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Look at the Evidence – the Spike and Delay Pattern in Social Care

signature
A number of years ago, I was transforming a city’s social care directorate and, as part of that transformation, we aimed to reduce the time it took to do anything when interacting with the service. The transformation was based on a more fundamental need to free up workers to be able to do the work they were meant to do rather than having to fight the fires caused by delays and resulting failure demand. I instigated a methodical approach for identifying which cycles to focus on first. As the team progressed through the cycles, I noticed a pattern; it’s the spike of activity followed by a lengthy delay as discussed in a previous article.
As we looked in particular at a few cycles of spike followed by a delay, I routinely advised the team to question the need for that common feature of bureaucracy: the signature.

Why require a signature?

In the case of social care, signatures are often required from service users or their representatives. This can be as proof that the content of a form is accurate or as a record of the service user providing consent (either for data to be shared from the form or for the authority to request data from other agencies).
These signatures create the spike-delay pattern in which a short spike of activity is followed by a lengthy delay while the authority sends the form to the customers and waits for the return of a signed copy. Part of that delay is caused by the postal service in both directions. Part will be the time it takes the service user to open the letter, read the form, make amendments, find an envelop and stamp and then go to the post box. Considering the high percentage of infirm service users compared to the general population, that sequence of activities can take a long time. Then we have the additional wait time caused by processing the response as it arrives into the authority.

First approach

So, my first instinct is to remove the need for a signature and thereby remove the need for the spike-delay round. This could be changed from requesting a signature to providing information on the form that the data will be used. If you don’t agree, don’t submit the form. The response from staff was that we needed the signature as a record of consent and/or accuracy, depending on the form in question.
On the fact of it, that seems a reasonable and fair response.

What does the evidence say?

However, the data showed a different reality. What actually happened is that, even if the form wasn’t returned, the process could still go ahead. True, it didn’t go ahead for every service user, but the fact that it could proceed implied that the signature wasn’t always required. Or rather, wasn’t required all of the time. We were able to look at the data to understand how many service users progressed without signature, we were able to look at common characteristics, etc.
By presenting this understanding back, we ended up moving forward in our joint understanding of the process; joint in that the consultant and the team had the same understanding. Before that point, they had had different interpretations.

So where does that leave us?

An undocumented process or exception is a risk. In the above case, we had uncovered that some of the cases were allowed to progress without signature, but there was no documentation defining which cases could proceed and which cases had to stop. Instead it was left to individual judgment, but again without defined criteria. So what happens if the usual staff members weren’t present? Were the decisions they made equal and equitable to all involved? How did we measure the outcomes?
Depending on the type of organisation and service involved, there will be a different focus regarding the risk involved.
In this case, we had a process with an unclear gateway, e.g. do we continue or do we halt and wait?
  1. Complete the analysis in terms of understanding when the process can continue.
  2. Engage with service users to understand what they need out of the process, what their engagement should be
  3. As a team, choose a default option, either they progress by default or they pause by default
  4. Help the team define the rules that govern the exceptions
  5. Implement a training and induction programme for ensuring that everyone knows how to apply the rules
I always prefer the default option to be the one that improves efficiency, e.g. the one that’s the most common option or the one that removes a spike-delay pattern.

Impact

The wider understanding that, in most cases, the signature wasn’t required let us to a better solution. Had we not challenged either with data or further questioning, we would have been left with the difficult situation of lack of signatures stopping the process and the resulting action of requiring signatures in order to proceed. Instead by challenging the assumption and developing solutions to the issues of the spike-delay caused by several signatures for a sequence of documents, we were able to reduce the expected time from 6 months down to just over one day (actually 2.5 completions per week). That’s a massive difference in expectations for customer and the organisation serving the customer.
Anything to say, get in touch at @alanward.
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The Delay Following the Spike – Issues with Cycle Time in Service Industries

speaker
How long does it take you to do what your customers want? Not just the first part, but the whole of it?

1. The Pattern

I see this pattern commonly replicated across service industries. It involves a very short spike of activity (e.g. 5-20 minutes) followed by a lengthy delay where something is sent to the customer and the organisation waits for the return. This is followed by a 2nd spike of activity which in turn is followed by another lengthy delay. Depending on the bureaucracy involved, this process may involve several rounds of spike and delay, each adding to the overall delay in service for the customer and, most likely, increasing failure demand on the organisation.

2. Some Samples

Let’s have a look at a few industries and see how this pattern plays out:

2a. Retail Industry

Bed
A bed to sleep in: What the customer wants
Take for example, ordering a new item of furniture. We’ll start at the sales phase – although the complete process starts before then with marketing or customer acquisition – where the customer is in the retail store.
The customer, let’s call her Lilly, is buying a bed. Lilly spends up to an hour viewing and trying beds on a Saturday afternoon, talking to the sales advisor and then committing to buying one particular bed. The sales advisor creates the order, takes details in order to arrange finance, takes some information regarding proposed delivery times.
This is the first spike. There may be finance involved and almost definitely delivery involved. Lilly is told that the delivery company will contact her by the end of the week. That’s the first disappointment, can’t they arrange delivery now for later that week? Instead, she begrudgingly continues with the order hoping for a delivery time that meets her needs.
Some customers stop the order and go elsewhere. They’ve arrange finance, but may not have committed at this stage. For Lilly, who continues with the order, she goes home, then spends her week as normal waiting for the phonecall. This is the first of the delays. In Lilly’s case, the delivery company ring her on Tuesday, two working days after the order. Two days is a long time when you’re waiting. And it’s definitely a long time when compared to the processing time in the showroom on that Saturday afternoon. So it would not have been surprising had she rang the salesman on Monday or even Tuesday morning, creating failure demands disturbing him from achieving more sales.
The delivery company have a van that delivers to Lilly’s area on Tuesdays but she’s missed the delivery for that week so it will be the following Tuesday. This is the second spike followed by the second delay.
The week passes and Lilly receives the bed at her house. She finds there’s a part missing and calls the number. There’s a spike of activity as the after-sales staff figure out what’s missing, decide what to do with it and then initiate that action. For Lilly, it’s a small part that’s missing, so they’re going to post it to her. A few days wait ensues and, on Saturday – that’s 2 weeks after the order was placed – she receives the part.
It’s broken, either in the post or during the picking process. Again she calls the after-sales and they go through the same conversation as the previous week; this time a bit more aggravated. The part arrives intact on Tuesday and 2 weeks and 3 days after the initial order, Lilly has her bed.
If we take into account a pro rata of the delivery effort, we end up with about 5 hours activity across 17×8 hours = 136 hours. That works out at 3.7%. If we look at the actual value-add activities rather than all activities, that’s probably a lot less (i.e. the original order time plus the delivery, but not arranging the bed delivery or arranging for delivery and redelivery of the missing part). Let’s say that’s 1.5 hours including ordering, picking and delivery that works out at 1.1%. That also assumes that we’re looking at working day hours, not full 24 hours as customers are becoming more accustomed to. Had we considered 24 hour days for 7 days a week, that 1.1% reduces drastically.

2b. Service Function

speaker
A working bluetooth speaker
Michael is returning a bluetooth speaker to an online retailer. It’s Saturday evening but, like most, the website is 24×7. First he logs onto the retailer’s website, looks at his past orders, finds the order for the bluetooth speaker and submits a complaint. This is the start of the RMA process that’s commonly used for returning (technical) goods.
On Monday afternoon, Maria a member of the service function, replies to Michael’s email. Maria expresses regret about the fault and attaches a fault reporting form for Michael to fill out. Michael’s a bit annoyed about this; he’s already provided some of the information in his original email to the company. However, he does accede that they will want some additional information in the form.
He has to print the form but he can’t do that until he’s next using a computer that can open the pdf document and print it to a nearby printer. So on Wednesday evening, he prints the Fault Report form, writes the details and then scans it. He emails back the completed form that evening.
On Thursday morning, one of Maria’s colleagues, Zoe reads the form, agrees that the bluetooth speaker is faulty and then sends Michael the RMA note, authorising the return.
Michael has to print this out, so again has to be next to the printer. He does this on Saturday morning, boxes up the speaker and posts it on Saturday afternoon. The parcel arrives on Tuesday morning, opened by customer returns who agree with the fault, authorise an exchange to be sent to Michael and inform Michael of such. Michael reads the email on Tuesday afternoon, around the same time that the warehouse dispatch his replacement to him.
On Friday morning, the delivery company attempted to deliver the replacement speaker to Michael’s address, but as he was working, it was returned to the depot. “Fortunately” for Michael, the depot is open on Saturday morning, so he drives to the depot and collects his blue speaker. That’s not really fortunate since a better solution would have been to have checked with Michael when he would be available to receive the package. But it could be worse, the depot could work standard mon-fri office hours.
Almost 2 weeks have passed since Michael reported the initial fault, with more effort required of the customer than of the retail company (so far). Michael has probably spent 4 hours of his time in sending emails, reading emails, printing, completing forms, boxing, arranging for delivery and subsequent collection. The retail company spent 3 minutes in the initial fault report form, 3 minutes reading the fault report form, 5 minutes arranging for the RMA, then 5 minutes despatching a new one. Less than an hour. They’d also have disposal or return of the fault item plus accounting and other supporting activities. However, having spent less than an hour of “value” time in the returns process, the company managed a process that took two weeks. The ratio of value added activities to the length of time to complete the process is low, 1 hour to 24 hours x 14 days = 0.29%. That’s not uncommon.

2c. Local Authorities

signature
signature
This is where I first encountered the pattern. Instead of writing about it in this article, I’m going to save it for its own article as I’d like to explore it in more depth. The pattern is rife in local government and related services. I’ll post a link here when the article has been published.

3. The Calculation

There’s a term for this concept and formula for calculating it. It’s called CPE for Cycle Process Efficiency or occasionally PCE for Process Cycle Efficiency.
In this case, I’m calculating the time for the whole end-to-end service process. If our examples are consistent, then the service function is showing a Process Lead Time of 2 weeks per unit. That’s the elapsed time it takes from the point that the customer first contacts us to the point that we deliver the solution back to the customer.
We also require the Value Add Time, i.e. how much time per customer is spent creating or transforming value? This may actually be easier to arrive at the Value Add Time as equal to the Process Lead Time minus the Non-Value Add Time. It’s often easier to identify the steps that do not add value. Whichever route we take, we’re aiming to identify the Value Add Time for this process.
The PCE is then the Value Add Time divided by the Process Lead Time. It’s usually way lower than you initially think. If it’s above 70%, then you probably haven’t identified all the non-value add steps. To put that statement into perspective, I’ve seen PCEs lower than 1% for appallingly bad processes and improved them to 25% for a drastic improvement. Unfortunately, finding PCEs <1%  is not that uncommon.

4. Resolution

So what can we do about the pattern?
1) Recognise if the pattern is active in your organisation’s services.
2) Focus on the delay. You’ll almost always achieve more value and improvement from resolving the delays since they outweigh the spikes.
3) Consider different methods for removing each round of the spike-delay pattern.
For example, in the returns process, the fault reporting form could be on the website, ready for customers to complete. In addition, the organisation could implement automated authorisations when submissions meet certain criteria. This could include printing returns labels on the invoices packaged with the original goods. That would be 2 of the rounds reduced.
There’s no question about the fact that fixing the problems so that they do not happen again is the most important step and will have a greater impact on CPE than any factor. However some of the above issues with CPE don’t involve a failure (such as a defective part), but are due to the inefficiencies present in the process. These are often caused by a bureaucratic need to manage risk. The question then becomes one of addressing that risk through other methods.
Do you want to comment, get in touch at @alanward.
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Where Do I Learn? – Part 2 – Books

Books

If I’m driving, I’m listening to podcasts. If I’m travelling by train, then I’m reading.

I typically read books that don’t directly relate to my profession, but those that I hope will change my approach to how I work with clients.

For every client I go to, I end up mentoring business analysts, business architects, programme manager, project managers and other change programme staff. So I’ve kept a list of references (not just books) on Evernote and I tailor it to the person I’m mentoring at that time.

Here’s the list of books that I recommend:

1. Lean

Production Line
Production Line

1.1. Womack and Jones: Lean Thinking: Banish Waste and Create Wealth in Your Corporation

This is the book I recommend to anyone trying to understand lean for changing services and organisations. However, once you understand, you’ll start applying it to other areas of your life. There’s a lot of argument in the field about whether this is really Lean, TPS or some other methodology. At this stage, if it’s your first introduction to field, this is a great book to start with. You won’t be an expert by the end of it, but at least you’ll understand more and be able to understand some of the differences in the arguments.

1.2. Womack and Jones: Lean Solutions: How Companies and Customers Can Create Value and Wealth Together

The 3rd book in the series by Womack and Jones. Most useful for service industries and how to value the time of the customer more. Sometimes this is the book that makes the reader sit up and go “I get it now”, especially if they’re working in health or social care.

1.3. Womack, Jones and Roos: The Machine That Changed the World

The first book in the series. It’s the book that introduced the term Lean to the world (although the term had been in minor use before that). It’s useful if you’re interested in the history and how automobile manufacture has changed. If reading, get a later edition due the updates. The world has moved on since it was written, so usually I’d say it’s only worth reading if you’re interested in the subject and want to read about the case studies. But there’s an element of learning about some of the issues faced by companies as they implement lean for the first time.

2. Lean – More Advanced

Production
Production

2.1. David Mann: Creating a Lean Culture: Tools to Sustain Lean Conversion

This book is useful since it covers a lot of ground that is missing from the Womack and Jones books; mainly that there has to be a culture to make it happen and foster the long-term improvement. So David focusses on the role of the manager and what they need to do.

2.2. The Lean Toolbox for Service Systems

Probably the driest book in this list, it’s worth persevering with. There are some gems of ideas in there. I tend to offer it more as a reference to analysts to pick and choose from, rather than read the whole book. Note that I don’t pay that much attention to the process part of the book; but the principles are still sound in that we should choose different methods and tools at different levels of granularity and purpose.

2.3 Michael L. George: The Lean Six Sigma Pocket Toolbook

Nicely summed up by it’s streamline: “A Quick Reference Guide to 70 Tools for Improving Quality and Speed”. It’s a small book with each tool described, how to use and when to use it. Useful to have at arms-length when checking which calculations should be used, especially if you’re not conducting them every day.

2.4. Toyota Kata – Mike Rother

https://www.amazon.co.uk/Toyota-Kata-Managing-Improvement-Adaptiveness/dp/0071635238/

One of my favourite books in this list. This includes tales and case studies highlighting the real root of TPS, in terms of how mentoring and problem solving are achieved and how they are intertwined. This is a necessary complement if you’ve started out with Womack and Jones.

2.5. Lean Enterprise – Jez Humble, Joanne Molesky & Barry O’Reilly

https://www.amazon.co.uk/Lean-Enterprise-Performance-Organizations-Innovate/dp/1449368425

An interesting book that takes learning from Toyota Kata + Cost of Delay + agile and continual improvement on an enterprise scale. It provides a way for structuring your business from a prioritisation, problem solving and personal development perspective. I’d suggest starting with Toyota Kata first and then reading this one.

3. Influence and Sales

3.1 Robert Cialdini: Influence: The Psychology of Persuasion

Out of all the books I recommend to anyone I’m mentoring, this is usually at the top of the list. Partly so that we can talk about the same concepts and understand how we’re being influenced (and how we can influence others). It doesn’t matter if you don’t use it at work, you’ll find a use for it when buying your next car, watching how supermarket designers manipulate your thinking, etc. Even in the RNLI station/shop in Blackpool, I noticed 3 of the principles being used on one display stand.

3.2. Robert Jolles – Customer Centered Selling

This is easily the best book on selling that I’ve ever read. He describes a process, and while we’re all human and don’t follow always follow processes, it’s really useful to know what’s expected at what stage and what’s missing if you’ve jumped straight in.
There are a few editions of this; all out of print, but some are more available than others. And check eBay and Amazon used.

3.3. Chris Voss – Never Split the Difference

Chris’ book is close to the top of my list for books to recommend to business architects and business analysts. There’s little point doing a great job from your professional domain if you can’t influence others to accept your way of thinking. That’s not to say that you should manipulate others, instead it’s to give your work a fair chance of being heard and an opportunity to be adopted.

3.4. Roger Fisher: Getting to Yes: Negotiating an agreement without giving in

Based on the Harvard model of negotiation, including Best Alternative to Negotiated Agreement. It concentrates on creating the framework first before discussing points. So agree how you’re going to agree before you start talking the specifics of the deals.

3.5. Dan Roam: Back of the Napkin: Solving problems and selling ideas with pictures

Can’t draw, have difficulty communicating ideas? Then have a look at this book for understanding the simplest type of diagram to draw for any situation. It’s here on this list because many of the pivotal moments when you’re describing your ideas can be accelerated by use of the appropriate diagram. Pay particular attention to the SQVID.

3.5. Joe Navarro – What Every BODY is Saying: An Ex-FBI Agent’s Guide to Speed-Reading People

The best book I’ve read on non-verbal communication and body language. There’s a simple theme running throughout the book; you can’t tell what someone is thinking, but you can tell if there’s a disconnect between their non-verbal communication and their communication.

4. Education

4.1. Josh Kaufman: The Personal MBA: A World-Class Business Education in a Single Volume

I’m often mentoring change professionals who, while they may be great at their chosen profession, don’t understand accounting practices or how decisions are made. So I direct them to these two books. This is the shorter one; quicker to read and digest.

4.2. Steven Silbiger: The 10-day MBA: A step-by-step guide to mastering the skills taught in top business schools

The second of the two general business books I recommend. This has more detail than the Personal MBA but also may require guidance due to the complexity.

5. Entrepreneurship/Innovation

innovation
innovation

5.1. Eric Ries: The Lean Startup: How constant innovation creates radically successful business

I find that this book can change the reader’s approach to large-scale programmes. It makes them think more about incremental change based experiments. I also find that I still have to remind mentees about the purpose of experiments, i.e. to validate learning. But if they’ve read the book, it’s absorbed easier with that gentle nudge.

5.2. The Startup Owner’s Manual: The Step-by-Step Guide for Building a Great Company – Steve Blank and Bob Dorf

Kindle is usually significantly cheaper than the paperback/hardback.
The Startup Owner’s Manual deserves more fame than it has. It’s unfortunate that it’s been somewhat eclipsed by the Lean Startup, since it has significantly more usable material in it. That hightlights the differences; the Lean Startup is a book that promotes the culture and activities, whereas the Startup Owner’s Manual is a guide to the activities that you have to follow. Admittedly, it can be a bit daunting to read at first, since it comes across more as a reference guide that you can dip in and out of. This is the book to read to understand the concept of Customer Development.

5.3. The Lean Entrepreneur: How Visionaries Create Products, Innovate with New Ventures, and Disrupt Markets

If I know you’re an entrepreneur or a startup founder, then I recommend this book above all else. It takes the learnings from a lot of other sources and puts them into one practical book. So expect to see references to the Lean Startup, Customer Development and Business Model Canvas as well as tables that you use to record and plan your own progress.
Pay attention to the reverse planning process; it’s important to know where you want to get to and then work back from there.

5.4. Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers

Alex Osterwalder has started a movement and initiated a number of more domain-specific spinoffs. If you have a problem you can probably find a canvas for it now. This is the book that brought canvases to us, taking a simplistic view of business architecture and making it accessible to all.

5.5. The Mom Test – Rob Fitzpatrick

A short book, but it doesn’t miss anything out. If you’re conducting user/customer interviews, you should read this book first. Ideal for users researchers in service design/design thinking and for startup founders. Don’t be fooled into believing what your customers say; they have other motives, so it takes a different approach to obtain the information you require.

6. Business Strategy

Chess
Chess

6.1. Richard Rumelt – Good Strategy/Bad Strategy: The difference and why it matters

This includes so many case studies regarding how to set strategy. It’s a fascinating read. Main point to take away is that a good strategy includes 3 parts:
  1. An analysis of the current situation
  2. A vision of the future
  3. A plan to achieve that vision

6.2. Michael E. Gerber: E-myth Revisited: Why Most Small Businesses Don’t Work and What to Do About It

At the other end of the scale from Good Strategy/Bad Strategy, Michael discusses small business strategy by using a small bakery as a example throughout the book. It does focus on franchising as a solution in the second half. It’s a useful book for small business owners, helping them think about the processes and systems they need to have in place.

7. Change

Butterfly
Butterfly

7.1. Richard Wiseman – 59 Seconds: Think a little, change a lot

Change yourself in less than a minute. That’s the main concept behind the book. Richard takes us through a journey, referencing many studies across the last few decades and how we can learn from them to influence our own lives.

7.2. Richard Wiseman – Rip It Up: Forget positive thinking, it’s time for positive action

The follow-up to 59 seconds. It’s actually the more practical book out of the two, but it makes sense to read 59 seconds first.

8. Facilitation

Session
Session

8.1.Understanding Facilitation – Christine Hogan

https://www.amazon.co.uk/Understanding-Facilitation-Theory-Principles-Principle/dp/0749438266

Christine covers a lot of ground in this book. She educates about the history of facilitation, different forms of it and how it has progressed. This is a must-read for facilitators.

8.2. Practical Facilitation – Christine Hogan

https://www.amazon.co.uk/Practical-Facilitation-Techniques-Christine-HOGAN/dp/0749438274

In the second book I recommend from Christine Hogan, she introduces tools and techniques for facilitating. This is a good read and worth keeping to hand as a reference guide when you’re starting out in your facilitation experience.

8.3. Sue Knight : NLP At Work

I wondered whether to include this since I don’t actually believe in NLP. There just wasn’t enough scientific evidence at the time I looked into it to prove it worked. However there have been times with facilitators who have had difficulties with some of their customers that I’ve recommended certain parts of this book. Critically, the concept of reframing has helped numerous analysts continue working with customers rather than going home stressed at the end of the day. It’s helped them realise where the problem could lie and, more importantly, that it doesn’t lie with any of the people.

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The Rockstar Approach to Visual Management

Visual Management Done the Rockstar Way

Van_Halen_(_DLR_era) by MarioVHF under CCA-SA3.0
Van_Halen_(_DLR_era) by MarioVHF under CCA-SA3.0

Visual management can take the most unlikely of forms. Done well, it should show you enough details at a glance so you can decide whether to look further into the situation.

Background

Major bands get riders, often part of the contract stipulating what the venue will provide the band to make them comfortable on the road. This can be sofas, champagne, beer, food cooked to a certain standard or even a curry take-away flown in from a specific restaurant in Wales. Some of the items on the riders are tiny and we’d consider them petty, but major stars have lived up to their diva reputations by blowing full-scale tantrums at not having their riders met.

No Brown M&Ms

One of the most legendary of these was the American hard rock band Van Halen. As a rock band they had a reputation to uphold; raucous, fun-loving, tolerating no nonsense. They also through tantrums when their rider was met entirely even down to minuscule details. The most popular of these details was a requirement that they would be provided with a bowlful of M&Ms with all the brown ones removed. If they walked into their changing room and saw a brown M&M in the bowl, then tantrums ensued.

Analysis

Van Halen perform in Toronto on their 2007 reunion tour by De-fexxx666 under CCA-SA3.0
Van Halen perform in Toronto on their 2007 reunion tour by De-fexxx666 under CCA-SA3.0

The interesting thing for us is that the presence of brown M&Ms was a form of visual management. As mentioned by the band’s lead singer, Dave Lee Roth, they used a lot of equipment in their tour and they needed to know whether the requirements for the tour, e.g. a stage that could support the weight of the equipment would be available on the night, whether the electrical supply was to specification, etc. All of this was in the band’s contract with the venues. Buried amidst all these technical requirements was the brown M&M clause.

On walking into the dressing room, the band could immediately tell if the venue operators had read the details of the contract. That was visual management. If there was a brown M&M in the bowl, then there was a high probability that other more potentially dangerous omissions had been made in conforming to the contract. Those omissions could have risked the safety of the band, the crew, the audience and the venue itself. So a quick check of whether the venue’s organisers had read the contract and applied it was a useful point for the band’s management.

As for the rockstar tantrums in response, they were just keeping up appearances and it didn’t hurt their reputation. So having the band perform the check in a rockstar style was genius.

Snopes has a great overview of the rider and implications.

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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.

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Applying Lean Startup in the Public Sector

Yesterday, I presented at #Leanconf 2013 in Manchester. It was the first Lean Conference covering Lean Startup in Europe. There was a great energy to the 2-day event with a variety of planned and unplanned talks plus lots of opportunity to network without the usual tradeshow conference feeling of being stalked by sales managers.

I don’t think I’ve seen a community spirit like that in a long time; every attendees helped someone else no matter how far along their own ideas were.

Pivoting as used in Lean Startup in Public Sector
Pivoting as used in Lean Startup in Public Sector

In the spirit of the energy that I encountered at the conference, I’ve placed the slides on slideshare. If you download the presentation, you can read the notes which will help you make more sense of the slides. Hopefully the video will be online as well soon. When it is available, I’ll update and post a link to it. The slides are at bottom of this article.

Background to the Programme

The programme I discussed in the presentation was a 2+year programme with a large city council in England. The programme was internal to the portfolio that handled Adult Social Care. It had a £1m+ budget with a team ranging from programme manager, business analysts, data analysts and communications officer, plus a governance structure and other associated stakeholders.

The aim was to make Adult Social Care more efficient, by removing waste, focussing on flow and reorganising around the value to the customer. All typical lean concepts. We did this with a mixed method that I’d developed specifically for this client. The method merged elements of Lean with Lean Startup with DSDM and Theory of Constraints, all under a typical local authority governance framework using  Prince 2.

The scale of change was to alter the way of working of 200-300 social workers/care managers, their team managers, their business support plus associated teams. Most were involved in the change and took the opportunity to steer the change in ways that would benefit their service users. Additionally partner teams (e.g. those responsible for 1000+ support workers within the council, NHS staff, payments and contact centre staff) were brought into the process and contributed to the changes where possible.

Customer Development in Social Care

Due to the time available for the talk, I didn’t discuss Customer Development. I’d like to address that here. Firstly, my customers and those of the programme, were the workers on the frontline of social care. However, we also had a duty to their customers, i.e. the service users of the city and, wider still, the overall population of the city.

We used common Lean and Six Sigma techniques (e.g. Kaizenblitz, Voice of the Customer, Gemba plus interviews, workshops, etc) for understanding the wishes and activities of the frontline workers. The default position was always to go and visit the workers where they worked including a visit out to service users where possible and where permitted. There was no “ivory tower” mentality and as little desk-based research as possible.

I did want to get to the wishes of the end user, i.e. getting the answers to what mattered to the service users. We were able to do this through a service user forum and similar activities. Just to clarify, the forum is actually a real meeting, not an online forum. However the typical customer-development approach of “get out of the building” isn’t necessarily a good idea in this case. The reason is that any change has to be ethically sound; it can’t introduce discrimination nor can experiments (or MVPs from Lean Startup) that make the situation worse for those on that trial path.

The ethical dilemma is exacerbated further when you consider the concept of equitability in that any change has to be able to be applied to the entire population of service users if appropriate to them. So if you make a change to services in October, you’d better think about how you’re retrospectively going to apply those changes to service users referred back in April onwards. That could be as simple as a rule stating that they’d change at the next review point or it could be a specific project to apply it now.

A good example of the fundamental ethical issue can be found in the simple concept of asking customers “what can we do to improve?”

I love that question; it encapsulates the whole point of speaking to customers about what they want without biasing them towards a particular solution. It usually turns any negatives about current experiences into positive actions for change.

However, frontline staff wouldn’t want to ask that question of their service users in all circumstances, e.g. those with a current likelihood of being violent, those recently bereaved or in any situation where the service user or social worker is likely to come to harm. That means that the results from a survey of such a basic question would already be biased.

Similar nuances were found in almost every typical method for achieving customer development, whether phone surveys, online questionnaires, paper-questionnaires, focus-groups, questions tagged onto the end of a visit, etc.

Now, as mentioned in the slides, greenfield opportunities such as those found in newly-commissioned projects whether within local authorities or within NHS CCGs (Client Commissioning Groups) are ripe for Lean Startup and may benefit from a more thorough application of Customer Development.

What Messages Can you Take Away from the Presentation?

  • That you can successfully apply Lean Startup in the public sector
  • That if you can do it in local authority (which is about the worst-case scenario for successful implementations), then it should be implementable in other large, existing organisations, whether private or public.
  • That you may not benefit from applying all of Lean Startup; the corollary is true in that you can benefit from using some elements of Lean Startup. It depends on what you are trying to accomplish.
  • That the behaviour of staff (inherited from the culture of the organisation) will likely be your biggest obstacle.

The Slides

 

Any Thoughts

I’d like to hear your comments, so leave a comment below or contact me

 

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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

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Be The Customer

Be The Customer

Introduction

Be The Customer
Be The Customer

I really believe in getting customer input, especially before you build you product or service. Lean Six Sigma includes the concept as part of Voice of Customer, Lean Startup and similar methods include the concept within Customer Development. If you work for an existing organisation that currently delivers products/services rather than a start-up, sometimes it’s easier to actually be your customer than to gather their input.

Many companies try to get closer to customer needs by using mystery shoppers. Again, depending on your product this avenue may not be necessary.

Examples

I’ve been reminded of this many times when I see a process that just doesn’t make sense for the customer, but looks like it would have made sense for the person working in the office who created the process. I’ll discuss three examples below:

Traffic Wales

I was driving back from Llandudno on the A55 and a roadside sign flashed a message of “Incident after junction 32”. These IP-enabled roadsigns are a common sight on most of Britain’s motorways allowing staff to remotely update the message on the sign. But this sign was odd for two reasons. First, it was an A-road so to provide a junction number on the warning signs rather than a destination is not that common a sight. This made me wonder whether the message referred to the road I was driving on now or a road that we would intersect with, e.g. M56 or M6. This was compounded by the second oddity; there were no junction numbers on the static road signs nor on my car’s satnav/GPS. I was left confused by a message that may have a large bearing on my journey or none at all. To this day, I still don’t know where the incident was, I was fortunate enough to have an incident-free journey on my route home.

HR department

I worked for a good ICT company almost two decades ago and another one a few years later. In between, I worked for a large consultancy. Both of the ICT companies were moving into the consultancy arena with more mobile staff taking on more business change and less pure ICT activities. As an employee, I found the treatment of mobile staff to be very different between the ICT companies and the consultancy. The policies – such as how much could be spent on hotels, time before you could claim for certain types of expenses, what time the head-office closed in case you were in another country needing assistance to get home – were all written by HR staff from headquarters in both the ICT companies. That made for some interesting events where there were no hotels available (not just a question of standards) for some meetings or no-one to help out when the hire car’s broken down and it’s better for everyone (especially your corporate client) if you change plans. In contrast, the policies at the consultancy were written by consultants who travelled and operated by HR. That made for a much more reliable service, one that gave the mobile staff much better support while travelling.

Local Roads

Local authorities in England inherit the duty to maintain local roads. That involves the scheduling of roadworks and should involve working with national agencies so that motorway roadworks don’t cascade into the local road network. I can think of at least two towns that have had concurrent roadworks on every route out of town, adding 1 or 2 hours to journeys each way. No doubt some of the council officials were involved but probably hadn’t thought of themselves as customers of their own service.

Be The Customer

Both companies could do with thinking about their customers and trying to use the service as a customer would. I think of two actions when I think of being the customer:

  1. Actively take time out of your product development to go and experience what it’s like as a customer. So go and drive on the road a few times a year and watch what messages, signs are being given, what the spacing of roadworks are.
  2. Engage your staff to think like customers as they go about their days and then to inform the teams responsible of what they find.

In the case of the the road sign, the HR policies and possibly the roadworks, the events were initiated by people in the office. All of these could have been improved by being the customer. I saw the difference with the HR policies, it was a much more comfortable experience recognising that as a mobile employee, you were often away from home and family. The issue with roadworks is probably more one of common sense, rather than being a customer. Why block every main artery and some of the minor ones? The act of being a customer creates a better mindset, by forcing you to think in more basic terms. It’s not about the difficulties in the office, takt time or production control, it’s about what you experience as a customer. I’m pretty sure that Traffic Wales would have had the equivalent of England’s Highways Agency Officers driving up and down the A55. Unfortunately, having them think what it’s like being a customer may not have helped too much since they would have to unlearn what they know as part of the job, e.g. abbreviations, road junction numbers, etc. In their case, they’d still have staff who are less integrated to the operation, e.g. new starters, who could be asked to act as the customer on their way to work and back.

In short, this is a variation on the typical lean battle cry of Gemba, “go to where the work is”. In addition, Be The Customer.

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Introducing the new Questions and Answers

Starting this week, I’ll be answering your questions on Lean and Lean Startup and how they can be applied to the public sector. I’ll also answer questions on wider subjects of business transformation and change management, although I expect most will relate to Lean in public sector and/or Lean Startup in existing organisations.

I’m assuming that any questions you ask me are public and can be posted on this site and publicly responded to. If you need a private response, let me know in the question and I’ll treat it so.

The idea behind this is to share some of my experiences, e.g. how I’ve overcome some of the typical obstacles to change or what to expect when transforming a public sector operation.

You can keep up-to-date with the questions and my answers by subscribing to the newsletter in the simple form below. Take the opportunity to ask a question in the form.

I hope you’ll join me in this.

thank you

Alan

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Lean Cost Benefit Analysis of a Quick Improvement

Kanban prototype for an NHS Acute service
Kanban prototype for an NHS Acute service
Kanban prototype for an NHS Acute service

Last week, I was provided with the short opportunity to improve a service within an NHS Acute Trust. I had 5 minutes to understand the problem and then I suggested a quick improvement. I’d like to take you through how we arrived at a solution and the resulting lean cost benefit analysis of that solution.

I don’t get that involved in the individual solutions anymore, instead I’m usually engaged for more strategic issues and end up mentoring others to make the changes across the whole organisation or enterprise. So it was fun to roll up my sleeves and suggest a solution that could work in a hospital. I fully expect the team to modify it to suit their specific needs and I’ll be on hand to help them improve it.

So let’s get to the calculations:

Lean cost benefit analysis

Analysis Investment

  • 5 minutes x 1 health professional explaining the problem
  • 5 minutes x 1 consultant listening to the problem
  • 5 minutes x 1 consultant developing a solution
  • 10 minutes x 1 consultant describing how the solution could work and what could be changed to make it more suitable
  • 15 minutes x 1 health professional understanding the solution
  • 1 x flipchart paper
  • 1 x pen

Potential Savings

  • 3.5 hours per day x 4 health professionals across a 5 day week = roughly 2,800 hours a year
  • The 3.5 hours is based on a reduction from 4 hours to 30 minutes for handover and prioritisation.
  • At roughly 1,400 working hours per year (based on 200 days per year and 7.5 hours per day), that equates to 2 FTE (full-time equivalent) posts saved per year.
  • So that could mean the service treating a lot more patients,  a potential cashable saving of roughly £70,000-£90,000 per year or – as is often more likely – a mix of the two

Not bad for a 15 minute session.

Practicalities

Implementation

The solution would need installing, but that’s the easy part. It would require some pens and a whiteboard or similar. That’s probably £200-£400 for a board and magnetic strip and counters plus £20-£50 per year for pens.

The implementation would usually rely on a critical core of the staff wanting to implement the change. In this case, by applying Lean Startup concepts, just one staff member could do it and then the others will learn about how it could affect their working lives and the impact on their patients.

What was the solution?

My suggestion was based on Lean, using a Kanban board. It relies on the principle of visual management. In this case, it’s easy to see at-a-glance where the work lies. It seemed a perfect fit for the problem. Due to the small amount of time spent with the service, there is a significant risk that the solution may not work for all the health professionals involved. I’d have liked more time with more of the team to mitigate this risk.

My aim was to improve flow. There was a blockage in the handover stage of the day and that’s what I wanted to eliminate. With more time, I’d have taken a more relaxed view of the entire process, involving other stakeholders, referring teams and teams that are being referred to. As it was, engaging with only one health professional, I focussed on what could be achieved quickest to remove the blockage.

The kanban board isn’t the end of the solution; it’s the start. I expect the therapists to find that the bulk of their work is being stuck in one or two stages or that they are not able to provide services to low priority cases. I don’t actually know what they’ll find, but that’s what I would be looking for. After the therapy team have been running the board for a week or two, they should be able to see patterns. Then they can act on those patterns.

Perspective

So which appeals more; the lean solution itself or the numbers in the lean cost benefit analysis?

From my perspective, they’re two sides of the same improvement and I teach analysts to remember both sides (and some others) when engaging with teams and their stakeholders.