Starting change by studying isn’t sexy but it’s right! Part 2/2

It’s not very sexy to say we’ll start by studying. Managers like to do things, they want to start and do their program of change. Saying ‘Let’s study’ is also rude because it implies they don’t know what’s going on.

I attended the Systems Thinking – Leaders Summit recently and John Seddon opened the conference with these confronting but honest words.  Many eyebrows in the room were raised. Expectations were set.

The conference featured case studies from business and public sector leaders who had used The Vanguard Method to achieve outstanding transformations in their organizations. In this post and the previous one, I’ll  discuss two different cases and show you how these leaders discovered that Systems Thinking delivers high quality at lower costs.

You will quickly discover too that culture change comes free!  A more in-depth explanation on The Vanguard Method will follow later.

Case 2: Steve Allder, Consultant Neurologist at Pymouth NHS

Systems Thinking in Health Services

Pymouth NHS had a big problem: their hospitals had the highest stroke mortality in the region. The hospitals were also spending too much on the patients: the costs were higher than the government funding per patient.

Strokes happened consistently, research showed, but the length of stay in the stroke unit was incredibly variable. So the government introduced targets, hospitals sharpened their management control and McKinsey Lean consultants measured unit times as they would in a manufacturing environment.

They all failed to understand the problem and ended up with folklore and opinions. The data that would help them understand the high patient costs, was overlooked.

So Steve went on a mission…

It took him 4 years to understand the variability in the length of stay at the stroke unit. He just didn’t know what he was looking for or where to look. He started by studying the system using capability charts (time-series data) on various data.

The purpose of these are to ask better questions. You might have to look at the data for a while, then get some inspiration and run more data. Like John said, studying the system isn’t sexy but it’s right!

The peeks in the data came from patients who were very frail before they had a big stroke. They usually stayed in the unit for 50 days. Although the patients and relatives just wanted to be comfortable, the doctors kept feeding them pills, putting them on machines, lengthening their stay and drastically increasing the cost per patient.

As Steve started to recognize this patient group and understood their wishes, the length of stay was dramatically decreased. Today, 100% of stroke patients come in and go to the Stroke Unit straight away. Previously, only 60% of the patients ended up where they belonged immediately because of the many hand-overs between other units. The average length of stay went from 16 to 6 days.  The hospital  now saves money on each stroke patient resulting in improved care.

It’s the systems, stupid!


I would like to conclude these two posts with a story Steve Allder told us on how hard it is to explain Systems Thinking to others. The story is part of The Happiness Hypothesis book and goes like this:

A short novel that takes place in a two-dimensional world called Flatland whose inhabitants are geometric and the protagonist is a square who is visited by a sphere from the three-dimensional world Spaceland. When the sphere visits Flatland, all the Flatlanders can see is the part of the sphere that is in their two-dimensional world – a circle that grows and shrinks as the sphere moves in the third dimension. The sphere yanks the square out of Flatland into the third dimension. When the square finally sees the third dimension for himself, the square is awestruck. But when the square returns to Flatland he can’t preach the gospel to the other two-dimensional shapes…

Looking into the mirror

Do you find yourself in a similar position where reports and targets say you’re doing great but your gut feeling and perhaps even your customers say otherwise?  Then feel free to get in touch, we’re more than happy to get you started on this journey. Among many other services AGILEMinds helps organizations change their command and control approach to a systems approach to design and manage work applying the Vanguard Method. This results in improved customer services at a lower cost and  an improved morale.

Vanguard has pioneered the translation of Taiichi Ohno’s ideas behind the Toyota Production System for service organizations. Service is different to manufacturing. In simple terms: there is inherently greater variety in customer demand, hence the need to have a design to absorb that variety.

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  1. Starting change by studying isn’t sexy but it’s right! Part 1/2 « AGILEMinds - December 3, 2010

    […] Vanguard Method to achieve outstanding transformations in their organizations. In this post and the next post, I’ll  discuss two different cases and show you how these leaders discovered that Systems […]

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