Improving productivity – time for a paradigm shift?

Improving productivity – time for a paradigm shift?
March 18, 2019 Andy Chilton

Its time for improvement, as always!

In the UK, we are constantly reminding ourselves – where others don’t do it for us – that “Productivity is a huge issue”. From Public to Private sector and now even Third sector (not for profit) organisations, calls for increased “efficiency”, “productivity” and “cost-effectiveness” to list but a few terms are common-place. It is big in the news. For the UK, it is increasingly important if we’re to remain competitive in the world market; especially following Brexit many believe – though who knows what that will mean… assuming it happens… as I write this,  there is just no way of telling!

Here to the right, we see 2018 data (source: OCD) showing  relative GDP/ hour worked normalized against 2010’s baseline of 100 US dollars. One thing is for sure – there will always be a focus on productivity – and why not; we should stay, as Tom Peters said, “In search of excellence” and beyond, always.

For decades, we Operational Improvement Specialists have carried out studies on current ways of working and sought opportunities to define new ways of working so that effort expended on wasteful activities is reduced or eradicated and we have sought the Nirvana of purely ‘value-adding’ processes. We have mapped processes in a host of different ways, gathered timings data and led many an improvement programme, endeavouring to involve and enthuse people in our client organisations and we’ve learned and ‘un-learned’ much.
Clearly, this is also an issue in most other countries – indeed, where there is NO call for “improved productivity” then this is evidence of complacency, ignorance or perhaps even arrogance; none of which are healthy states to be in.

And this work continues.

There are masses of us; Consultants with varying titles and descriptions – all essentially offering to carry out a ‘critical’ and/or ‘appreciative inquiry’ review and then provide recommendations to help clients improve the way their organisations work, with the right numbers of people in the right roles with the right skills, the best processes, great enabling and fit-for-purpose technology and a whole raft of other enabling features, including effective and flexible leadership! We are making an impact, but is this service accessible or affordable to all organisations? If not, how can we really accelerate productivity improvement?

For simplicity, I am going to focus on our own recent experience in Community Pharmacy for the rest of this article, but I’m confident you’ll agree that the content applies to any organisation in any sector.

So… to put this into context, let’s consider the wider ‘Healthcare system’. Again, BIG news in the UK. “The NHS is in crisis” is in our news almost every single day. Queues are lengthening in most, if not all, departments. Patients are waiting longer for treatments, and some reports suggest the average life expectancy is actually starting to decline for the first time in decades of upward trend! Politicians wax lyrical about what could and should be done. An army (literally) of NHS management strive to solve the problem. The public cry out for improvement, more funding, more staff and… yes, more productivity.

I am not going to even attempt to address how to solve the NHS crisis – there are a few thousand souls trying to do that already, and many that have given up. But if extra money is not going to be ongoing answer, then we need to be pretty darn innovative to avoid the continued deepening of this problem.

All politics aside, I think there is broad agreement in all quarters that there is plenty of scope to improve productivity in hospitals and all areas of the health care system. But it doesn’t have to just be working differently WITHIN the NHS – others, outside of hospitals can help!

Community Pharmacy – an example where the paradigm shift has begun

One very clear, complementary solution to the pressures on the Healthcare system, which has been suggested for some years now, is that Community Pharmacists – themselves highly qualified clinicians – could do more to alleviate the pressure felt by the NHS, without any extra spend pressure on the system.

Already, there are pockets of success where innovative Pharmacists have worked with the relevant organisations, including commissioners, to develop clinical services such as Flu Jabs, Asthma management, New Medicine reviews, diabetes management and even chemotherapy! Though not all commonly available, there is now clear evidence that these and other services can be supplied reliably, professionally and lead to even higher quality outcomes for patients… often more cost-effectively!

Here’s a challenge: If you were to list all the services and activities carried out by hospitals – how many of them could actually (and should actually) be carried out by Community Pharmacy – or indeed any other healthcare sector (optical, dental, etc.)?  Imagine, if these were delegated to these other sectors, what capacity would be freed up to bring queues for operations down, reduce costs and reduce stress on our much-needed front line staff and management too – arresting attrition of these amazing, caring people from the healthcare system?

Currently, Community Pharmacy itself is also under immense pressure to reduce costs and increase productivity; the government have already cut the price being paid per item dispensed AND the GPs have been asked to reduce the number of items being prescribed to save the UK money on a very large medicines bill and avoid over-prescribing. This pressure is added to, further, by growing concerns over drug shortages.

So, there is a negative motivator for change (reduced payment for current services) and a positive motivator for change (an opportunity to offer more clinical services that would take away the burden on the NHS).

But change takes effort. And, if there is a way to get at latent capacity in Community Pharmacy, to facilitate change and offer new services more widely, then that would really facilitate wider change! Well… there is a way, and one which is now affordable due to technology. Let me explain.

Many (especially small independent community pharmacists) are feeling the pinch on profit with some even fearing bankruptcy. Expensive consultancy is out of reach for them. But they need it and, for reasons outlined above, somehow we need to make it more affordable.

Sharing how we have made things more affordable to the masses:

We are Operational Improvement Specialists – just like many reading this article.

Over the last 3-4 years, we have carried out detailed activity studies on over 150 Community Pharmacy dispensaries, and their Pharmacists. Through these studies, we have proven that an average of over 50 hours per pharmacist per month is readily available… and we’re being conservative to allow for variation in implementation of recommended improvements.

That’s almost 10 million hours per year of extra capacity for the Healthcare system! Just think how that capacity could reduce the current ‘burden’ on the NHS!

We have found evidence-based opportunities to improve productivity in the dispensary processes and team by 70 hours per month on average, so that the Pharmacist can safely delegate ‘non-core’ activities which they are currently having to do, because the dispensary is not as productive as it could be. It means the team does not have to work harder or faster; just smarter, with reduced waste. They should even have spare capacity to take on new tasks!

We have done this using our brains, like the other specialists would. We’ve gathered not only qualitative information on opportunities but quantitative data to develop the business cases for prioritising changes… again, just like other specialists would.

We use the usual Lean Six Sigma techniques and just good old ‘common sense’ (is it really that common?) … like other specialists.

BUT we have turned our ‘Improve Productivity’ lens on our own consulting process. Here’s what drove us to do that…

In 2014, we worked with one of our larger Community Pharmacy clients and carried out just 15 days of detailed study (by hand), recording all activities, to the second. It then took almost 20 days to safely and accurately transcribe the observation data into a spreadsheet and analyse it. It was incredibly difficult to discern what was happening, as all staff were multi-tasking and active on several processes at once. We did it, but it was very difficult indeed and there were a few headaches, to say the least!

We realised that this was not acceptable either to ourselves (the late nights were awful as well as the stress associated with the potential for making transcription errors) or to our client, as transcription of data adds no real value – only the interpretation does.
So… we developed our digital enabler; v-Flow®

A “game-changer” for Operational Improvement?

In order to focus our activities as consultants to only add value, and thereby save our clients money, we developed a piece of software. We have developed it over the last 4 years or so and invested heavily in what is now a very capable, unique, flexible tool. Effectively, it works like this:

  1. We can gather masses of data, easily and in detail using an easy to operate tablet-based App’ which is configurable to any process, in any sector – we can even look at more than one process at a time, easily.
  2. We can then instantly upload the studies to a cloud-based, secure location where they are transcribed and analysed instantly – allowing us much more time to interpret and add value in our recommendations. And we can feed back to dispensary teams what we’ve found, before we even leave the building – increasing their engagement and reducing resistance to any recommendations.

The traditional Operational Study process was:

paradigm 2

Turning the principles of process optimisation on ourselves, where there should only be activities that add value, we set about developing a tool which would not only make data capture easier, faster and more accurate, but which would automatically transcribe and perform initial analysis.

Therefore, the new Operational Study process has become:

paradigm 3

In developing v-Flow, a number of benefits became apparent:

  1. Studies are twice as fast and therefore half the cost of traditional specialist studies
  2. We have more time to ‘look up’ and spot / capture improvement opportunities
  3. We can get to benefits delivery faster, delivering benefits earlier

More importantly, whilst we originally developed this tool to help ourselves, we have realised – and many of our clients and associates have commented – that it will ultimately revolutionise the way all Operational Improvement Specialists’ work is done. But why? Well, because:

  • It will become a critical success factor – not just a competitive advantage
  • Client buyers are more sophisticated and simply will not accept high day rates / fees for low value activities
  • Technology is enabling many areas of operational improvement – why should we be exemot
  • Most importantly, because we can improve PRODUCTIVITY on a global scale, faster than if we do it using traditional means

Some of our fellow specialists and even clients have said, perhaps cynically, that using v-Flow® might “shorten assignments and therefore lead to a drop in revenue”, but The evidence we have is that we can help MORE customers to access such services by making them more affordable, using this enabling technology. So, our revenue increases because more clients have access to more affordable Operational Improvement services!

We see three key groups who should be interested:

  1. Clients who need specialists to come and do the studies but can’t or don’t want to pay for low-value activity like transcription.
  2. Clients who have sufficient size to justify internal specialists who can use v-Flow® under license – we ensure competency in using the tool and they actually save time so the tool pays for itself AND they don’t need to call in specialists as often for these studies.
  3. Fellow Operational Improvement Specialists – not only to remain competitive in the future, but to help them focus on only value-added service activities which will drive growth in their businesses – whether big or small consultancies. They too can do more study projects with the same or even less resource.

So… if it’s productivity we’re after, we first of all need to turn the improvement lens on the way we specialists do things. The digital age is making this decision for us in all aspects of life. And, rather than see this as a threat, why not embrace a huge opportunity to be more productive at helping our customers increase productivity.

We strongly believe v-Flow® will ultimately accelerate PRODUCTIVITY IMPROVEMENT and economic development, across the globe in all sectors.

by Andy Chilton

paradigm andyAndy started work at 16 and worked for the next 19 years, in the Speciality Chemicals Industry, where he qualified as a Chemist and gained an MBA studying part time. Originally in the lab, and becoming a Senior Research Chemist, he then held several roles across most functions, but specialised in Operations. Working ‘hands-on’, at all levels, to improve processes and ways of working, he helped deliver significant uplifts in profit and overall productivity.

Ultimately, Andy worked as an internal Operational Improvement consultant, leading a team of specialists, before leaving to become Senior Consultant at Boxwood (now KPMG Boxwood); an award winning Business Improvement consultancy. He worked in a range of private and public sector organisations from Rail to Retail, Central government to defence, improving business performance.

Andy is a founding partner of Velresco; Operational Improvement specialists with a deep expertise in sectors including Community Pharmacy, FM, Retail and Veterinary. He is passionate about helping organisations and the people in them be as productive as they can be whilst still enjoying their work! Velresco have developed a range of enabling tools to maximise their own productivity whilst maximising the engagement of their clients’ teams to make change sustainable. Connect with him on LinkedIn.

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