CHAPTER TWO THE RESEARCH
2.1 In order to meet the aims and objectives of the study, four main data sources and methods were used: a literature review, survey, case studies and pilot studies. This chapter will outline the data sources and the research methods used.
A. Literature review
2.2 A systematic literature review was carried out to provide a critical review of the available literature. Systematic reviews were first developed in the medical sciences as part of the search for a better evidence base for policy-making and for clinical practice (Tranfield et al, 2003). More recently, they have been used in a range of health and education fields to bring together research in an orderly and transparent way so that research evidence can be used by professionals to inform policy and practice.
2.3 Systematic reviews take a defined sequence of locating, analysing, ordering and evaluating literature from defined sources within a given timeframe. The advantages are that the process is "replicable, scientific and transparent" (Tranfield et al, 2003).
2.4 A total of 81 sources of data were reviewed, summarised (in Data Extraction Sheets) and analysed. These comprised:
- Journal articles, including peer-reviewed articles
- Unpublished articles, papers and reports from current and previous research projects
- UK Government sources, including work done at the National Health Service, service delivery units and other central government departments.
- Websites of professional institutes and consultancies
- Consultation with other academic professionals
2.5 The literature review was carried out between August - November 2005. The report of the full analysis and presentation of the findings can be found in Annex 1 (Literature review).
B. Survey
2.6 A survey was undertaken by an independent research company, AtoZ Business Consultancy, on behalf of Warwick Business School to ensure that individual opinions remained confidential. AtoZ Business Consultancy undertook the questionnaire design, the design of the analysis schedule, the data inputting and the data analysis. The questionnaire contained 20 questions designed to obtain information on the type of Lean projects that have been implemented, how they were implemented and whether they had been successful in achieving their original aims. The questionnaire contained a mix of open ended and closed questions.
2.7 The Scottish Executive distributed the questionnaire via email to all public sector organisations in Scotland during September 2005. Organisations were given seven weeks in which to complete and return the questionnaires.
2.8 Completed questionnaires were returned directly to AtoZ Business Consultancy via either email or post. In summary, 26 organisations responded to the survey, with 24 providing enough data for use in analysis. It should be noted that only those organisations that had worked on Lean projects were asked to reply to the survey. This, therefore, restricted the number of replies received.
2.9 A report from the survey is presented as Annex 2 (Survey Report). Due to the small number of responses and the limitations of the survey approach, the survey results will only be used in this report in order to support any relevant findings, as will the literature review findings.
C. Case Studies
2.10 In order to assess the relevance of Lean a number of case studies were identified across public service bodies in Scotland in order to compare the application of Lean tools and techniques. Eight sites were visited by researchers including organisations in local government, central agencies and health. The primary purpose of the case studies was to gain an understanding of the following aspects of the application of Lean thinking:
- What factors made the sites suitable for successful application?
- What factors are relevant to the development of organization readiness for Lean?
- Which tools and techniques within the domain of Lean thinking have been used and which were seen to work?
- What types of problems/issues were being tackled by the Lean initiatives?
- What are the outcomes of Lean?
- What lessons are there for successful implementation?
Case Study Process and Selection
2.11 Eight case studies were conducted by gathering a range of material. This material included semi-structured interviews; site visits; observation and analysis of implementation reports, organisations' annual reports and internal management documents, such as progress meeting minutes and project and management board minutes. Care was taken to ensure that research data was validated by each host site.
2.12 In terms of case study selection the primary requirements were to identify sites where Lean and/or Lean-type initiatives had been applied, that sites should be able to be assessed in a timely manner, using a suitable cross-section of types of organization and predominantly based in Scotland 1 (see table 1.1). This achieved a suitable mix of:
- 2 healthcare applications
- 2 local government sites
- 3 national/agency sites
- 1 military site
2.13 One of the case studies was in England but the rest were in Scotland, spread across the central belt and into the east of the country.
Interview Process
2.14 For each case study, it was requested that the following people were interviewed:
- At least one senior manager to confirm links between strategy and the initiative
- The programme lead
- Up to 2 programme team members
- Up to 2 staff members who were affected by the change
- Up to 2 customers/stakeholders affected by the service
- External trainers/consultants where relevant
- Relevant middle managers & service professionals ( e.g. clinical leads)
- 1 IT manager/data manager
2.15 The actual numbers and profiles of those interviewed across the eight sites varied due to the varying size and nature of the organisations.
2.16 A semi-structured interview pro-forma was prepared, which was divided into key topic headings, with key questions to be asked. The document also highlighted follow-up topics for each interviewer as key words were mentioned (see appendix 3). Most interviews were conducted during September and October 2005 with the final case study being carried out in January 2006. Notes were taken of all interviews and most were recorded on audio tape and then transcribed so a full record was available.
Overview of Case Study Sites
2.17 In order to give some context and background to the case studies selected Table 1.1 gives an outline of their engagement with previous improvement programmes as well as details of the 'Lean' programme.
Table 1.1 Overview of Case Study Sites
Case Study2 | Past improvement programme/s | Present improvement programme |
CS1
Health Agency | No previous programmes mentioned | Programme supported by a consultancy (in partnership with the Institute for Health Improvement) One year targets of programme are to: - increase awareness among key stakeholders
- equip people with the basic skills and tools - Lean and philosophy
- get people working together
- make people see the end to end process to realise the benefits
- get people thinking a different way about the organisation
- introduce the tools from the private sector to the public sector
- become an NHS pilot for Lean management in healthcare
Technique used was the Rapid Improvement Event ( RIE) involving staff delivering service. |
CS2
Government Agency | No previous programmes mentioned | A project rather than a programme this initiative was to enable the organisation to respond to a sudden increase in demand. Consultants were engaged to conduct a Rapid Improvement Event ( RIE) involving staff, focusing on: - accommodation
- ownership of cases
- change in structure
- increase in workload
- waste of staff time on admin tasks
|
CS3
Local Authority | Best Value and TQM (described as too long drawn out not good at driving change) EFQM (but not at corporate level) | Consultants engaged for initial 6 months to launch programme of Rapid Improvement Events ( RIE) for process improvement. Ambitious programme with 12 processes dealt with in first year. RIE chosen primarily because of its power to engage staff. Now integrating it as a tool into strategic improvement programme based on EFQM. |
CS4
Local Authority | There had been a previous continuous improvement programme (technique not named) but unsatisfactory because it was not customer focused and did not deal with staff resistance to change | Business Change Process - based on 'systems thinking' aimed at delivering better customer focus supported by consultants. Rooted in Lean thinking but focussed on changing culture rather than using a Lean 'toolkit'. Processes are improved using 'check- plan -do' approach involving service practitioners. |
CS5
Government Agency | Rigorous performance management culture supported by Business Excellence survey which has been used for past 6 years to highlight areas for improvement. | Currently a range of improvement initiatives: - Value Chain - Enterprise Architecture
- Waste Reduction
- Process Workflow Efficiency
- Defect Analysis
- Continuous Improvement ( CI) using 9 criteria in the EFQM model
- Customer Satisfaction
- Benchmarking
Moving towards a more strategic approach with recent appointment of a Change Manager. |
CS6
Government Agency | EFQM model has been used to link the organisation's strategy to operations practice. Other models ( e.g.ISO 9000) are not liked - too bureaucratic. They have also avoided bureaucracy in project-based working. | No formal programme. Improvement work was project based process improvement using team working and mainly linked to implementation of new ICT systems. |
CS7
Health Agency | No previous cross-organisational thematic improvement programme. Some participating organisations would have had previous change/improvement programmes | Focusing on improving the patient experience. Multi-functional teams use PDSA (Plan - Do - Study - Act) technique to generate process improvement. Programme provides external change agents to support organisations through the process. |
CS8
RAF Base | No previous programmes mentioned | A Lean programme - mainly tactically deployed, but with aspirations to strategic Policy Deployment - using three main techniques: Value stream analysis ( VSA) - to map out the processes and identify waste - initially at an enterprise level and then at a process level - out of which comes an implementation plan which consists of quick wins, Rapid Improvement Events ( RIEs) and longer term projects. Also use a tool which is called 2P (or 3P) - production process preparation - where the nature of the process change is so great that it is impossible to do it in an RIE. The Rapid Improvement Event ( RIE) is an intensive week where the new processes are trialled and put in place. It is preceded by a three week preparation phase and followed by a three week sustainment phase. |
D. Pilot Studies
2.18 During October 2005 to February 2006 three pilot sites were chosen by the Scottish Executive to pilot a Lean implementation methodology. This methodology was based on the 'Weir Model 3 with the main focus being the format of a Rapid Improvement Event ( RIE) (see 3.12). The team from Warwick Business School evaluated the methodology in terms of:
- Were the staff and management engaged before, during and after the RIE?
- Were the sites suitable for successful application?
- Which tools and techniques within the domain of Lean thinking were used and which were seen to work?
- What were the outcomes of Lean initiatives?
- Are there any lessons for the development of the Lean implementation methodology?
- Are there any lessons for successful implementation?
Pilot Process and Selection
2.19 Access to the sites and selection of the pilot studies was negotiated by a team from the Scottish Executive. This team also managed and facilitated the Lean implementation process which included:
- 1 day management workshop to set objectives
- Running and facilitating the 3 to 5 day RIE
- Supporting on-going implementation and project work.
2.20 As with the case studies across the three pilot sites a range of material was gathered. Observation and interviews were carried out at the 3 to 5 day RIE. Then a 'follow up' occurred where a site visit was carried out in order to conduct semi-structured interviews, analysis of reports and internal management documents (such as progress meeting minutes and project and management board minutes). A guide to the follow up was a document titled 3 C's (Concern, Cause, Countermeasure) which was a main output from the RIE and outlined the changes and improvements planned and proposed implementation. This could, therefore, act as a reference document for follow-up analysis.
2.21 However, it should be noted that due to time scales this research evaluates the Lean implementation within four weeks of the RIE event. In all cases, further work related to Lean implementation was planned for beyond that time period and so, if any subsequent evaluation of the impact and results were to be carried out after three or six months after the RIE, for example, it is likely that further outcomes would be noted.
2.22 The pilot sites selected are outlined in Table 1.2 which indicates past improvement or change as well as the purpose of engaging with Lean and the data gathered to carry out the evaluation.
Table 1.2 Overview of Pilot Studies
Pilot Study4 | Past Improvement/ Change | Purpose of the Lean Project | Data Gathered for Evaluation |
PS1
College of FE | Planned relocation | Improvement of the contact centre using RIE. Objective to handle telephone calls at first attempt without error & to improve the quality of information given to students. 8 participants involved in the RIE. | - RIE observed for 2 days
- RIE documentation including the 3C document monitored
- Site visit/ Interviews:
- 4 staff who had participated in the RIE
- 2 managers (including one who 'signed' off the changes)
- 1 telephone interview with senior manager
- Contact centre data for weeks before and after the RIE
|
PS2
Local Authority | Some investigation of Lean | Improvement of the housing repairs process from first contact by customer to access to the property by repairs contractor. 20 participants in the RIE | - Management workshop day observed
- RIE observed for 2 days
- RIE documentation including the 3Cs document monitored
- Site visit/ Interviews:
- 3 staff who had participated in the RIE
- 2 senior managers
- 1 union rep
- Data before and after the RIE
|
PS3
NHS Hospital | Centre for Change and Innovation ( CCI) improvement initiatives | Improvement of the patient records process for emergency admissions. 7 participants in the RIE | - RIE observed for 2 days
- RIE documentation,
- Site visit/ Interviews:
- 3 staff who had participated in the RIE
- 2 managers (recent and current) of admissions health records.
- RIE sponsor - Head of Information
- Deputy Head of Information
|
E. Other relevant research
2.23 During the research opportunities also arose to interview and, speak with a number of Management Consultants who were either engaged with carrying out Lean projects in public sector organisations (both in Scotland and England) or wished to. Some of these Consultants had had some involvement in the case studies and pilot sites. The interviews with the management consultants were used to obtain information about the implementation methodologies they used. However, anecdotal opinion from these sources was not incorporated into the research evidence.