Closing the Healthcare Performance Gap

Around the world healthcare organisations are being challenged to do more with less resources. In the UK the NHS is trying to find £20 billion in efficiency savings. Can this be done without reducing services to patients? After carrying out experiments in numerous hospitals in several different countries we can now see how lean can help to close this performance gap in healthcare, as lean has done in many other sectors. 

There are two approaches to lean - the bottom-up involvement of front line staff in continuous improvement activity and the top-down use of lean to close critical performance gaps. The weakness of the bottom-up approach is that the many islands of improvement are never joined up to deliver hospital-wide gains. The weakness of the top-down approach is that it fails to address the end-to-end patient journey or to reach down to the front line. 

Combining the two approaches is a winning combination for all parties - less hassle and unnecessary waiting for patients, more time for staff to spend caring for patients and freed-up resources for management to use to meet the challenges facing the organisation - to for instance reduce waiting times, to take on additional elective work or to close excess capacity safely. One of the best examples can be found at the HSJ’s Best Acute Trust of 2010, Calderdale and Huddersfield NHS Foundation Trust, which has reduced medical length of stay by 30% to one of the shortest in the NHS, while also closing two wards last winter. Other hospital pioneers around the world are now following their example.

The first step is to recognise that patient demand (both for admission and discharge) is in fact very predictable, even for emergency patients. Our research shows that much of the apparent variability, including the so-called "winter pressures", is caused by the way internal and external resources are scheduled and compounded by the close proximity to the financial year end, not by patients or the seasons. The second step is to follow the elective and emergency patient journeys all the way to discharge. Typically over 25% of medical patients are medically fit for discharge but continue to block beds for several days. Unlocking this entails re-thinking the way that the work on the wards is planned, the timely delivery of the support services patients need to be able to leave and working with outside agencies to prepare nursing home beds, care in the community or financial support ahead of time. 

The essential building block to manage these patient journeys is a Visual Hospital board where the status of every bed in the hospital is updated every two hours. This makes the "demand to get out" visible, triggers the necessary discharge actions and signals the need to match capacity with changes in demand. The second building block is for the core medical staff to develop and make visible a plan for every patient, detailing what is expected to happen and when during their stay all the way to discharge and that is updated daily. Synchronising these plans makes the work to be done and whether it has been completed clear and visible to all staff. Finally someone has to be given the responsibility for managing the patient journeys across many departments from admission to discharge. Their job is to see that today's work is being done as planned, to unblock disruptions and to gain agreement from all concerned on what needs to be done to improve these patient journeys. Without these foundations, hospital performance is unlikely to improve.   

Putting these building blocks in place, focusing improvement activities and turning freed-up capacity into bottom-line savings is the responsibility of top management. But in our experience NHS managers are locked in a viscous circle that distracts them from doing so. They are continually responding to new policy initiatives from central government, which can translate into over 500 live projects chasing 350 or more targets in a typical organisation The endless rounds of meetings to prepare these project plans, review them and then explain why, on top of an already overloaded day job, they were not completed eats up all their time. We call this the "Bermuda Triangle" of management in the NHS. This makes it impossible to support managers improving patient journeys or to focus efforts on the vital few actions that will make the biggest difference to the performance of the organisation. As long as this viscous circle continues, managers will struggle to realise any efficiency savings. 

This viscous circle also explains why so many well intentioned initiatives to reform the NHS from the centre have run into the sand and failed to deliver performance improvements. Although these initiatives are often hijacked by vested interests, the core problem is that there is no effective mechanism for translating them into action. This is often made worse by periodic structural reorganisations that further distract managers and their staff to worry about their job security rather than improve hospital performance. 

A period of stability in which hospitals and commissioning bodies can work together to align demand and capacity with the available resources and remove sources of unnecessary variability in the healthcare system is the key to escaping this viscous circle. Foundation Trust status is improving hospitals' ability to manage their own finances, but the next step is to create the operational management to improve patient journeys and reduce unnecessary length of stay. Once hospital management begins to see that this is delivering results they will have the confidence to deselect the many other projects that consume valuable resources but do not contribute to improving healthcare
performance. 

Join us to hear this story first hand at our Lean Summit 2011

Yours sincerely
Professor Daniel T Jones

Lean and Operational Excellence

It is a mistake to think of lean as just one of the many tools in the Operational Excellence portfolio. Operational Excellence is really a catch all label for many different "best practices". Lean on the other hand is a very specific set of interlocking practices, tools and behaviours derived from a very clear reference model. Lean grew out of years of practice and experimentation at Toyota and at companies in other sectors that have followed their example. It did not come from applying theoretical insights to business practice.

Correctly understood, lean is a much more fundamental and comprehensive approach to solving business problems and creating value for customers. It is also a great deal more than engaging employees in continuous improvement and eliminating waste.

One of the key things that distinguishes lean is its scope – which encompasses the whole value creation process – such as a global supply chain or an end-to- end patient journey. Instead of developing new support systems - such as better forecasting or decision support systems - lean focuses on the actual work that creates the value customers pay for, which lean thinkers call value streams.

Lean brings many different tools to bear so each value creating step can be performed right first time on time, then links the steps together in a physical flow or through pull signals and then levels the workload to align capacity with demand. As the primary value creating work begins to flow lean applies these tools to synchronise all the supporting activities that enable the primary value stream to flow and all the elements a customer needs to solve their problem – such as the test results, medications and therapies for a hospital patient. This in turn requires the right lean management to ensure the work can flow according to plan, to escalate issues and unblock obstacles to flow and to support root cause problem solving.

The net result is a value creation system designed back from the customers’ definition of value and around the activities that create this value, more accurately and with far less wasted effort and cost. While most organizations cut their teeth leaning their existing activities the true potential of lean comes from the opportunity to redesign the next generation products or services and the value streams that deliver them without the drag of existing assets. Manufacturers are for instance now looking to local rather than distant “low wage” suppliers and polyclinics are now offering services previously only available in big district hospitals.

The other thing that distinguishes lean is its depth. The more activities are linked together and synchronized and the physical or time buffers between them are removed the more the operation of the whole systems depends on the skills, behaviours and direction of every employee.

On the one hand such an integrated system multiplies the probability of interruptions that must be responded to quickly. On the other hand it provides extremely valuable feedback on the causes of these interruptions and other changes, which may otherwise be hidden or lost. It is precisely to leverage this feedback that the core lean skills are not just the tools and techniques, but the use of the scientific method to define and diagnose a problem, understand the facts, try several countermeasures and check which of them solved the problem. Because solving problems can only be done by combining a detailed knowledge of the work with the context of the problem these skills need to be learnt by every employee, not just the experts. Developing these skills and using this experimental approach to constantly improve the performance of each value stream is learnt by doing rather than in a classroom.

In order to enable value streams to flow across facilities, departments and organisations someone has to take responsibility for creating the conditions for collaboration between all the actors involved. Lean chief engineers, project managers and value stream managers carry the responsibility for the performance of their product, project or value stream while the authority over the resources needed to accomplish this remains with vertical department of function heads. The keys to making this work are agreeing the right metrics for tracking the operation and performance of the system as a whole and creating the right visual management context in which to gain agreement from all parties on the facts of the current situation and to commit to a jointly agreed plan going forward. The team then reviews deviations from the plan very frequently, unblocks any obstacles and captures any learning for the future. Lean thinkers use visual management everywhere precisely because it reinforces collaborative behaviours.

Highly transparent and interdependent systems throw up literally thousands of possible things that could be improved across an organisation. The skill of a lean leader is to be able to set the direction and to focus everyone’s efforts on the vital few things that will make the biggest difference to the organization, its customers, employees and shareholders. This means being able to translate organizational goals into measurable gaps that need to be closed and using strategy deployment to create a dialogue down the organization to agree the actions that will contribute to closing these gaps, so these can be adequately resourced while others are deselected. It also means diagnosing and addressing the underlying causes of instability - such as the amplification of orders passed upstream or discharge delays causing queues for admission to a hospital. Finally leaders must act to use the freed up  capacity or cash to reduce costs and grow sales without requiring additional capital.

Yours sincerely
Professor Daniel T Jones

PS. I look forward to debating this and other issues with you at our Lean Summit on 9-11 November in Kenilworth.

How to Judge the Sucess of Lean?

Lean is a journey and to my mind the best way of judging success is by how much people have learnt so far and how ready they are to take the next leg of the journey.

I often meet people who tell me that “Lean has changed their lives”. While this certainly makes writing books worthwhile it also presents an opportunity to ask some probing questions. Can they show me how lean has changed the way they work with their colleagues and the things they are working on? Are they for instance really working together in teams, defining their own standard work, visualising progress against the plan and solving problems that prevent them doing the right things for customers and their organisation? This tells me a lot more than how many training courses or Kaizen weeks they have done.  

I then ask them to show me whether lean has enabled them to change the way the work flow or value stream that they are part of is run. Has lean helped them to create stability where there was chaos, to level the work and to allow it to flow in line with customer demand? Indeed are they clear who their immediate and final customers are and can they distinguish real from created demand? From their answers and looking at their value stream maps it soon becomes clear how much of their end-to-end value stream they can see, particularly beyond their own area, facility, department or organisation. It is also easy to see whether the underlying logic has fundamentally changed – from batch to flow and from push to pull etc. 

The next step is to ask whether they have managed to join up all the lean improvements along their value stream and deliver significant results for customers in terms of quality, delivery and cost and for the business in terms of freed up cash, greater productivity and growing sales, while saving or forestalling capital expenditure. Moreover have these results been recognised by senior management, because being able to demonstrate that a good process is the best way to get good results is essential to sustain support for lean from the top. 

As we learn to practice the scientific method embodied in A3s I increasingly hear managers say that “Lean has changed the way I think”. I now start by asking what the problem is that I am trying to solve and how important it is that this, rather than many other problems, get solved.” Taking a look at their A3s shows you a lot about the thought process behind the stories their A3s are telling. The less polished – in pencil and rubber rather than PowerPoint – and  the more visual – more pictures and less words – the deeper this thinking has taken root. Their portfolio of A3s also tells you the scope and level of the problems they have been able to tackle to date.

Then I ask managers to take me on a Gemba Walk of the areas they are responsible for to understand how deeply this thinking has spread and influenced decision making. Are the key targets, the progress of the work against plan and current problems visible and regularly reviewed on the Gemba, or are decisions still based on data reviewed in an office? Are escalation processes to respond quickly to problems clear and is everyone engaged in reviewing the progress of project A3s on a daily or weekly basis? Is management using A3s to translate higher level goals into actions and to create a dialogue between teams along the value stream and are they using these projects to mentor staff in using the scientific method?

I then ask whether this scientific approach to thinking has improved the productivity and effectiveness of management, particularly in the way they use their time. Can they really focus on the vital few actions that will make the biggest difference in meeting their goals while having the confidence to deselect the rest? Do they spend far less time in endless meetings and more time reviewing progress and projects on the Gemba? Has the greater stability in their processes freed up time spent fire-fighting that can now be used to lead and mentor improvement activities?

I am now beginning to hear managers say “Lean means we need to change the way we manage” . Yes it does! This is an important threshold when top management recognises that they have to lead their lean transformations and focus these new ways of working together and new ways of thinking on closing the key performance gaps that will make the biggest difference to the business and to their customers. Has the debate over the vital few gaps been visualised in an Oobeya room and turned into key projects and actions using strategy deployment? Have these key projects been resourced and the many other projects deselected? 

This leads to the next important step which is giving someone the responsibility for leading these end-to-end projects to turn previously separately managed activities into an integrated work flow or value stream, including synchronising all the key support processes. Managing the relationship between this horizontal responsibility and the vertical authority over the resources necessary to accomplish this redesign is a new challenge. Is the organisation ready to embark on experiments to learn how to make this work?

The final challenge is to recognise that in the end lean is a line and not a staff responsibility and that lean knowledge is developed through involvement in successive controlled experiments – learning by doing – rather than through a standard training programme rolled out by experts from the centre or by outside consultants. A lean transformation is built through running clusters of controlled experiments, building knowledge through communities of practice and shared through recognition ceremonies and an intranet of project A3s. In my experience this “get to action quickly” approach not only generates faster results but also “turns on the lights” in peoples’ heads to own it and run with it over time, rather than survive another initiative from head quarters.  

As we have seen the lean journey is about learning new ways of working together , learning new, scientific ways of thinking and learning new ways of managing organisations. The more you learn the more you discover there is to learn!

Yours sincerely
Professor Daniel T Jones

Managing Visually

Learning to See is the starting point for Learning to Act. By making the facts of any situation clearly visible it is much easier to build agreement on what needs to be done, to create the commitment to doing it and to maintain the focus on sustaining it over time.

However what makes visualisation really powerful is that it changes behaviour and significantly improves the effectiveness of working together to make things happen. It changes the perspective from silo thinking and blaming others to focusing on the problem or process and it generates a much higher level of engagement and team-working. This can be seen at many levels on the lean journey. Here is my list, but I am sure you can think of many more.

Standardized work defined by the team as the best way of performing a task makes the work visible, makes the need for training to achieve it visible and establishes a baseline for improvement. Likewise standardized management makes regular visits to the shop floor visible to audit procedures, to review progress and to take away issues to be resolved at a higher level.

Process Control Boards recording the planned actions and what is actually being achieved on a frequent cadence make deviations from the plan visible, so teams can respond quickly to get back on plan and record what problems are occurring and why for later analysis.

Value Stream Maps make the end-to-end process visible so everyone understands the implications of what they do for the rest of the value creation process and so improvement efforts can be focused on making the value stream flow in a levelled fashion in line with demand.

Control Rooms or Hubs bringing together information from dispersed Progress Control Boards makes the synchronisation of activities visible along the value stream, defines the rate of demand for supporting value streams, triggers the need to escalate issues and to analyse the root causes of persistent problems.

A3 Reports make the thought process visible from the dialogue between senior managers and the author or team, whether they are solving problems, making a proposal or developing and reviewing a plan of action.

Strategy Deployment makes the choices visible in prioritising activities, deselecting others and conducting the catch-ball dialogue to turn high level goals into actions further down the organisation.

Finally the Oobeya Room (Japanese for “big room”) makes working together visible in a project environment. So far it has been used for managing new product development and engineering projects. However organisations like Boeing are realising how powerful it can be in managing projects in the Executive Office (see the presentation and the podcast by Sharon Tanner).

The Oobeya Room is in my view the key to making all this visualisation effective. It brings together all of the above to define the objectives, to choose the vital few metrics, to plan and frequently review the progress and delays of concurrent work-streams, to decide which issues need escalating to the next level up and to capture the learning for the next project (see the Discussion Paper, presentation and podcast by Takashi Tanaka).

But more importantly it creates the context in which decisions are based on the facts and recorded on the wall, avoiding fudged decisions and prevarication. It also ensures that resource constraints and win-lose situations that can arise between Departments are addressed and resolved so they do not slow the project down.

Reviewing progress and delays on a daily or weekly basis rather than waiting for less frequent gate review meetings leads to much quicker problem solving. Because these stand-up meetings only need to address the deviations from the plan and what to do about them they also make much better use of management time.

In short the Oobeya Room brings all the elements of lean management together. Taken to an extreme visual management can of course itself become a curse. I have seen whole walls wallpapered with often out-of-date information that is not actively being used in day-to-day decision making.

Learning how to focus attention on just the right information to make the right decisions in the right way is the way to unlock the real power of visualisation and team-working in the Oobeya Room.

Yours sincerely
Professor Daniel T Jones

The Financial Consequences of Lean

Why is it so hard to see the financial consequences of lean? Failure to answer this dilemma has derailed many lean initiatives. This is not such a problem if top management really understands the significance of focusing on getting everything to flow right-first-time-on-time to customers. Like top management at Toyota and Tesco, they know that good processes lead to good results. Alternatively if you have an experienced Sensei who knows where the gold lies buried and who has worked on similar situations before, there is a good chance that they can help you to deliver the kind of results you expect from lean.

But in my experience help is needed if you are pioneering lean in your organisation while at the same time trying to convince top management that it can deliver lasting financial results. This is particularly true when you are dealing with a complex shared pipeline with multiple steps and routings through which many different products or services flow. It becomes much harder to see where to act to deliver the greatest gains for the organisation and for its customers. And as my colleague John Darlington has shown traditional accounting systems and even sophisticated product costing systems end up rewarding the wrong kinds of actions.

As John puts it, they encourage overproduction by valuing what has been made not what has been sold, they do not recognise the importance of bottlenecks and constraints, they encourage point optimisation rather than flow, they have nothing to say about lead times, they promote the idea that bigger batches lower the unit cost and they encourage cost reductions that often prove to be mirages. In other words they fail to show the power of focusing on compressing lead times, which lies at the heart of lean. Struggling against this kind of headwind is almost impossible for any length of time.

Unlike Financial Accounting for reporting results to the outside world, we are free to choose how to construct our internal costing systems to drive the right kinds of actions. For instance lean organisations use Target Costing systems to focus improvement efforts in new product development. Why do we not do something similar to design and improve how well we run our end-to-end processes or value streams, particularly where they involve shared resources and cross several departments?

John shows how adding operating expenses to value stream maps for all the products going through these shared resources and turning inventories into time gives us the basis for Flow Costing, which relates the time products take to flow through the value stream (rather than to the cycle time through each operation) to the operating expenses of running it. Inventories (and delays in services) are the richest source of insight into how well we are using our capacity to generate money through sales.Shorter throughput times increase the ability to respond to quality problems and to introduce engineering changes, they may make it possible to raise margins and postpone the need for new investment, and meet due dates with lower finished goods stocks.

The real value of Flow Costing is to help set the priorities for lean improvement actions by being able to see the financial consequences in terms of increased sales, less cash tied up in inventories, reductions in operating expenses and postponed investments. These priorities can then be built into the policy deployment goals for each department, and the resources in their budgets to accomplish them. Flow Costing is a powerful way to help to bring throughput times much closer to value creating times, by which time the differences between Flow and Product costing systems almost disappear.

Yours sincerely
Professor Daniel Tiones

What Makes Lean Work?

Toyota’s lasting contribution to the practice of management is that it created a unique synthesis of three fundamental approaches to improvement — the analysis of quality and the use of the scientific method learnt from Shewhart and Deming, process thinking about organising the flow of work inspired by the early Henry Ford and honed through Taiichi Ohno’s own experiments at Toyota, and how people learn drawn from the Training Within Industry programme developed by the US Government during World War II.

Many organisations have experienced the power of engaging employees in using lean tools to eliminate waste in their workplaces. Others have gone on to use the lean principles to streamline the flow of work through their value streams. But in fact these are only part of a very different way of managing and leading change. While a lot has been written recently about Toyota’s management tools, such as A3 thinking and strategy deployment, it is equally important to understand the purpose or the glue that makes them effective. The key is not the tools themselves, but how you use them. A good way of seeing this is by asking four fundamental questions.

First; how to focus everyone on the vital few improvements that will make the biggest difference to the organisation? The lean answer is to use the scientific method to understand the choices and to dig down beyond what are in many cases symptoms to the underlying causes, which are often common. Addressing these common causes is much more effective than jumping to many different solutions and launching hundreds of projects, hoping that some of them succeed.

It is no accident that the first things a new manager ¡s given by their superior when they join Toyota is a problem and an A3 form. The A3 frames the dialogue between them and ensures that no step is missed on the journey from really defining the problem, through going to gather the facts (rather than just relying on past data), establishing a target condition or the gap to be closed, understanding the root causes, proposing a series of countermeasures (not just one), checking whether these worked and reflecting on the lessons learnt. All the time the superior is asking questions rather than telling the subordinate the answers.

Struggling to define the problem, understand the root causes and come up with alternative ways of addressing the problem is a really formative experience which lays the basis for a deeper understanding of more complicated problems as managers rise through the ranks. This experience greatly facilitates the tough discussions about deselecting the many to focus on the vital few in drawing up the strategy. I also helps to frame the deployment discussions with each level down the organisation to translate these vital few goals into the vital few actions that will close the important performance gaps. The deeper point of using the scientific method to focus on the vital few is that everyone learns to think in the right way about the right things.

Second; how to close the performance gaps which are critical for the organisation? The lean answer is to remove the obstacles to the flow of work that creates the value that customers are paying for, which we call a value stream. This means combining previously separately managed activities into an integrated value stream, eliminating the sources of unnecessary variation, optimising the whole rather than the parts, removing queues, bottlenecks and handoffs as they cross from one department to another, and aligning the flow of work with the rate of demand. In most organisations no one sees or is responsible for these horizontal, end-to-end value streams. There is now a wealth of experience in using the right lean principles and tools in the right sequence to redesign all kinds of value streams.

However no value stream is an island and exactly the same principles are needed to streamline and synchronise all the support activities that enable the primary value streams to flow, such as delivering the right drawings and parts to assemble an aircraft or delivering the right test results, take-home drugs and therapies to be able to discharge a patient from hospital. The third critical dimension to enable value streams to flow is aligning the management decision-making processes with the heart-beat of the value stream, so problems are escalated and responded to quickly and projects are not held up waiting for infrequent review meetings. Quite simply this means seeing and managing the organisation as a collection of inter-connected processes or value streams as well as the traditional, vertical organisation chart.

The final piece of this puzzle is to see how streamlining these work flows translate into bottom line savings - cash freed up by reducing unnecessary inventories and delays, capital investments in extra capacity or warehousing for instance that are no longer necessary, lower unit costs from being able to make more with less and growing sales from more satisfied customers. The deeper point of taking a value stream perspective is learning to see the whole and where to act to close the critical performance gaps.

Third; how to change behaviour in order to work together more effectively along these value streams? The lean answer is to plan not only what should happen to every product, patient or drawing as they progress through the value stream but exactly when this should happen and to make progress and deviations from this plan as visible as possible. Reviewing progress on an hourly or daily basis enables teams to respond quickly to get back on plan and to prioritize recurrent problems for root cause analysis.

Making progress and problems visible in a no blame environment is much more productive than hiding them from view or in a computer. It is also essential to be able to manage a much more interdependent process where interruptions have a much greater impact on overall system performance. Anyone who has been part of a value stream mapping exercise will have witnessed the dramatic change in behaviour as participants stand in front of the map and see for the first time how to fix their broken process rather than blaming each other Managers also begin to recognise that their role is to support front line staff in doing their work and helping them resolve the most important hindrances to doing so.

This is equally true in a project environment. Toyota’s Oobeya or visual project room is an effective way to gat agreement from different departments on common actions and to agree the few common metrics on which the project will be measured. Breaking the work into daily or weekly increments and reviewing progress daily means that slippages and issues that arise can be dealt with quickly, rather than waiting for the next gate review meeting. Capturing these issues also provides a rich source of learning for future projects. The deeper point about making everything visual is learning to work together to optimise the whole system.

Fourth; how to sustain the gains? The lean answer is by building new knowledge through learning by doing. We have already described the power of mentoring using A3s throughout the organisation. In a complicated social environment where causality is not always clear real learning comes from doing many controlled experiments to see what works and what does not. Very often problems are not where people think they are and the root causes are also not always obvious. Establishing a common language for all kinds of problem solving makes it possible to capture and share not only what worked but also how problems were solved, so others can do the same.

Learning by doing is also the basis for a very different approach to lean transformation. Instead of spending a lot of time planning and then deploying a centrally designed training programme across the organisation that is quickly forgotten when the experts move on, a lean transformation begins with a series of controlled experiments in key activities to build an experience base as quickly as possible. This then forms the basis of further experiments and for building communities of practice to share results and experiences. These may also be consolidated on an intranet accessible to everyone in the organisation and reinforced by competitions and recognition ceremonies for the winning projects. The deeper point to this experimental, evidence based approach is that everyone learns how to learn by doing and reflecting.

The net result of all of this is that organisations are able to do new things that were previously impossible to do economically. The business opportunity is to use these new capabilities to turn the tables on your competitors, until they learn to follow your example, by which time you should have moved further ahead. But that is another story for another e-letter.

Yours sincerely
Professor Daniel T Jones

Convincing Executives to go Lean

I was recently asked how to convince senior executives to go lean. The best way to answer this question is to summarise two contrasting real stories — one that got it and one that still does not — at different ends of the same sector.

The successful case began with a question from a senior Director — “How could these lean Toyota ideas help my business?” “Let’s take a walk and see” was my answer. As we walked it because clear there was waste everywhere. This very quickly led to a meeting with the CEO who was intrigued and gave us the go ahead to begin some experiments to demonstrate the potential scale of the improvements that might be achieved. But I insisted that we begin by taking a team of top managers from this company and a few of their suppliers to walk the end-to-end process back from the customer. This proved to be a game changing experience — they were shocked at what they now learnt to see!

So we were quickly given several places to carry out experiments and these quickly showed huge amounts of wasted time and effort could be saved. At the time no one had tried to do these things in this industry, even though I had the Toyota example as my reference model. Meanwhile teams from both companies began meeting to reap the low hanging fruit they could now see. And their internal team worked with other consultants to calculate the financial implications of the process savings we were demonstrating from each of our experiments. This was essential to get Board approval to go further and do the next set of experiments. In each case once this had happened their team worked out the operational detail before rolling out the next piece of the system as the new standard across the business.

Gradually as the different pieces came together more savings were uncovered. The fastest things to change were the physical operations and it took a few years before the systems could be changed to support the logic of continuous flow. But the CEO was quick to spot new capabilities he could build on to introduce new business models that were previously too expensive to do. The rest is history — they moved from an also ran in the UK to number three in the world in a decade and their competitors are still struggling to catch up with them! The Board never lost sight of the core insight that removing any interruptions to the flow of products through their system would be good for them and their customers and they never used lean language to describe what they were doing, even though their Chairman is a great admirer of Toyota!

The other case also started with the same question — but from the head of improvement. Several meetings in hotels eventually led to a visit to HQ to meet the new CEO. This company was making huge profits so I did not get a clear answer to my question “Why do you want to do Lean?” This was followed by days of meetings with armies of very bright staff in the improvement function at HQ and a few awareness training sessions. Which were followed by more visits and more meetings to refine our PowerPoint proposals and to develop their Training Manual and the Plan for rolling this out across several hundred plants across the world. These visits continued for several months, and frustration began to set in.

Meanwhile we persuaded them to allow us to begin some experiments in chosen plants to build some demonstration sites and create a network of people with hands-on experience. Because this company had a long history of rolling out new initiatives from HQ local plants were very wary of this new programme as they saw it and jealously guarded their independence and as a result these experiments quickly ran into political problems. Our approach was seen as rocking too many boats and they began to look for more traditional consultants who would stick to training and improvement workshops. This came to a head when we were only allowed to do our workshops in hotels and not on the shop floor and when their central improvement team asked for our proposals and then blocked us sending them to the CEO!

We probably learnt more from this “failure” than from the earlier success. In retrospect we failed to get them to define the business problem the CEO was trying to solve with lean. We never managed to persuade his senior team to take a walk through the process with us. We were told this could only be done with an army of minders and a big security presence. We never convinced them that this was not about rolling out new tools across their plants but about getting to action quickly to design a set of carefully controlled experiments to create hands-on knowledge and examples.

But the biggest obstacle turned out to the very bright staff in the improvement function at HQ who wanted to control the roll out of the programme based on their theoretical understanding rather than hands-on operational experience with lean. I have since seen very similar situations in several big multinationals, where we were in danger of getting sucked into a never ending cycle of meetings to discuss ever more elaborate PowerPoint presentations that never result in any action!

But I do not despair — we planted the seeds of lean. I know that several of their competitors have got it and are making steady progress and achieving dramatic results. As these translate into growing market share and volumes this company will be back in a couple of years asking why all the money they spent on more traditional consultants did not yield the same kinds of gains. Resisting the temptation to say “we told you so”, we can begin again with a bottom up programme of controlled experiments, tightly focused on closing the vital few gaps that will make the biggest difference to the business. Over time we will link them together and build the community of experienced lean line and plant managers who can make it happen day in day out. The focus and the will to work across functions to make this happen can only come from the top. I have always said that I only need one company in each industry to really get what lean is all about — and in time the rest will be forced to follow!

Yours sincerely
Professor Daniel T Jones