NHS at Bolton - there's two sides to every story

I've received some anonymous comments on the NHS Bolton/Toyota story - I think they're worth Blogging as they show that there are at least two sides to every story!

Anonymous comment 1

Superbug cases at hospital soar by nearly halfBy Jane LavenderTHE number of people infected with a potentially deadly superbug at the Royal Bolton Hospital has gone up by nearly half.Rates of Clostridium Difficile, which can cause severe diarrhoea and is especially dangerous to the elderly, have increased from 208 in 2004 to 297 last year, according to Government statistics.And the number of people infected with MRSA, which is an infection in the blood, has also gone up from 17 between April and September last year, to 19 between October, 2005, and March this year. From April to September, 2004, there were just 14 cases.

Anonymous comment 2

17, 19, 14? Surely that's just variation

Anonymous comment 3

Threat of strike at cuts hospitalBy Jane LavenderUNION bosses at the Royal Bolton Hospital say they are prepared to hold a ballot on industrial action in a bid to protect patient services.Senior UNISON members say they are horrified at plans for £8 million worth of cuts at the hospital.

Anonymous comment 4

Like Toyota? They're having a laugh.

Anonymous comment 5

Well they can't take it down now can they. That would say even more.

NHS - 250 steps to discharge a patient!

This picture appeared in The Times recently, showing that more than 250 different interactions took place to discharge a patient with complex health problems. With the NHS trying to adopt "lean", one process involving a routine blood sample was reduced from 309 steps to 57 with just simple changes.

They want to "improve service by better understanding how patient demand varies, and identifying and removing the valueless activities that create bottlenecks in the system.

Early results of a study in Bolton showed the lean method helped to cut by a third death rates for patients having hip operations, reduced paperwork in the trauma unit by 42%, and halved the amount of space needed by the pathology dept.

The Chief Executive of Bolton hospital trust said "When we started out, some people were very sceptical. But I've never seen anything that energises staff in this way".

The Government keep saying that the NHS must increase productivity and cut waste before they can justify more public funding. At least in this pilot study, hospital chiefs seem to have understood the new definition that Productivity = maximise customer satisfaction and eliminate waste and rework.

NHS - thinking like Toyota

"Chief Executives of NHS Trusts vowed yesterday to adopt the techniques of Tesco and Toyota to save lives and reduce costs by introducing the principle of "lean" management pioneered by successful companies. By eliminating unnecessary processes, the NHS could speed a patient's progress from A&E to the operating theatre.......

The approach was tested in Bolton hospitals, where mortality rates were cut by at least a third after services were redesigned around the needs of patients instead of the convenience of staff.

(Guardian 15th June 2006)

Toyota or Toyoda?

True or False?
Toyota changed its name from Toyoda in 1937 because when written in Japanese it not only looks better, but it only needs eight brush strokes - a lucky number in Japan.

(from Summer 2006 "If." - The Toyota magazine)

Well... is it true or false? Doesn't say. And I thought Seven was the Japanese lucky number!?

Call centre technology - steam driven

I was watching an agent in a call centre of a mobile phone company. Lots of technology to help - information screens, agent script, extensive intranet, and so on. In a lull between call rushes, she switched to screening emails. Each email is assigned to a different "business stream", each of which have differing Service Level Agreements for responding to email. Her first action was to identify the Business Stream: then refer to a fairly dog-eared piece of paper sellotaped to her workstation, being a list of the "due by" number of days in which a response is promised; then she referred to her desk calendar and counted forward 10, 15, or 20 days according to the Business Stream and entered that date alongside the email on her screen; then she would allocate the email to the appropriate team for response.

No value added there then!

An Insight into one company’s changed culture because of SPC

An Insight into one company’s changed culture because of SPC

Sample job - circulars editor

Before SPC
1. Manager decides improvement/change is required
2. Manager calls in Organisation and Methods Section to analyse job and recommend efficiencies
3. Manager introduces O&M staff to job holder
4. O&M ask job holder to record activity (number of circulars edited during 2-week period)
5. O&M observe jobholder in action (job holder anxious to impress, does not like to be seen to be 'slow')
6. O&M analyse stats of 2 week activity period and compare with observations
7. O&M draw conclusion that even allowing for 'difficult' tasks and unspecified 'down time' jobholder can achieve an average of 'X' editing jobs per day.
8. Jobholder recognises this is 20% to 50% more than currently achieved
9. Manager receives report
10. Manager suggests that jobholder provides a report and strategy for achieving this projected average turnover (this is called empowerment and 'ownership), timescale 2 days
11. Jobholder works late and at the weekend to come up with a scheme which might work.
12. Manager says "excellent! - that can go on your objectives for the rest of the year"
13. Jobholder gets depressed
14. Jobholder works longer hours to achieve 90 % of target by year end
15. Manager understands the difficulties jobholder experienced and only reduces potential bonus by 5%
16. Jobholder resolves to look for another job

The SPC way
1. Data capture - at several points in the life of the document
2. Control charts identify whether process is stable/non-stable and whether particular 'jobs' cause atypical action times
3. Process maps (deployed style)
4. Periods of delay and inactivity in the life of the document identified
5. Further investigation to understand "the voice of the process"
6. Process changes proposed and studied - and piloted
7. Further process changes proposed and implemented
8. Data capture continues
9. Control charts indicate improvement or otherwise
10. Manager involved throughout
11. Jobholder 'comfortable' that improvements are genuine and sustainable
12. Agreed Objective is to follow and implement the Improvement Statement
13. Jobholder and Manager spend much time persuading others that the Objective is SMART
14. The process is improved and the jobholder goes home at nights!!

The most important figures are unknown or unknowable

One of Deming's paradoxical quotes is "the most important figures that one needs for management are unknown or unknowable. David Walker picked up this point recently in the Guardian with an article about how difficult it is to measure productivity in the service sector. For example (in the NHS) "measuring the cost is a damn sight easier than evaluating the output. Just counting the number of patients a consulant sees gives no scope for assessing the quality of the episode or illustrating the improvement that might result, in the long run, in their lives"
It's a problem in policing, too. "Officers on patrol are very unlikely to spot or stop a crime, which makes their productivity seem unimpressive. But a glimpse of a patrolling officer is highly valued by members of the public. They might still feel good even if they registered the "unproductiveness" of the officer in terms of detection of criminals.
Deming lists "Running a company on visible figures alone" as one of the Deadly Diseases of Management. "A company may appear to be doing well, on the basis of visible figures, yet be going down the tubes for failure of the management to take heed of figures unknown and unknowable".