Service Improvement @ itSMF conference

Excerpts from itSMF Practical Service Improvement

Solution 3: Understand the variable flows

Some processes have been engineered to create a single standard route e.g. you can have any colour so long as it is black.
Often, and especially in services, then a standard and non-standard items are passed through the same process. The Pareto principle usually applies: 80% of the items are standard and 20% are non-standard; and the non-standard items consume 80% of the capacity of the the process.

Solution 2 - Schedule the bottleneck process

A bottleneck in is one process in a chain of processes, such that its limited capacity reduces the capacity of the whole chain. This is sometimes called the rate determining step. Ideally you will eliminate this; however until you can then you need to work around it.#

Solution 1 – continuous one piece flow is created

Bucket Brigades were the first occurrence of an organised fire fighting effort. It was the practice for each household to maintain 2 well kept water buckets in a conspicuous place the door or front window.
At the onset of a fire, the local church bell would be rung frantically, and all able bodied residents would grab their buckets and rush to the fire. If a resident was unable to help, they would throw their bucket into the street to be picked up by those running by. Two lines were formed from the fire to a local water source with the men passing water filled buckets down the line to the fire, and the empty buckets were passed back to the water source by the women and children.

Solution 0 – A reliable method is created

Once you understand how to identify the seven plus one wastes then perhaps it is useful to understand the Solutions that can be used to decrease or eliminate waste.

It might be a massive generalisation to say that men tend to avoid reading the instructions before commencing on assembly; however…. The instructions in the absence of previous specific experience tend to be the most reliable method available.

Outlining the Seven Wastes

Waste is the use of any material or resource beyond what the customer requires and is willing to pay for.

One of the key steps in Lean and Toyota Production System (TPS) is the identification of those steps which add value and those that do not. By classifying all the process activities into these two categories it is then possible to start actions for improving the former and eliminating the latter.

Shigeo Shingo, a co-developer of TPS, observed that it's only the last turn of a bolt that tightens it - the rest is just movement. This level of refined 'seeing' of waste has enabled his team to cut car body die changeover time to less than 3% of its duration in the 1950s as of 2010. This focus has been called “Single Minute Exchange of Die” or SMED; within TPS. When we applied this in the NHS I coined the phrase “Just a Minute”; because it was more patient focused and friendlier. 

The following "seven wastes" identify resources which are commonly wasted. They were identified by Toyota's Chief Engineer, Taiichi Ohno as part of the TPS. Subsequently an eighth waste has been identified; which is particularly relevant in a service environment.

The Dice Game

The Dice Game highlights how end to end processes work or perhaps more importantly how often they do not work: showing the impact of dependencies between process steps and variation in performance of the individual process steps.
An interactive learning event incorporating the game takes less than a couple of hours; however it is concentrated learning. The game is easy to set up.
You will needs a good understanding of variation: the causes and effects.

Affinity Diagram

This tool gathers large amounts of language data (ideas, opinions, issues, concerns, etc); and organises these into groupings based on the natural relationship between each item. It is more of a creative than a logical process that::
* Sifts through large volumes of information efficiently
* Lets new patterns of information arise

A 7-Step Improvement Process

ITIL v 3 Continual Service Improvement (CSI) defines three key processes for the effective implementation of continual improvement, the 7-Step Improvement Process, Service Measurement, and Service Reporting.

This 7-step improvement process covers the steps required to collect meaningful data, analyse this data to identify trends and issues, present the information to management for their prioritization and agreement, and implement improvements. .