A set of 4 short videos on the website for the NHS Institute for Innovation and Improvement are reviewed here. I’ve chosen these as although they don’t delve too deeply into the theory, they show the benefits of a powerful set of management techniques referred to briefly through the series as the 5s approach. A number of years ago I came across a technique referred to as Kaizen which is a Japanese management technique for introducing gradual improvement into practice. Masaaki Imai is credited with the term which he wrote about in the book Kaizen: The key to Japan’s competitive success. The story goes that Deming introduced american factory techniques into Japan just after the end of the second world war. The western techniques were gradually synthesised with eastern culture and the result was recognised and then written about by Imai. The idea is that at a workplace, the team focuses on improving their performance and does so with feedback mechanisms which move away from the classically western hierarchical systems as all members of the team can contribute to refining the team’s working methods and not just senior management. This can release a lot of untapped potential.
So imagine my surprise when I came across the videos above and found that they were referencing the 5S approach which Imai wrote about in his original work. The 5 S’s stand for sorting, straightening, sweeping, standardising and sustaining. Thus with sorting, the idea is to go through the workplace eliminating items or tools that are not required. With straightening, the remaining tools are organised so that they can be used efficiently. Sweeping refers to the continued tidying of the workplace usually at the end of each work session. Standardising roles ensures that team members are aware of their responsibilities and sustaining is essential as this becomes a means of working rather than a time-limited project.
What was really interesting about these videos was that we heard feedback from a number of staff who had taken part in programs collectively referred to as ‘The Productive Ward’ in trusts in King’s Lynn, Nottingham, Manchester and Leeds. From their experience it seemed as though in the first few months, it was difficult to see many benefits although there was a sharp rise in workload due to the new techniques being used. After a few months though, the benefits were apparent and staff were very enthusiastic. I thought it was remarkable to see people being recorded on video while they went about their duties, then sitting down and watching the footage and being surprised at what they were seeing. They were then able to change their working habits and free up a good deal of time which people tended to agree would mean that they would be able to spend more time with their patients. One particularly interesting idea was to bring in other disciplines when assessing tasks. So for instance when nurses were preparing meals for patients, bringing in members of the catering department for the assessment process resulted in them using 2 trolleys instead of 1 to shave time off the process and change 30 years of practice!
These are exciting times as perhaps we are seeing the transfer of management technologies from the United States to Japan and then into the NHS. Apparently there has been a great deal of interest in this approach not just from over 50% of trusts in the UK but also from a number of other countries. There might even be further developments and it would be interesting to see if the technology is further refined within the NHS.
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