PERSPECTIVES
PERFORMAN C E I MP RO VE ME N T
How do you sustain
improvement in your
organisation?
This article identifies the 8 key ingredients necessary for making improvement stick.
Issue No. 005
AUTUMN 2013
PERFORMANCE IMPROVEMENT
Every organisation, no matter what it does, can draw on a wide range of tools and techniques to generate
improvement. However, when it comes to sustaining these improvements over the longer term, success
can be much harder to achieve. In this article, we identify the eight must-have ingredients for making
improvements stick, using real-life case studies to show how some of our clients have successfully
sustained change in practice.
1
Get the ownership right
PERSPECTIVES
Consultants and other external staff should be
used to pass on knowledge, provide resources and
help identify opportunities, but they can’t be the
owners of delivering a change. Leaders within the
organisation must own the project and behave
in a way that demonstrates their commitment.
will finish, and I can get back to the way I used to work.
Those best placed to own the project are located within
the line management of the relevant division or, in the case
of projects which span multiple divisions, higher up the
organisation. The involvement and commitment of these
leaders must be clear to staff; participation in a name-only
Getting the ownership of a project right is probably the
sense is not enough. The owners of the initiative must bear
single biggest variable affecting sustainability of change.
– and be seen to bear – the ‘emotional load’ for its success
It needs to be addressed right at the start – before any
or failure and, if change is to occur at the required pace,
project management office (PMO) has been involved, before
regularly repeat their messages of support to staff. Without
the external consultants have been called, and certainly
this leadership, visible to everybody in the organisation,
before the final few weeks of the project, which is when,
ownership will naturally default to somebody else.
in practice, ownership issues often tend to be raised.
Case study:
So, who should own the project? It might
A project in the pathology department of a large Trust was
be easier to define who shouldn’t:
successful in reducing turnaround time by a quarter. However,
• External supporters, such as management consultants,
in order for these results to be sustained, the behaviours of
should never own the project - yet, very often, it seems
staff in every ward would have to be changed. At the start
that they do. It is far from unusual for us to hear leaders
of the project, the leader of the pathology division took
within an organisation refer to ‘the 2020 project’. Branding
ownership, but as the project progressed it became clear that
a project with an external name may make it a little
this wasn’t going to be sufficient, as staff outside the division
simpler to describe and perhaps more recognisable
were key to success. The solution? A cross-divisional steering
to others, but it may also send the message that the
committee, led by pathology, was used to drive change,
external consultants are the owners of the project, and
resulting in continued improvement in turnaround time.
perhaps that the project isn’t a high priority for the
organisation. Conceptualising the project in this way also
makes it more likely that, when the contract is finished
and the consultants move on, any change will falter.
115 minutes
89 minutes
• The PMO should not own the project either, although again
this often happens in practice and poses a similar threat to
sustainability of change. If the PMO owns the project, this
is likely to disincentivise those whose engagement is really
needed to change behaviour (typically not working for the
PMO). These staff might think: at some point the project
2
Specimen transport time reduced by a quarter
Pick one thing, go BIG and finish it!
Only those programmes which meet urgent
organisational needs, and receive a high level of
focus and commitment, will be successful and
sustainable. If a project does not address a headline
2
priority, or will be unable to attract sufficient
time and attention from all those who need to
be involved, focus on something else instead.
PERFORMANCE IMPROVEMENT
In a recent study of one of 2020 Delivery’s clients, it
and is just seen as a nice-to-have, will struggle to build the
was found that the project office team were engaged
required support, leaving the project office team looking for
in supporting no less than 300 ‘live’ projects.
excuses for why it didn’t deliver on its promises. Moreover,
needs a significant commitment of both time and emotional
energy – not just from the project office, but from all the
staff involved. And change initiatives very often require the
research shows that an individual loses around 40 per cent
of their productivity by multi-tasking, due to time lost in
‘switching’ between tasks, lower concentration levels and
more distractions. This way of working also increases stress.1
support of a wide group of people. In a hospital, for example,
Successful change occurs when there is a clear need to act
clinicians, nursing staff, divisional managers, project office staff,
and a clear direction set by the leaders. If a project does
lab technicians, communications staff and board members
not address a key business priority, or won’t have the full
may all have a role to play. It is, of course, very common for
attention of all those who need to be involved, then it is better
staff to complain that they are far too busy to get involved.
to dedicate your team’s full attention to something else.
This means that the project office team have to spend
even more time and energy getting them all on board!
Case study:
In the great majority of cases, it would be naive to believe that
As part of a Trust-wide campaign to reduce length of stay, a
by hiring an external resource for a couple of months, adding
the project to the long list of other ‘priorities’ the leaders
believe to be important, and putting an article in the monthly
newsletter, the desired changes will materialise. Change
requires focus, and focus comes from doing one thing at a
time. So go BIG: find a project that addresses a key business
need, get the full attention of the right people, make it a real
priority for the entire organisation, and finish it. Be bold!
number of wards were chosen to start trialling a set of new
discharge principles. However, the leadership team believed
that the biggest impact could be achieved by targeting just
one pair of wards (one male and one female) to be the first
to try out the procedures, allowing staff to focus their efforts
on one goal in one area. The results were fantastic – a 20 per
cent reduction in average length of stay in just eight weeks
– thereby increasing momentum for other wards to join in.
This idea is not new. Apple, the world’s most valuable
15 days
company, takes the approach of focusing on one
12 days
thing at a time and doing it really, really well. They
say no to good ideas every day so that they can put
enormous energy behind the projects they choose.
A project that lacks this level of focus and commitment,
Length of stay reduced by 20% in 8 weeks
1 Rubinstein, J.S., Meyer, D.E., Evans, J.E. and Shiffrin, I. (2001) Executive control of cognitive processes in task switching, Journal of Experimental Psychology, 27, 4, 763-797.
3
Go and lead on the shop floor
As a leader, get out on the shop floor. This is
where your organisation’s reputation, costs and
income are all won and lost, so go and find out
what can be done to improve them. Your team
will follow your lead and allow change to stick.
and giving them some ‘improvement tools’, change
Our experience shows that going out on the ‘shop floor’
goals on a regular basis. The discipline of hoshin kanri states
is the best thing a leader can do to find the real root
that short-term activities should be determined by strategic
causes of problems, implement sustainable solutions
plans, rather than by daily fire-fighting; it is the job of the
and manage change on a daily basis. The importance of
leader to help each member of staff understand his or her part
senior leadership presence on the shop floor should not be
in this overall strategic plan. It isn’t easy – in a hospital setting,
underestimated. The involvement of senior leaders needs to
for example, there is so much happening on a ward every day
be more direct than just providing ‘support’ or ‘sponsorship’
that strategic messages are easily forgotten and lost. George
from a distance. They need to make daily or weekly visits
Bernard Shaw famously said, “the single biggest problem in
to the shop floor to help drive forward the change.
communication is the illusion that it has taken place”. Senior
We’ve seen a few change initiatives fail because
staff must ensure that their messages about vision and
it was assumed that by ‘empowering’ employees
strategy can be heard above the hubbub of daily working life.
would bubble up from the shop floor. Without visible
senior leadership, this is unlikely to happen.
Leaders have a responsibility not only to define specific goals to
meet the organisation’s biggest needs, but to re-enforce these
3
PERSPECTIVES
It might seem obvious but, to be successful, an initiative
Mike Meredith, Director at 2020 Delivery, tells the story
communicate the vision to the shop floor. The director, armed
of an executive in Italy who used to walk the shop floor
with a checklist, would walk the floor and ask questions related
every day after lunch, sharing an espresso with employees,
to the performance of the processes, thereby encouraging
getting to know the real issues affecting them, and
others to do the same. It is a simple thing to do, but the impact
continuously reinforcing the company’s strategic vision.
of the company chairman asking an operator, for example,
This is the kind of leadership that makes it easier for
what ideas she might have for reducing waste even further, is
messages to flow both up and down an organisation.
significant. For one, it helps to empower the operator, giving
her permission to challenge procedures and others in the
Case study:
A global manufacturing company with a factory in the East
waste reduction is an important issue for the company, and
Midlands, who had spent many years developing a very
that her ideas have a direct impact in delivering the strategy.
successful continuous improvement culture, had made
Now, for this to have most impact, the priorities of the
efforts to ingrain this kind of shop floor leadership at every
organisation must be made clear (as in ‘TWO: Pick one thing,
opportunity. Whenever the site was visited by a director,
go BIG and finish it!’), otherwise the messages from the leaders
the local management team would use this opportunity to
will start to confuse.
4
PERSPECTIVES
organisation. Secondly, it helps the operator understand that
Start with the best performing department
When choosing where to start your programme,
find somewhere that will offer plenty of success
and plenty of opportunity to spread the word.
committed to it. So what do staff in other departments
make of this? Of course, there will always be those who feel
inclined to attribute the improvement to unfair distribution
of funding or talent, or some other well-used excuse – but
At the beginning of an initiative, a decision has to be made
these people would say the same whichever department
about where to start making changes. Do you pick the area
was selected for the trial. Apart from these few naysayers,
of the organisation where performance is poor, and which
most people will look at the trial department and think: well,
therefore offers lots of scope for improvement? Or do you
if the best can get better, there must be more we can do.
start where the team and processes are performing well?
The advantage of working with the high-performing
While it may be possible to make a bigger change in the
department first is that there are often fewer obstacles
poorer performing area in terms of short-term financial
standing in the way of change. For example, the success
or quality measures (depending on whether the root
of a high-performing department is likely, at least in part,
causes of under-performance can also be addressed),
to reflect the motivation and adaptability of these staff,
for the long-term sustainability of an organisation-
which in turn means they are more likely to be willing
wide campaign, our experience indicates that the
to change their working practices to generate further
high-performing area is in fact likely to offer the best
improvement. One of the dangers with starting in the low-
opportunities for deep and far-reaching culture change.
performing department is that you end up spending the
Imagine the results six months down the line: the low-
majority of your time addressing underlying issues, such as
performing department has worked hard to use best
staff motivation, rather than achieving and demonstrating
practice and managed to improve one of its key quality
success. In this scenario, your initiative will soon grind to a
measures by 30 per cent, bringing it back in line with the
halt as efforts are not being targeted on improvement.
other departments. What do staff across the rest of the
organisation think? Perhaps that they’ve done a great job and
the changes have had a marked effect. More likely, people
will think: OK, now they’re doing what the other departments
have been doing for years – what’s so special about that?
An approach to behavioural change known as Positive
Deviance is based on the observation that, in any community,
some people adopt uncommon behaviours that allow them
to succeed. Find these departments, find these people, and
help make them visible to others. Focus on the positive!
Now consider the high-performing department. At the start
of the project, they didn’t think they could do much more to
Case study:
improve, yet, by adopting the new ways of working, they have
A European packaging business had two identical sites –
improved their quality by 20 per cent, making them one of the
one in France and one in Germany – with very different
best performing departments in the country. This happened
histories. The German business had been run by a stable
because the staff in this department were really prepared to
management team for many years, whilst the French
make significant changes to the way they worked, not just
business had been disrupted by a number of high-impact
to ‘tighten-up’ procedures. They bought in to the validity of
issues, including a strike. As a result, the output at the
the principles behind the change programme and genuinely
German factory was around 11% higher than the French
4
site. The opportunities for rapid improvement at the French site
the German site. Their reasoning? They wanted to improve their
were clear to see, especially for the leaders of the business, but
entire business in the long-term and not just the short-term.
they chose to start launch their improvement campaign from
Find a simple measure
Consultants and other external staff should be
used to pass on knowledge, provide resources and
help identify opportunities, but they can’t be the
owners of delivering a change. Leaders within the
organisation must own the project and behave
in a way that demonstrates their commitment.
tracking performance goes further than just demonstrating
that the initiative is delivering results – it can also help
sustain behaviours. Very often, just displaying the indicator
is enough to start improvement, and once those using the
process understand how they can influence the results, the
level of improvement will take another leap. An easy-toinfluence measure can generate a new set of behaviours.
success of a change initiative will always hinge upon whether
real results have been generated and then communicated
effectively. Do not fall into the trap of starting a project without
a way of measuring success. Despite what you might hear, at
the end of the day all that matters are hard results. Without
them, your project may make progress but fail to substantiate
its existence with the wider organisation. Find a measure or,
if there isn’t one (which is very often the case), invent one
which directly communicates the success of the project.
A good measure will be simple to obtain, simple
to understand, and easy to influence.
• Simple to obtain: In large public-sector organisations,
Case study:
A clinical nurse specialist running a cancer diagnostic pathway
at an acute hospital sensed that it was taking longer to get
from referral to decision than it used to; this was partly caused
by increased referral activity. The timeline was not routinely
and visibly tracked, but when analysis of the previous six
months was done, her concerns were confirmed, as it was
shown that the referral to decision time had increased to an
average of 60 days, twice as long as in a neighbouring Trust.
Performance against this measure was subsequently
reported on a monthly basis and, after a six month period
obtaining information can sometimes be difficult. The
of focused project work, the timeline had been reduced
right data may well exist, but due to the complexity of
to just 16 days. This was achieved through a reorganised
extraction, it might take until the end of next month before
clinical pathway and better capacity management.
they are ready to be used. In this case, it is worth thinking
about how the data could be captured in a different way,
or if a proxy could be used which wouldreturn results
64
quickly and easily. If the data collection process is simple,
it will be easier to lock into daily or weekly rituals.
62
59
65
67
59
• Simple to understand: Ideally, somebody new to a
department would be able to walk past a chart showing
your results and instantly understand what it is telling
them. Clear communication is very important and there
18
are many ways of displaying data which can be tailored
to individual applications. Instead of just producing a
15
black-and-white line graph, consider using graphics,
heat-maps, or even adding colour to data tables.
Jan 09
Mar 09
Apr 09
May 09
Jun 09
Jan 10
Feb 10
Referral to decision time reduced by 75% from
an average of 63 days to just 16 days
• Easy to influence: The advantage of having a good way of
6
Feb 09
Lock procedures into existing systems
Don’t assume that change will stick without
formalising the new processes. Use new standards
and rituals to help reinforce the behaviours you
need.
The influence model (John Drew, McKinsey & Company)
on the next page shows the four ways in which an
individual’s behaviour can be influenced. In addition to
role-modelling, fostering understanding and conviction
and developing talent and skills, the model shows that
reinforcing with formal mechanisms is also needed.
The same model can be applied to a group’s behaviour,
5
PERSPECTIVES
5
ROLE-MODELLING
REINFORCING WITH
FORMAL MECHANISMS
“I see superiors, peers
and subordinates
behaving in the
new way”
“The structures, processes and
systems reinforce the change
in behavior I am being asked
to make”
Case study:
A large consumer goods manufacturer was having difficulty
achieving an acceptable level of efficiency in its plants.
After studying the problem, it was found that different
manufacturing processes were set to run at different speeds
by different operators for different products. On the face of it,
there seemed to be many good reasons for these variations,
DEVELOPING TALENT
AND SKILLS
“I have the skills and
competencies to behave
in the new way”
FOSTERING
UNDERSTANDING
AND CONVICTION
“I know what is expected
of me - I agree with it
and it is meaningful”
such as increased levels of downtime observed at higherrunning speeds on some product lines, but the company
decided that they would take a structured approach to
improvement, understand the root causes behind these
losses in speed and challenge the issues head-on.
The Influence Model
They implemented a standard speed philosophy which locked
PERSPECTIVES
all lines at the same speed no matter which product was
and thought should be given as to which processes and
running. At first, as expected, this highlighted a number of
structures will help promote the desired outcomes.
problems. However, instead of turning the speed back down,
Many organisations that have been successful in locking
the team decided to tackle the root causes of these problems
change into their daily working practices use standards and
and solve them in order to keep every line running at the
operating procedures to help reinforce behaviours. This
standard speed. After a while, speeds were up, efficiencies had
is necessary as, very often, following a change project, it
become more consistent and overall efficiency had improved.
becomes all too easy to revert back to old ways of working.
But they didn’t stop there. From this point on, higher standard
Changing job descriptions, appraising people on the new
speeds were trialled on a regular basis and the resulting
way of working, and adding new rituals to the running of the
problems analysed and solved, allowing a controlled increase
process are all good ways to lock in change. Don’t assume
in speed across all products. With downtime under control and
that change will stick without formalising the processes.
speeds gently increasing, their efficiencies set new records.
7
Incentivise the team
Whether you celebrate success with donuts or find
career progression opportunities for staff, find some
simple benefits which directly link to your change
vision. And, at the very minimum, always remember
to thank your team when they perform well.
• Think about small recognition awards, such as free
coffee from the vending machine, star awards for
a nominated employee, an extra day’s leave, or
a box of donuts for those who have decided to
demonstrate their commitment to the change.
• Bring some competition to work. Is there a healthy
If you could incentivise your team to behave in a different
way, a way which fostered new ideas and helped generate
way in which you can make the new way of working
improvement, then you would have a much more sustainable
more fun? Use simple measures to track success.
model for delivering change. Over the years, 2020 Delivery
• Make the new way of working easier than the old way
has witnessed many mechanisms for incentivising
or, if you can’t, make the old way more difficult!
employees. Below is a shortlist of our favourites:
• Say thanks regularly, making sure that the reasons for
• Put yourself in your staff’s shoes and ask ‘what’s in it for
saying so are communicated and re-enforce the vision.
me?’. Is there, for example, an opportunity for them to
Case study:
gain exposure, improve their career prospects, or make
working easier? How could you link this to your campaign?
• Is there a moral vision to which staff might aspire?
One of 2020’s clients was rolling out a programme to
encourage a continuous improvement culture. When it
For example, helping people understand how
came to finding volunteers in the first year to help deliver
many lives might be saved by implementing a
specific improvement projects across the organisation,
change might provide additional motivation.
the leaders really struggled. When asked why they were
not volunteering, potential candidates stated that the
• Can you link your staff’s professional development
increased level of responsibility and additional effort
to the change, so that acting with the desired set of
required to deliver a project outweighed any visible
behaviours is formalised as part of their role?
benefit. They would be required to continue their ‘day job’
6
and spend time working on their initiative in addition.
However, those who did succeed in delivering results with
their projects in year one received some rewards. Firstly,
they were encouraged to focus their efforts on solving
problems that caused everyday frustrations, thereby making
leading to a number of promotions and other exciting
opportunities. In year two, more volunteers came forward
because people had realised that, despite the hard work,
being a part of the programme created career opportunities
and the chance to improve daily working practice.
their work easier. Secondly, they were given the freedom to
The programme, now in its third year, is delivering
experiment with solutions, something which was previously
business-changing results, whilst still encouraging
discouraged both actively and passively. Thirdly, they gained
staff to get involved with improvement, challenge
recognition from those at the highest level in the business,
the status quo and experiment with new ideas.
8
Keep solving real problems
There may have been a wealth of problems identified and
tackled during the high-intensity phase of a project, but
• Root cause focus: As well as the very common brainstorm
approach to finding solutions, encourage your team
to use logical root-cause methods, as these will lead
to more targeted, and potentially simpler, solutions. In
the words of one 2020 Delivery consultant: “The closer
you get to the root cause, the cheaper the solution”.
• Fact-based approach: Using a method such as value-stream
how do you keep momentum high and focused on the
mapping to draw out a process based on the how the
important things? As described in ‘TWO: Pick one thing, go
product or patient actually moves through the organisation
BIG and finish it!’, there isn’t much value in trying to tackle
always (and that’s not an exaggeration!) uncovers process
many problems at once; better results can be achieved by
steps which were not initially thought to occur. Wasted time,
focusing efforts in one area at a time. However, stopping staff
resources and money can all be identified by understanding
from tackling issues might kill enthusiasm, so consider how
what really happens rather than what you and others think
each team’s individual problem solving might link together,
happens. Using a fact-based problem solving approach,
thereby solving one of the big organisational issues.
rather than relying on theories or opinions, is essential
In order to formalise problem solving within the organisation,
invite staff to have a go at using structured ways of
for understanding the real issues in any organisation.
• Common language: Picking some common tools for the
solving problems. Some of the tools which may have been
organisation to use will also help simplify communication
employed during earlier phases of the project could be
throughout the sustainability phase. If different teams
valuable for sustaining benefits. Encourage staff to focus
are encouraged to use a similar tool-set, then each
on root causes and take a fact-based approach. It is also
department will become more open to others. There
important that the whole team speaks the same language.
are a number of advantages: it enables people from
other departments to understand the process quickly,
thereby allowing them to bring an ‘external’ perspective
to problem solving; it encourages cross-departmental
learning; and it demonstrates an openness to change.
By encouraging your team to challenge the status quo in
DEFINE
a structured way, focused on the organisation’s biggest
issues, you will increase staff engagement, develop
process understanding and generate better results.
DIGEST
DESCRIBE
Case Study:
The organisation detailed in the case study in ‘SEVEN:
Incentivise the team’ used this approach in order to tackle one
big problem. After developing a set of common tools, and
encouraging their employees to take a fact-based approach
to find root causes, they set out to reduce turnaround time
across the whole end-to-end process, with each department
DELIVER
DESIGN
undertaking their own delay-busting problem solving.
7
PERSPECTIVES
Encourage your staff to keep challenging and
solving problems, especially those which get
in the way of their daily work. Use evidence,
rather than opinion, to ensure that efforts are
targeted at real problems. And don’t give up.
About the author
Chris Bradley is an associate with 2020 Delivery and has over
a decade of management consultancy experience, delivering
results for clients through operational improvement, across
a variety of industries including health, consumer goods,
chemicals, agriculture, defence and construction.
With 2020 Delivery, Chris’ experience includes implementing
improvements to hospital discharge procedures, reducing
treatment times for cancer patients, driving down the time
needed to turnaround pathology samples, and sharing
his expertise through training and mentoring participants
in our Continuous Improvement and Capability Building
programmes.
Recently, Chris helped a global consumer goods company
to streamline the project management of their European
integration programme, demonstrating that process
improvement methodologies can be applied to any situation.
He uses his analytical but practical approach to help his clients
get the most from their operations.
Chris holds Master’s and Bachelor’s Degrees in Engineering
from Trinity College, Cambridge.
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