EFFEKTIVITET NR

1. Doing the wrong things righter?
Dr. Keivan Zokaei (Director of M.Sc. in Lean Service Operations)
Professor Melanie Fritz, Lean Enterprise Research Centre, Cardiff University
The term Lean is arguably the most unfortu- is translated as “Jing Yi” which means the patients with learning disabilities’. Such indi-
nate phrase in the management lexicon. It essential core for the benefit of people. For cators drive GP behaviour to focus on referring
was coined in the 1980’s by John Krafcik – now the Chinese Lean goes beyond value creation people for various tests and examinations and
Acting President and CEO of Hyundai Motor for the customer to include a wider range of to focus on data management tasks. Similarly,
America – to describe Toyota’s ability to do stakeholders – at least potentially. the framework encourages practices to provide
more with less and what seemed to be a re- appointments within 48 hours as well as offe-
lentless focus on waste elimination. However,
as the Lean community learnt more from the LEAN=“精益” ring certain range of appointments. Effectively
the ‘practice management’ indicators incenti-
Toyota Production System, it became increa- vise offering 10 minute slot (or even shorter) to
singly obvious that waste is crucially defined in 精 (Jing)=Essentials, take each patient.
relation to value. Waste elimination is a virtue out waste and focus on The QOF indicators seem plausible, on the
so long as it leads to value enhancement, essentials surface. However, they curiously ignore the
e.g. inventory reductions leading to shorter actual purpose of the system which is treating
delivery times for the customers at a given
益(Yi)=Benefit for people the patient. For example the 10 minute slots
or even lower cost. Whereas the term Lean (Consumer, Employee, sometimes mean that the GP is not able
carries a strong efficiency connotation, Toyota Employer, Society) to treat patients leading to repeat visits. In
Production System is all about effectiveness. fact when a Vanguard consultant carried
We define efficiency as doing things right and out a study of the demand in a practice in
Focusing on effectiveness means starting with
effectiveness as doing the right things. England he found that patients were visiting
value and understanding the purpose of the
The dubbing of the Toyota system as “Lean” the practice between 1 and 16 times for the
system from the customers’ point of view. No-
is an American manipulation influenced by same – or closely related – condition. This
netheless, conventional management thinking
the mass production paradigms. In fact when clearly shows high levels of failure demand or
is preoccupied with measuring and improving
Lean is translated to other languages it often demand which arises as a result of the system
cost or efficiency which very often could lead
takes on different meanings closer to its not doing something right. Ironically a given
to increasing costs. We visit the example of
origins. In French the literal translation of Lean practice can go on to receive high financial
primary care and GP practices in the National
results in “gestion maigre” meaning skinny rewards by only focusing on good record kee-
Health System in the UK. General Practitioner
or anorexic management. It is interesting ping, by having many patients on the register
doctors [praktiserende læger] are regulated
that this translation is sometimes used in the and turning around appointments as quickly as
and rewarded by the government through the
French speaking parts of Canada, maybe sho- possible regardless of the actual outcomes for
Quality and Outcome Framework (QOF). Put
wing mass production influences. However, the recipients of the service. The QOF pretty
simply, the higher the score in the QOF, the
the common phrase for Lean management much means that practices are being incenti-
higher the financial reward for the practice.
in French is “gestion au plus juste” meaning vised to do the wrong things righter. For those
The government claims that the framework
the most appropriate or justified manage- who would like to know more about effec-
helps practices to benchmark and improve the
ment. While Germans and Italians prefer to tiveness thinking in the UK public sector, we
delivery and quality of care that the patients
use the English phrase, Persians translate suggest reading a recent report on Lean and
receive. There are hundreds of indicators
Lean production as pure or limpid production systems thinking approaches: www.wao.gov.
within the framework nearly all of which mea-
which again provides a value connotation as uk/assets/englishdocuments/Systems_Thin-
sure ‘activity’ within the practice such as this
well as emphasising the simplicity aspects of king_Report_eng.pdf.
one: ‘the practice can produce a register of
TPS. But most interesting, in Mandarin Lean
34 EFFEKTIVITET NR. 2 2010