)

4.35 The pilot studies also successfully managed to engage staff and convert initial scepticism into enthusiasm.

4.36 Finally, there was evidence that the experience of participating in a process improvement initiative had changed people's attitudes to the concept and prepared them for a future culture of continuous improvement. For example, in the case of one of the local authorities, at least as important as an outcome of the "Kaizen blitz" was the culture change reported at a personal level by those who had participated in the Kaizen process. Almost without exception the team members interviewed reported that their very negative attitude towards Kaizen was transformed by their participation in the process. This was reflected in other cases too:

"This event has enabled me to spot waste in every process and question why we are doing things in a particular way." ( CS3)

"This process has shown the amount of steps that we are dulpicating and which can be easily eliminated" ( CS3)

E. Communication

4.37 According to the literature, lack of communication is a factor that can lead to Lean programme failure. This was reflected in the case studies where communication of the activities and achievements of the improvement events was not widespread which, at times, led to people feeling as if their efforts had not received wide enough recognition.

"Although internal communication in relation to the change programme had been good, respondents felt that there had been little or no external communication." ( CS4)

"Communication was seen to be a big issue - it was felt that there had not been sufficient internal communications." ( CS3)

"All this is supported by wider communication…this aspect was seen as a weakness by one of the Kaizen team, amongst others." ( CS3)

4.38 Good communication during a Lean implementation has a number of benefits, including:

4.39 In a poorly communicated Lean implementation, the initial enthusiasm for Lean may quickly fall, while other staff not directly involved in the RIE may remain disengaged, resulting in a reduction in improvement activity and a consequent lack of sustainability of the changes made.

F. External Support

4.40 Outside consultants specialising in improvement were engaged by five out of the eight case sites studied. In the other case studies a special team was set up to facilitate the sector. These facilitators performed the role of external consultants to the organisations and they worked with a standard methodology ( e.g.PDSA) which had already been used elsewhere in the sector.

4.41 Two of the three consultant organizations reported that they did not think they were being used to best effect. They did not see the Kaizen Blitz as "true Lean" and suggested that such approaches in isolation would not work as well as a longer-term approach to implementation.

"We try to avoid "kamikaze kaizen" - just seeing a problem - trying to put fires out all over the place. Sometimes they put the fire out but it does not make a real difference to the overall world." ( CS8)

4.42 There are clear benefits and drawbacks to the use of external support. From the case studies that had used management consultants and external support, there were benefits, which included:

4.43 The survey report notes that the use of external support was seen as effective or very effective by the majority of respondents (90%). In no circumstance was the external support seen as ineffective. One caveat, however, is that the management consultants used by the case study sites were all experienced in the implementation of Lean thinking in public sector/health organisations. Consultants with less exposure to public sector work, or experience only in manufacturing, might not be as effective as those used within the case sites.

4.44 The potential drawbacks of using external consultants may include:

4.45 One local authority recognised the risk of becoming dependent upon external support and addressed this by outlining clearly from the start the role of the management consultant.

The task for the consultants was to introduce their version of the Lean approach - which they termed "Kaizen" - to the organisation and build capacity to enable the Council to take it forward itself. This meant specifically:

4.46 Although the risk of dependency is most acute for private sector support, due to the costs of the assistance, the literature also highlighted that the NHS collaborative programmes suffered a similar problem. At some NHS sites the programme support was intended to be present for a period of 18 months. However, it often needed to be retained after the official finish of the programme due to lack of spread of capability to front-line staff.

G. Summary of the Perception of Lean