Toyota will be the biggest car company in terms of cars made as well as the most profitable in 2007. I just had to cut and paste this paragraph from a NY Times article on Toyota becoming the biggest:
"Ford’s new chief executive, Alan R. Mulally, readily says he is an avid student of Toyota, something no Detroit leader in the past would admit.
For American consumers, Toyota vehicles have been “a better value proposition” than Detroit’s products, said Mr. Mulally, who owned Toyota and Lexus cars before joining Ford in September."

Having worked with suppliers to both Toyota and Ford, I believe that a lot of the success of the Toyota approach is the culture they promote which is about perfection, consistency and quality - but all within a win-win environment as Toyota recognise that their suppliers have to win too - although they only win by putting the effort in.

An example of how to get this wrong can be seen in the aerospace industry where a huge supplier had a programme called 'Supply Partners' which actually meant - 'Improve your performance by 10% and then give it to us'. Not unsurprisingly this led to some very challenging relationships.

Whilst TPS (Toyota Production System) is very useful for identifying wastes and improving performance, making it sustainable in the NHS is much more than just the application of tools and there has to be a strong focus on the associated cultural change too.

Drop me a lineif you have any comments to markeaton@amnis-uk.com.

The real power of Lean is that it applies equally to clinical services and administrative operations -- in fact to deliver the results that everyone wants (and needs) Lean has to be applied to the entire value stream - from consultation to inpatient care to follow-up (in-hospital or out) and full discharge .... and all the administraive and support services associated with the patient journey.

A lot of manufacturers tried to introduce Lean by dealing with it at a 'point' (called Point Lean) and found that it had the effect of damaging either upstream or downstream activity, and frequently the impact of Point Lean is that it has not impact on the overall process (the entire Pathway/Value Stream).

In healthcare a lot of Lean has focused on point activities and there has to be a greater focus on both preparing the organisation to go Lean and also on looking at improvements from a Value Stream perspective - as you advocate.

I have successfully implemented lean in manufacturing, for nearly 20 years and over the last 6 years in retail banks and central government. Results have always been fantastic and I and many others only ever use 'point' lean.
Waiting for large organisations to commit to a complete value stream approach is just another excuse for not getting started.
Lean tools, as epitomised in the Toyota Production System, are completely focussed on small team based work. Does Toyota use Value Stream Mapping?
People do not 'get 'lean until they have experienced it in their own workplace and the sooner staff get an opportunity to experience the power of lean, no matter how small the gain in relation to the size of the organisation, the better.

Lean is a philosophy that needs to incorporate all value streams, internal and (to be most effective) external as well.

However there are tools that can be used to affect a change at a single point - 5S and TPM are perhaps good examples of this. And both can have dramatic departmental effects on performance, quality and value delivery.

Whilst single points of change can be expedient and 'get the ball rolling' to be really effective the Lean philosophy has to part of the culture and ingrained at all levels of the organisation. With this in mind the key would be not only to understand what needs to be done and how to do it but to have an implementation STRATEGY that guides the organisation towards fulfilling the value demanded by it's customers (patients, relatives, colleagues, partner organisations ... the list goes on).

It's all about getting the right things done - and that needs support from a knowledgable workforce, in turn supported by strategically focused, Lean thinking managers.

The NHS must have a strategy which is aligned all through its organisational structure to move itself closer to its future vision. If you choose to have "lean" and its tools as a mechanism to support the strategy then the senior leaders must be bought into the philosophy that "lean" can achieve. The correct leadership behaviours must then support the deployment of the strategy or you risk switching off and confusing people as to what direction you are taking. Toyota has the lean philosophy bread into its employee's as soon as they walk through the door and that is what sustains the culture dedicated to improving everyday.

Yep - I too have spent years working in Manufacturing. In a former life I established the DTI's Flagship Lean Programme for Manufacturing and I agree that many manufacturing businesses get a lot benefit from doing point Lean without having to look across the entire value stream.

The problem is the sustainability of improvements.

My own research (now three years old) with 115 Manufacturers who had gone Lean found 87% had failed to achieve sustainable results. Later research undertaken by Henley Management College with 250 Businesses found this was closer to 75% (although I do not have the base data for this as it was just statements they made at a conference).

Only last week I was in Newcastle and met the lead Lean person for NEPA (North East Productivity Alliance - a manufacturing focused body funded by the government) and he was doing his PhD in Sustainability of Lean. His research with 140 Automotive Suppliers demonstrated that 76% have failed to deliver the improvements they wanted over time.

Amongst the reasons for all of these failures are applying Lean at the wrong level (point lean), failing to coordinate improvements, failing to provide sufficient focus for further improvement and not focusing on creating a bigger vision (which can be achieved via Value Stream Analysis within a department, an organisation or an entire supply chain or Health Community).

If you are interested in having the results of my research please drop me a line. I am also hoping to get the base data from the chap from NEPA sometime soon.

markeaton@amnis-uk.com

I am a new member of the nhs networks, so I apologize for picking up on an old thread. I have practiced medicine as an active ED physician for 20 years and as a healthcare administrator for 5. I am currently the Graduate Director for Operational Excellence at Saint Vincent College in Latrobe, PA. As part of this opportunity I am engaged in implementing cultural change at several hospitals with which the college works.
I find many references to Lean initiatives in healthcare and quite a few organizations that have tried Lean/TPS from a tools approach. I find very few who sustain financia or clinicall gains and even fewer who have established a growing organization capable of engaging their employees in a culture of mutual trust and respect, continuous learning and customer first thinking (internal as well as external).
I am interested to find others that are shifting their focus from tools to cultural change initiatives in healthcare.
A number of the facilities with which we are working are showing some very promising results based on cultural change first thinking. They are making great strides in problem recognition and problem solving activities. Clinical outcomes are improving and employee engagement is consistently and noticeably better.
Would appreciate learning of other experiences that you are engaged in in Great Britain or other areas.

I have worked in manufacturing sectors and NHS is new for me. I work throughout the trust training Lean and developing Lean projects in clinics and wards and I find it a "real challenge" to get staff to switch the firefighting culture to the Lean Thinking culture. The lack of resources (staff and financial) and the increasing number of patients, make it difficult for consultants and staff to "get the time to think to do something in a different way" . Whenever one area decides to implement a lean project, they confront that the rest of the departments (some of them acting as their suppliers) do not change so the changes become more difficult to sustain.

I think that the success is based on building a culture as you said, not in offering some tools. In the car assembly companies where I worked, Lean was the way, Lean was a corporate strategy and staff had to work applying Lean and continuous improvement and that set the direction. Staff and management were measured through Lean improvements.

So, I think that in NHS the challenge is firstly to continuously demonstrate that Lean works and we need case studies, we need to share our experiences applying lean (successes and failures) and this is a very good way to do it (this network), secondly to get top management engaged in this cultural changes and have them set in their agendas the action plan in achieving cultural changes and lean thinking behaviours. In this time of financial difficulties is when we need to apply this philosophy and improve continuously what we do with what we have and be able to see more patients with same resources.

I would appreciate your comments and your experience in NHS, which will help me understand better the system.