The First Draft

Running with Knickers on Your Head

I’m pleased to announce that the first draft of my book on achieving change in front-line services is available. It’s been many years in the writing as I’ve changed direction a couple of times, adapted to newer, emerging methods, but recognised that the core of the book is still as pertinent now as it was when I started writing it.

It’s the first in a series of books. The rest should be significantly quicker to appear and will cover more strategic elements. This is the practical book for anyone.

I’ll be launching the book on Amazon, initially for Kindle, however there’s a chance to get it for free. I’ll put details up soon.

How much is too much training?

Hospital ward
I’m divided in this, but lean towards only brief training, just enough to inform them, rather than enough to practice.
 
On one hand, it pays to understand why change in general is necessary and specifically, why the change that you’re about to implement is necessary. Often I see professionals who spend time with the person sat in front of them (and so they are patient-centred) but ignore the mass of people also requiring the same service. It’s not that they can’t see the queue (whether a real standing queue or a waiting list), it’s that if they recognise the queue then they realise that they can’t serve everyone to the same level. For some, it’s a question of professional ethics, where their professional body demands that they treat the person in front of them to the best of their ability, regardless of the needs of others. There are good reasons for that approach.
 
Usually, someone, e.g. a manager or budget holder, recognises the capacity issue and so increases the eligibility threshold or reduces the professional time available for that treatment. This is an attempt to average it out. However it misses the point that some treatments take time to work, if you half the time available, then you may get zero results, not 50% of the results had you allowed the necessary time for full treatment. It also leads to a worsening service as the capacity gets further reduced through a series of cuts, so that wouldn’t be the answer that we’d choose given a choice.
 
More fundamentally, the communities that the local and regional health providers serve are different to those that existed 30 years ago and the changed communities have different needs. So, it seems obvious that we have to adapt the service to meet the changed needs.
 
On the other hand, the health professionals are just that; professionals in health. There will be some with additional skills; some complementary, some tangential. I wouldn’t expect health professionals to be experts at change. However they do need to be aware of the change and why they have to contribute. As do we all, no matter what job we perform, no matter which sector we work in.
 
By recognising the above issues, we can more easily understand why we have to continually change. It’s a matter of adapting to needs. However that doesn’t feel like it requires a formal training in the guise of a university module, more an hour or so during induction combined with some questions during the interview to assess their attitude to change. I expect the professionals to know the service best, so they should be best placed to change it rather than having budgetary changes applied without thought to impact on patients.
 
To get this message across and gain acceptance and commitment from the group, I usually go through the need for change at the start of any change programme and definitely before each intervention.
 
One area where I think some training could be useful is in negotiating and debating how services will change. The changes will happen, but being able to influence the changes could be invaluable. Oddly enough though, it’s probably not the health professionals who need the training, instead it’s for anyone who’s trying to change the service, e.g. performance improvement staff, HR/OD, commissioners, etc.
 
I think the reason for my varied opinions above is that I see a difference between management and change management. I acknowledge that management techniques should be taught in advance as well as broad concepts of changes management, whereas the required, more detailed parts of change management can be taught as required.
 
I don’t believe we should conduct changes without speaking to the end customer. Taking on the role of patient, I’d much prefer the consultant to have spent their time learning how to treat patients, rather than learning how to manage change. Let’s permit some degree of functional specialisation, with front-line professionals continuing to be good at what they do and change professionals helping them create/design the service that the patients need.
 
However, I recognise that many front-line professionals either don’t have access to change professionals or do have access but that they’re not listened to. Hence the need for a book that’s applied for front-line staff.

Service Improvement Book – In Progress

Lean Service Improvement Book

After a year or so working with a large, complex client and some time before that working on a startup, I’m back to writing the book I started a couple of years ago.

Three good things have come from this break:

  1. Both of the experiences have confirmed that the book needs to be written. What I have seen in the last two years has proven to me that there is a gap and this book will fill that gap
  2. Both of the experiences have provided more evidence about which tools and techniques work well
  3. From a personal perspective, the break has given me more motivation to complete the book

I expect to be publishing in 2016.

Forthcoming Book on Improving Your Own Service

Lean Service Improvement Book

Some of you may already know, I’m in the process of writing a book on improving your own service.

Lean Service Improvement Book
write by followtheseinstructions under CC BY-SA 2.0

I’m aiming the book at the people who work the process themselves, e.g.:

  • nurses
  • social workers
  • claims adjusters
  • HR/OD staff
  • office managers
  • office administrators
  • hotel staff
  • and their managers
  • and change agents/analysts

As you can see, it’s not restricted to any industry, but will be most relevant to those working in service industries (whether from private, public and 3rd sector), so that should include:

  • public sector
  • health
  • finance
  • retail
  • leisure
  • legal

More accurately, the information in the book could be useful for any industry, however there already exist books for improving manufacturing production processes, so I have not covered them.

What’s the book about?

The focus is on improving a service without recourse to large consultancy fees and should work well on small changes locally within a team and managed changes with partner teams and organisations (e.g. suppliers and B2B clients). It’s heavily based on Lean concepts, using simple tools, but also includes a framework in which to manage the changes. I’ve borrowed from a number of methodologies and concepts to meld together a method that is suitable for the average worker and implementable in any service team.

Your Input

While I’m happy to write this book alone and for everyone to read, I really like the idea of the readers contributing their thoughts as I write it. This fits nicely with the Lean Startup model, so to accomplish this, I’ve listed the current table of contents below. Please have a read through the table of contents and let me know what you think. If you’re interested in this book, let me know what you want to learn from it.

Draft Table of Contents

Section I: Beginning
1    Introduction
2    Background
3    Where to Start?
Section II: Redesign
4    How to Redesign the Service
5    Detailed steps for How to Redesign a Service
Section III: Other Paths
6    Refocus service on customer
7    Only have today to make changes
8    Bottleneck Resolution
9    Reduce errors and improve service
10    Create a new service
11    Improve office layout
Section IV: Case Studies
12    A Real World Example: Capacity and Value Stream Owner
13    A Real World Example: Duty Role in Social Care
14    A Real World Example: Urgent Cases in Social Care
Section V: Extensions
15    Other sorting methods
16    Making it Happen
17    Managing the Change
Section VI: Continuing
18    Sustaining Change
Section VII: Reflections
19    Important Perspectives
20   Other Frameworks
21    A final piece of advice
Section VIII: Appendices
22    Appendix A: The Rules
23    Appendix B – Pocket Guide for Service Redesign
24    Appendix C – Indicators of Blocked Flow and Waste
25    Appendix D: Tools
26    Appendix E: References
27    Quotes