1. Change Agent Training Day 1

2. Objectives of the course 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

3. 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

4. Reflection from Half Day Session Any thoughts you’d like to share with the group?

5. Lean Flow Game Game Number 1!

6. Learning Points from Flow Game Types of ‘Waste’ what were they? Transportation Waiting Re-work Motion Kanban Flow Value Stream Single Piece Flow – no batching

7. Transformation Approach

8. 1. Preparation Voice of the Customer Defining Value Project Scoping

9. 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

10. Who are the customers? Who are the users of the service.. 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?

11. Project Scoping A Project Charter is a simple tool for formalising the nature and boundaries of the project. It allows clear communication to all project team members and stakeholders. No matter how small a project/idea its always good to draw up a project charter so everyone knows the scope

13. 1. Preparation Voice of the Customer Defining Value Project Scoping

14. 2. Value Stream Analysis Data Collection Pareto Analysis 5 Whys Value Stream Mapping (process mapping)

15. Data Collection Before you start any project you must look at where you are now i.e. baseline measurement What data do I need, where do I start?

16. Pareto Principle (80/20 rule) Italian economist Vilfredo Pareto observed that for many events, roughly 80% of the effects come from 20% of the causesVilfredo Pareto 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.

17. Pareto Principle 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. 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

18. When to use Pareto? 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.

19. Pareto Chart Exercise 1 Draw a Pareto Chart

20. Analysing the Data Ask the 5 whys 1. Why do TTAs take a long time to get to the ward? 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

21. Value Stream “ Wherever there is a product or service for a customer, there is a value stream. The challenge lies in seeing it”

22. Value Stream Mapping What is Value? In NHS terms – Value is any activity which improves the patient’s health, well being and experience Why Value Stream? Identifies the core set of actions required to deliver value for patients Why Value Stream Analysis? To align healthcare processes to facilitate the smooth flow or patients and information Eliminate stop – starts and identify ‘hand-offs’

23. Value Stream Mapping

26. Value Stream Mapping Exercise 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. Start of value stream: Client requests the picnic End of value stream: Deliver picnic to venue

27. Value Stream Mapping Analysis Step 2 Once you’ve mapped the process identify the following; 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?

28. 2. Value Stream Analysis Data Collection Pareto Analysis 5 Whys Value Stream Mapping (process mapping)

29. 3. Identify Constraints Identify Bottlenecks Root Cause Analysis Variation

30. Introduction to Variation The extent or degree to which something varies Too much variation in the workplace introduces risk, so reducing variation reduces risk. E.g. introduction of the Theatre WHO checklist The variance is a measure of how far a set of numbers are spread out.

31. Variation Exercise Airplanes!

32. Reducing Variation Can you see variation in your work place? How could you use the airplane principles to identify variation in your workplace? E.g. what could you measure To understand variation in more detail you can use the fish bone tool

33. Root Cause Analysis Problem Statement: ManMaterials Method Mother Nature Measurement Machine/ Technology

34. Root Cause Analysis Problem Statement: Variation in distance travelled by aeroplane ManMaterials Method Mother Nature Measurement Machine/ Technology Height and strength One person throwing all planes Different paper/texture /size Same size paper Different throwing techniques Standardised operating instructions Air pressure of room Maintain temperature Not clear what we were measuring Measure and scale agreed in advance Could we have used technology in this process Technology to be investigated

35. 3. Identify Constraints Identify Bottlenecks Variation Root Cause Analysis

36. Human Dimensions of Change Circle of influence Role of a Change Agent Killer Phrases Belbin

37. What is a change agent? Facilitator Continuous Improvement facilitator Service Improvement facilitator Champion of Change Internal or Lean Champion Other?

38. What is a change agent? A person within an organisation who has the requisite knowledge, skills, desire and motivation to make improvements happen through change Usually not in a position of authority within the areas of the organisation over which they make these improvements happen Someone who achieves improvement results with and through other organisational members and stakeholders

39. Change Agent Experience

40. Planning your project Spend the next 20 minutes thinking about your next steps Use the project charter template to think about a problem and the desired solution If you have already started a project think about which lean tools you might apply to the project

41. Summary of Learning – Day 1

42. Change Agent Training Day 2

43. Overnight thoughts

44. Transformation Approach

45. Waste Walk In pairs visit each others department and observe. Note any of the 7 wastes using the waste template When you introduce yourself to the department please say that you are observing the process not the people

46. Waste Walk De-Brief

47. 4. Future State Other Problem Solving Techniques Ideal Future State Future State Map

48. Motion Analysis

50. Exercise Draw a spaghetti diagram for round 1

51. Carrying out a Spaghetti Diagram Obtain department/hospital plans from Facilities Agree what you’re going to measure Agree on your measurements and scale You will need; Red pen or pins and string Stop watch Pedometer Tape measure or measure wheel

52. Getting to the Ideal Future State “Think Different” 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

53. Creative Thinking Divergent Ideas generation Convergent What will we test and how will we do it?

54. Exercises House Paper Clip

55. Tools to think differently (Convergent Thinking) Random Pictures Random Words Look to other industries What’s the worst thing to do

56. Exploring an Issue RUH North The RUH want to create an innovative and exciting space to house the new cancer centre How creative are you?! Look at the pictures and note what you see (outside of the obvious!)

57. Designing the Future State (Divergent Thinking) What ideas could you realistically take forward? Be achievable in 6 to 9 months (medium term) 12 months + (long term) balancing long term actions with quick wins

58. Designing The Future State Design a value stream for an outpatient appointment within your new Cancer Building Start: Patient enters the RUH End: Patient leaves having attended their appointment Think about pull, flow, value added and 7 wastes

59. 4. Future State Ideal Future State Visual Management Future State Map

60. 5. Implementation Plan Action Plan Deliver Findings

61. Effort Impact Analysis Effort Low High Impact Low High Low hanging fruit! May not be worth investing the time

63. Delivering your Findings Project Team Meetings Communications Board Newsletter – Departmental Bulletin Intranet Show information collected – before and after project – visual impact

64. Next Steps Define your project (using the project charter) 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!

65. Feedback 2 mins feedback on your next steps

66. Summary of Training

67. QUIZ!

68. Any Questions?