The healthcare sector has been learning and implementing lessons from other sectors for some time. The teaching of W. Edwards Deming influenced both systems thinking and largely laid the foundations for quality improvement. Walter Shewhart, who went on to collaborate with Deming, developed the use of tools to measure improvement, including the Statistical Control Chart.
I recently facilitated and undertook a ‘work experience’ placement at Rolls-Royce (Derby), a global company with approximately 54,000 employees that develops, manufactures, and services power systems, and is one of the leading producers of aero engines for large civil aircraft. During my time at the company I was located centrally in the Civil Large Engines (CLE) business project team. The CLE core team has recently defined its vision to “have the best jet engines in the world” within the next ten years, and they have aligned strategic projects with operational projects in order to realise this vision.
My visit was extremely insightful. It was quickly apparent that a robust and standardised approach to project management was the key ingredient driving all business and technical processes. After my first few days at the company, I came home and described the ‘style’ to my husband as ‘project management on steroids’ and we had a giggle, but in truth I was slightly green-eyed about just what had been achieved. People within the company told me that ‘project management’ had improved the efficiency of processes by a staggering 40%. Indeed, I learned that the company had been improving the efficiency of its engines by 1% each year for the past 20 years. Efficiency gains are made both through engine modification to improve fuel efficiency (and, by the way, it costs an airline approximately $1 million to fill up at the fuel pump for the average long-haul flight path) and by reducing the cost of manufacturing or purchasing the parts that made up the engine. Although the standardisation and governance was impressive, (and probably necessary for such a high-value product) the balance between working autonomously, making one’s own value judgements and operating in a highly controlled environment where individual decision making is moderated, felt a little tipped. I wondered if there was any ‘headroom’ or ‘space’ for the staff to be creative within the tightly governed processes. Nevertheless, the UK healthcare sector is particular riddled with ‘silo thinking‘ and we continually fail to look at ways of introducing sustainable change. Perhaps, if we introduced a standardised project management approach to our improvement programmes, we would reap the rewards of efficiency gains and cost savings.
One of the strategic projects currently running is the implementation of a ‘High Performance Culture’ (HPC) tool, developed and tailored by the ‘culture-shaping’ firm Senn Delaney, to “change the organisational culture” from a manufacturing to a supply chain management mind-set. As you might imagine, I got quite excited about the implementation of a ‘culture tool’ and immediately applied my evaluative hat recommending that they should consider a formative evaluation involving ethnographic work to explore the various cultural and geographical layers within the organisation, alongside a staff survey, and that the data should be triangulated to give a clear picture of the intervention. I shared papers authored by Professor Russell Mannion, who has explored culture tools for measurement of patient safety in NHS. A familiar debate emerged around the ability to measure culture and what culture is anyway, as ‘we’ see it as a certain set of behaviours that we want to promote. The psychology of behaviour is also something that we are very interested in and I mentioned the work that Professor Ivo Vlaev has done using the ‘authoritative’ eyes above posters and hand hygiene stations, and how the ‘staring eyes’ appeared to influence whether someone would use the hand hygiene station. As I walked down the corridor on my last day in the CLE office, I overheard a conversation between two people walking in the opposite direction. One said to the other “So I suppose you have had your HPC training and all that” and the other said “Oh yes of course, I am now very much ‘in the zone’.” I really hope that Rolls-Royce takes on my advice and studies the HPC culture tool in some way, and I plan to keep the lines of communication open with the project manager to find out how this progresses.
During my visit, I learned more about the R&D infrastructures and the relationships Rolls-Royce has with a number of HEIs across the globe, which are largely termed ‘University Technology Centres’. Each centre is focused on a particular technology and some centres had Rolls-Royce-employed staff to act very much like our own Leadership and Diffusion Fellows i.e. acting as ‘knowledge-brokers’ between the company (or, in our case, the service) and the research centres. In turn, the knowledge acquired during the development of the technology (e.g. a new way of using a laser drill) would be shared across the overall network of collaborative industry partners – this appeared to be a similar to the premise of the Academic Health Science Network to share better ways of doing things across the patch. The actual product itself, however, would be protected by intellectual property clauses in contractual agreements. The R&D infrastructures have improved the cost, either by reducing the amount of time it takes to make something, or by finding or developing cheaper materials, and the efficiency of component parts that make up the engine. I guess this would translate down-stream to improvements in the overall functionality, efficiency, and cost of the engine.
In summary, my placement was an educational and fascinating experience. I was asked by the Rolls-Royce group to feedback my reflections/observations at their group meeting and my slides can be viewed online. There were many parallels between both ‘organisations’ and some useful lessons than we can both draw upon.
— Nathalie Maillard, Head of Programme Delivery, CLAHRC WM
- Davies HTO & Mannion R. Will prescriptions for cultural change improve the NHS? BMJ. 2013; 346: f1305.
- King D, Vlaev I, Everett-Thomas R, Fitzpatrick M, Darzi A, Birnbach DJ. “Priming” Hand Hygiene Compliance in Clinical Environments. Health Psychol. 2015. [ePub].