Change Agent Training
Day 1
Objectives of the course
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Apply the Lean methodology to the workplace
Apply practical principles through simulations
Use knowledge gained to develop a Lean
investigation in your own area
Provide a network of support for each other
Agenda
09:15 Lean Simulation
10:30 Coffee
11:15 Transformation Approach Parts 1 and 2
12:00 Lunch
12:45 Transformation Approach Part 3
14:00 Coffee
16:30 Close
Reflection from Half Day Session
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Any thoughts you’d like to share with the group?
Lean Flow Game
Game Number 1!
Learning Points from Flow Game
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Types of ‘Waste’ what were they?
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Transportation
Waiting
Re-work
Motion
Kanban
Flow
Value Stream
Single Piece Flow – no batching
Transformation Approach
1. Preparation
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Voice of the Customer
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Defining Value
Project Scoping
Voice of the Customer
“Lean thinking …must start with a
conscious attempt to precisely define
value…. Through a dialogue with
customers”
James P. Womack & Daniel T. Jones
Who are the customers?
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Who are the users of the service..
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people upstream and downstream of you that
receive what you deliver (patients are our
customers)
payers/manager of the services provide the Voice
of the Business
VoC and VoB can give rise to conflicting
requirements
Can you identify your customers?
How would you identify what ‘value’ means for
your customer?
Project Scoping
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A Project Charter is a simple tool for formalising
the nature and boundaries of the project.
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It allows clear communication to all project team
members and stakeholders.
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No matter how small a project/idea its always
good to draw up a project charter so everyone
knows the scope
1. Preparation
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Voice of the Customer
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Defining Value
Project Scoping
2. Value Stream Analysis
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Data Collection
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Pareto Analysis
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5 Whys
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Value Stream Mapping (process
mapping)
Data Collection
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Before you start any project you must look at
where you are now i.e. baseline measurement
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What data do I need, where do I start?
Pareto Principle (80/20 rule)
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Italian economist Vilfredo Pareto observed that
for many events, roughly 80% of the effects
come from 20% of the causes
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in 1906 he found that 80% of the land in Italy
was owned by 20% of the population
Pareto analysis is a very simple technique that
helps you to focus efforts on the problems that
offer the greatest potential for improvement.
Pareto Principle
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Pareto's principle, the 80/20 rule, should serve
as a daily reminder to focus your time and
energy on the issues that really make a
difference.
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80 per cent of a nurse's time is spent on 20 per
cent of the patients
80 per cent of the decisions made in meetings
come from 20 per cent of the meeting time
When to use Pareto?
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A Pareto Chart breaks a big problem down into
smaller pieces, identifies the most significant
factors, shows where to focus efforts, and allows
better use of limited resources
A Pareto Chart is a good tool to use when the
process you are investigating produces data that
are broken down into categories
A Pareto diagram puts data in a hierarchical
order, which allows the most significant
problems to be corrected first.
Pareto Chart
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Exercise 1 Draw a Pareto Chart
Analysing the Data
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Ask the 5 whys
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1. Why do TTAs take a long time to get to the
ward?
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Because pharmacy don’t get the list of TTAs in time for
discharge
2. Why?
Because doctors don’t order the TTAs in time
3. Why?
They batch them up and do them at the end of the day
4.Why?
TTA pads are at the nursing station and not used during the
ward round
5. Why?
Because it’s always been done that way
Value Stream
“Wherever there is a product or service for a
customer, there is a value stream. The
challenge lies in seeing it”
Value Stream Mapping
What is Value?
In NHS terms – Value is any activity which improves the
patient’s health, well being and experience
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Why Value Stream?
Identifies the core set of actions required to deliver value for
patients
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Why Value Stream Analysis?
To align healthcare processes to facilitate the smooth flow or
patients and information
Eliminate stop – starts and identify ‘hand-offs’
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Value Stream Mapping
Value Stream Mapping
Value Stream Mapping
Value Stream Mapping Exercise
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You are an event organiser and have been
asked to organise a picnic for 10 clients in a
week’s time.
This is the first time you’ve organised a picnic so
you want to document the current state (what
happens now) and test out the process with this
client.
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Start of value stream: Client requests the picnic
End of value stream: Deliver picnic to venue
Value Stream Mapping Analysis
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Step 2 Once you’ve mapped the process identify
the following;
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Who is the customer?
Identify the value added and non value added
steps for the customer
What’s the elapsed time? Min and max
What’s the value added time?
2. Value Stream Analysis
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Data Collection
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Pareto Analysis
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5 Whys
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Value Stream Mapping (process
mapping)
3. Identify Constraints
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Identify Bottlenecks
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Root Cause Analysis
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Variation
Introduction to Variation
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The extent or degree to which something varies
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Too much variation in the workplace introduces
risk, so reducing variation reduces risk.
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E.g. introduction of the Theatre WHO checklist
The variance is a measure of how far a set of
numbers are spread out.
Variation Exercise
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Airplanes!
Reducing Variation
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Can you see variation in your work place?
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How could you use the airplane principles to
identify variation in your workplace? E.g. what
could you measure
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To understand variation in more detail you can
use the fish bone tool
Root Cause Analysis
Man
Materials
Method
Problem
Statement:
Mother
Nature
Measurement
Machine/
Technology
Root Cause Analysis
Man
Height and
strength
Air pressure
of room
One person
throwing all
planes
Different
paper/texture
/size
Not clear
what we
were
measuring
Maintain
temperature
Mother
Nature
Method
Materials
Different
throwing
techniques
Same size
paper
Measure
and scale
agreed in
advance
Measurement
Standardised
operating
instructions
Could we
have used
technology
in this
process
Machine/
Technology
Technology
to be
investigated
Problem
Statement:
Variation in
distance
travelled by
aeroplane
3. Identify Constraints
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Identify Bottlenecks
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Variation
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Root Cause Analysis
Human Dimensions of Change
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Circle of influence
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Role of a Change Agent
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Killer Phrases
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Belbin
What is a change agent?
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Facilitator
Continuous Improvement facilitator
Service Improvement facilitator
Champion of Change
Internal or Lean Champion
Other?
What is a change agent?
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A person within an organisation who has the requisite
knowledge, skills, desire and motivation to make
improvements happen through change
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Usually not in a position of authority within the areas of the
organisation over which they make these improvements
happen
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Someone who achieves improvement results with and
through other organisational members and stakeholders
Change Agent Experience
Planning your project
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Spend the next 20 minutes thinking about your
next steps
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Use the project charter template to think about a
problem and the desired solution
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If you have already started a project think about
which lean tools you might apply to the project
Summary of Learning – Day 1
Change Agent Training
Day 2
Overnight thoughts
Transformation Approach
Waste Walk
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In pairs visit each others department and
observe.
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Note any of the 7 wastes using the waste
template
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When you introduce yourself to the department
please say that you are observing the process
not the people
Waste Walk De-Brief
4. Future State
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Other Problem Solving Techniques
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Ideal Future State
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Future State Map
Motion Analysis
Exercise
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Draw a spaghetti diagram for round 1
Carrying out a Spaghetti Diagram
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Obtain department/hospital plans from Facilities
Agree what you’re going to measure
Agree on your measurements and scale
You will need;
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Red pen or pins and string
Stop watch
Pedometer
Tape measure or measure wheel
Getting to the Ideal Future State
“Think Different”
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Steve Jobs (Apple’s CEO from 1996 – 2011)
along with advertising executives coined the
slogan ‘Think Different’.
Converted the phone into a centre for music,
film, photography, communication etc.
Turned Apple into the most valuable public
company in the world
Creative Thinking
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Divergent
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Ideas generation
Convergent
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What will we test and how will we do it?
Exercises
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House
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Paper Clip
Tools to think differently (Convergent Thinking)
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Random Pictures
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Random Words
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Look to other industries
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What’s the worst thing to do
Exploring an Issue
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RUH North
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The RUH want to create an innovative and
exciting space to house the new cancer centre
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How creative are you?!
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Look at the pictures and note what you see
(outside of the obvious!)
Designing the Future State (Divergent Thinking)
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What ideas could you realistically take forward?
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Be achievable in 6 to 9 months (medium term)
12 months + (long term)
balancing long term actions with quick wins
Designing The Future State
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Design a value stream for an outpatient
appointment within your new Cancer Building
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Start: Patient enters the RUH
End: Patient leaves having attended their
appointment
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Think about pull, flow, value added and 7 wastes
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4. Future State
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Ideal Future State
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Visual Management
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Future State Map
5. Implementation Plan
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Action Plan
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Deliver Findings
Effort Impact Analysis
High
Low
hanging
fruit!
Impact
May not be
worth
investing
the time
Low
Low
High
Effort
Delivering your Findings
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Project Team Meetings
Communications Board
Newsletter – Departmental Bulletin
Intranet
Show information collected – before and after
project – visual impact
Next Steps
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Define your project (using the project charter)
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Talk to key stakeholders
Get to a shared purpose
Start to gather evidence of current practice
Speak to Lisa/Tricia or any of the change agents
Plan your value stream mapping event (if
applicable)
Please complete your feedback sheets, we need
to hear from you!
Feedback
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2 mins feedback on your next steps
Summary of Training
QUIZ!
Any Questions?