Implementing Lean in the School of Nursing and Midwifery Studies at Cardiff University

1. Implementing �Lean� in the School of Nursing and Midwifery Studies at Cardiff University Professor Sheila Hunt: Dean and Head of School Dr Heather Moyes: School Manager Introductory remarks (1 minute) Purpose of presentation is to give an overview of how one School at Cardiff University is using Lean principles and methodologies to improve its day-to-day operations for the benefit of our students, staff and stakeholders. Not going to talk in detail about specific projects, but rather to give an overview of the way in which we got to where we are today, the challenges we�ve faced and the lessons we�ve learned so far. Sheila introduces self � Dean since May 2007, previously at Dundee etc. Appointed with remit to develop School to mirror more closely that standard profile of Russell Group, which challenging given historic development of discipline generally and this School specifically Heather introduces self � SM since November 2007, previously at Lancaster etc. Appointed with remit to improve and professionalise administrative infrastructure and support strategic development of School as a wholeIntroductory remarks (1 minute) Purpose of presentation is to give an overview of how one School at Cardiff University is using Lean principles and methodologies to improve its day-to-day operations for the benefit of our students, staff and stakeholders. Not going to talk in detail about specific projects, but rather to give an overview of the way in which we got to where we are today, the challenges we�ve faced and the lessons we�ve learned so far. Sheila introduces self � Dean since May 2007, previously at Dundee etc. Appointed with remit to develop School to mirror more closely that standard profile of Russell Group, which challenging given historic development of discipline generally and this School specifically Heather introduces self � SM since November 2007, previously at Lancaster etc. Appointed with remit to improve and professionalise administrative infrastructure and support strategic development of School as a whole

2. Structure Context and background Scoping and prioritisation Major projects undertaken to date: achievements and challenges Creating a Lean culture Lessons learned to date Questions? Overview of presentation (1 minute � SHEILA) Context and background � about the School, where we were three years ago and why we embarked upon the project Scoping and prioritisation � the initial work with the University Lean Team to a establish basic level of understanding of Lean amongst staff (and students) and to identify key issues and plan of work Major projects � not going to talk through detail of individual projects but highlight some of the key issues that arose that might have relevance for others Creating a Lean culture � what done to embed Lean at all levels, ensure that not a top-down project and facilitate continuous improvement mindset Lessons learned to date Time for Q&A at the end Overview of presentation (1 minute � SHEILA) Context and background � about the School, where we were three years ago and why we embarked upon the project Scoping and prioritisation � the initial work with the University Lean Team to a establish basic level of understanding of Lean amongst staff (and students) and to identify key issues and plan of work Major projects � not going to talk through detail of individual projects but highlight some of the key issues that arose that might have relevance for others Creating a Lean culture � what done to embed Lean at all levels, ensure that not a top-down project and facilitate continuous improvement mindset Lessons learned to date Time for Q&A at the end

3. About the School 86 academic staff plus research associates 23 p/t inward secondments (approx 10 fte) 46 fte support staff 1,100 fte students 46 week academic year Educational contracts with WAG and local health boards �9M turnover 3 sites Background information and context (2 minutes � SHEILA) One of the larger Schools within CU in terms of staffing, student numbers and turnover Mixed mode staffing with core of academic staff plus Associate Lecturers � inward secondments from NHS to ensure programmes are clinically up-to-date and grow next generation of nursing/ midwifery academics Current academic staff made up of 2 professors (3 pending), 13 SL (1 pending), 71 Lecturers, 1 Research Fellow. Staffing figures exclude vacancies. Large and diverse student body Approx 900 students on full-time pre-registration undergraduate programmes in nursing and midwifery, with two intakes per year for nursing (September/ March) Approx 60FTE on Masters programmes, mainly part-time (=about 100 bodies) Approx 125FTE part-time undergraduate post-registration students studying with us in any academic year on a rolling basis (= about 500 bodies on the books!) Nature of business means multiple, very involved stakeholders, different key relationships from �traditional� disciplines � mainly funded by WAG Health budget/ NHS organisations, rather than HEFCW � which can create challenges within HEI in terms of alignment with CU strategy, policy and practices. Added complexity of operating on three sites, one 17 miles away � has effect on how processes work and how important it is to get them right. Background information and context (2 minutes � SHEILA) One of the larger Schools within CU in terms of staffing, student numbers and turnover Mixed mode staffing with core of academic staff plus Associate Lecturers � inward secondments from NHS to ensure programmes are clinically up-to-date and grow next generation of nursing/ midwifery academics Current academic staff made up of 2 professors (3 pending), 13 SL (1 pending), 71 Lecturers, 1 Research Fellow. Staffing figures exclude vacancies. Large and diverse student body Approx 900 students on full-time pre-registration undergraduate programmes in nursing and midwifery, with two intakes per year for nursing (September/ March) Approx 60FTE on Masters programmes, mainly part-time (=about 100 bodies) Approx 125FTE part-time undergraduate post-registration students studying with us in any academic year on a rolling basis (= about 500 bodies on the books!) Nature of business means multiple, very involved stakeholders, different key relationships from �traditional� disciplines � mainly funded by WAG Health budget/ NHS organisations, rather than HEFCW � which can create challenges within HEI in terms of alignment with CU strategy, policy and practices. Added complexity of operating on three sites, one 17 miles away � has effect on how processes work and how important it is to get them right.

4. Context to �Lean School� project School drivers Academic/ administrative restructure � �whole School� focus Financial constraints General concern about effectiveness of support services/ processes Cultural change from �blame� towards �action� Institutional drivers University Lean Team looking for a guinea pig! Context (2 minutes � HEATHER) Serendipity! School drivers Academic restructure commencing late 2007, followed by administrative restructure in mid-2008, focussed on moving from �departmental� structure to more integrated, �whole School� focus to activity, resource allocation, teaching (where possible), research activity Financial constraints due to reducing NHS budgets and lumpy nature of educational commissioning � needed to be working as efficiently as possible and making most of available resources Concerns about fitness for purpose of support services and processes - Lack of integration of support services/ academic units and lumpy resource distribution. High sickness absence amongst support staff. No longer able to just throw money at problems by recruiting more staff � needed to look at underlying issues. Blame culture deeply embedded � need to move to action instead �Whole School� drive providing clear opportunity/ imperative to review what doing. University drivers Institutional commitment to capitalising on its own existing research expertise in Lean by implementing it within own organisation. Lean Team done some work on University-wide processes but looking to embed at sub-institutional level too. School as perfect guinea pig. Great benefit to us as able to get high level of support in initial stages of project. Context (2 minutes � HEATHER) Serendipity! School drivers Academic restructure commencing late 2007, followed by administrative restructure in mid-2008, focussed on moving from �departmental� structure to more integrated, �whole School� focus to activity, resource allocation, teaching (where possible), research activity Financial constraints due to reducing NHS budgets and lumpy nature of educational commissioning � needed to be working as efficiently as possible and making most of available resources Concerns about fitness for purpose of support services and processes - Lack of integration of support services/ academic units and lumpy resource distribution. High sickness absence amongst support staff. No longer able to just throw money at problems by recruiting more staff � needed to look at underlying issues. Blame culture deeply embedded � need to move to action instead �Whole School� drive providing clear opportunity/ imperative to review what doing. University drivers Institutional commitment to capitalising on its own existing research expertise in Lean by implementing it within own organisation. Lean Team done some work on University-wide processes but looking to embed at sub-institutional level too. School as perfect guinea pig. Great benefit to us as able to get high level of support in initial stages of project.

5. Scoping and prioritisation Staff training in key Lean principles and methodologies Focus groups & 1:1 meetings with academic and support staff and with students Striking level of agreement about problem areas Divergent interpretations of nature of problems �Sheila�s wheel� Major review of enabling strategies (2 minutes � HEATHER) Staff training - Sessions held to explain Lean to staff across all sites by Lean team as we were novices at time. At same time, Heather participated in Lean Skills for Managers programme within CU. Staff sessions as really important first part of process. Quickly apparent that certain key phrases providing staff with real �light bulb� moments � especially �failure demand�, �runners, repeaters and strangers�, �plan, do, check, act�. Also �right first time� rather than reliance on �checking�. Been really valuable on-ongoing basis. Shared vocabulary. Then focus groups and 1:1 meetings with academic and support staff and also with students to identify key concerns. Identified key point for collating �reality� of problems experiences by students via �Student Information Desk�. Strikingly high level of agreement about issues for School, but often very different views as to cause. Remember: blame culture strong, so about looking at problems for variety of perspectives. Beneficial that both Sheila and Heather new to School and so not wedded to existing ways of doing things. Result has become know around the University as Sheila�s wheel�. Major review of enabling strategies (2 minutes � HEATHER) Staff training - Sessions held to explain Lean to staff across all sites by Lean team as we were novices at time. At same time, Heather participated in Lean Skills for Managers programme within CU. Staff sessions as really important first part of process. Quickly apparent that certain key phrases providing staff with real �light bulb� moments � especially �failure demand�, �runners, repeaters and strangers�, �plan, do, check, act�. Also �right first time� rather than reliance on �checking�. Been really valuable on-ongoing basis. Shared vocabulary. Then focus groups and 1:1 meetings with academic and support staff and also with students to identify key concerns. Identified key point for collating �reality� of problems experiences by students via �Student Information Desk�. Strikingly high level of agreement about issues for School, but often very different views as to cause. Remember: blame culture strong, so about looking at problems for variety of perspectives. Beneficial that both Sheila and Heather new to School and so not wedded to existing ways of doing things. Result has become know around the University as Sheila�s wheel�.

6. Sheila�s wheel (2 minutes � SHEILA) About who we want to be, why and how. Visual � displayed throughout School and to all staff offices. Breaking down the enormity of the task into bite-sized chunks and enabling staff to see where they could/ should contribute. 3-5 years� worth of work contained within initial wheel � evolved since then, but that�s to be expected because not operating in a fixed context. Sheila�s wheel (2 minutes � SHEILA) About who we want to be, why and how. Visual � displayed throughout School and to all staff offices. Breaking down the enormity of the task into bite-sized chunks and enabling staff to see where they could/ should contribute. 3-5 years� worth of work contained within initial wheel � evolved since then, but that�s to be expected because not operating in a fixed context.

7. Initial major projects BSc Clinical Practice admissions process Committee structures Placements Examinations and assessments processes Four initial projects identified (2 minutes � SHEILA) BSc Clinical Practice � Heather�s Lean Skills for Managers project � meant to be small but turned into a major project! Placements � the major issue raised by all categories of staff and also by students during scoping exercise� no brainer that this would be amongst first set of projects launched Committee structures � major issue raised by academic staff, also clear that School taking too long to make decisions about key academic issues that needed to be progressed if School strategic goals to be achieved Exams and assessments � major area of concern for staff. Clearly no longer fit for purpose. Serious morale issues as well as reputational risk if something went wrong. Four initial projects identified (2 minutes � SHEILA) BSc Clinical Practice � Heather�s Lean Skills for Managers project � meant to be small but turned into a major project! Placements � the major issue raised by all categories of staff and also by students during scoping exercise� no brainer that this would be amongst first set of projects launched Committee structures � major issue raised by academic staff, also clear that School taking too long to make decisions about key academic issues that needed to be progressed if School strategic goals to be achieved Exams and assessments � major area of concern for staff. Clearly no longer fit for purpose. Serious morale issues as well as reputational risk if something went wrong.

8. Further key projects to date Student file Student travel expenses Room bookings Student evaluations Staff conference/ course attendance IT replacement programme Budgetary management Blackboard (VLE) site management Other projects (1 minute � SHEILA) � just some of the other areas that applied Lean to directly. Some of these via other members of staff attending Lean Skills for Managers programme. Others generated within teams, as understanding of Lean principles increased. Key has been to involve an increasing number of staff in projects, to spread understanding. Return to this later. Now look at three of major projects undertaken to date. Focus on what we�ve learned that might be of interest to people outside of the School.Other projects (1 minute � SHEILA) � just some of the other areas that applied Lean to directly. Some of these via other members of staff attending Lean Skills for Managers programme. Others generated within teams, as understanding of Lean principles increased. Key has been to involve an increasing number of staff in projects, to spread understanding. Return to this later. Now look at three of major projects undertaken to date. Focus on what we�ve learned that might be of interest to people outside of the School.

9. Standard approach Initial scoping and defining boundaries Current state mapping with process owners/ operators Focus groups/ 1:1 meetings with stakeholders/ users Collation of hard evidence Future state mapping Implementation Periodic evaluation Move to continuous review Standard approach to projects � won�t spend time on details (2 minutes � HEATHER) Current state mapping incredibly powerful tool � fascinating to see how people work around problems and how we even make a virtue out of process failure, rather than dealing with actual cause. Surprising anxiety about/resistance to collation of hard evidence on occasion, yet critical to understanding the scale of problems and the real blockages. Runners, repeaters and strangers idea invaluable here. Future state mapping � again, real anxiety as major barrier. Classic change resistance. Also keeping balance between doing what can and not just finding new work-arounds, especially when addressing processes than doing reside entirely within the School.Standard approach to projects � won�t spend time on details (2 minutes � HEATHER) Current state mapping incredibly powerful tool � fascinating to see how people work around problems and how we even make a virtue out of process failure, rather than dealing with actual cause. Surprising anxiety about/resistance to collation of hard evidence on occasion, yet critical to understanding the scale of problems and the real blockages. Runners, repeaters and strangers idea invaluable here. Future state mapping � again, real anxiety as major barrier. Classic change resistance. Also keeping balance between doing what can and not just finding new work-arounds, especially when addressing processes than doing reside entirely within the School.

10. BSc Clinical Practice BSc Clinical Practice � introduction (1 minute) CPD programme for registered nurses not holding degree, but also ad hoc specialist education for graduate nurses Major interface with local NHS but also major cause of stress for staff and poor student experience of initial commencement of modules � late applications, not sure which students NHS-funded, not sure which modules viable at any time, etc. Students not getting access to blackboard/ library for several weeks after start of module. Knock-on consequences for assessments � extensions required which interfering with exam boards (about which more later!). BSc Clinical Practice � introduction (1 minute) CPD programme for registered nurses not holding degree, but also ad hoc specialist education for graduate nurses Major interface with local NHS but also major cause of stress for staff and poor student experience of initial commencement of modules � late applications, not sure which students NHS-funded, not sure which modules viable at any time, etc. Students not getting access to blackboard/ library for several weeks after start of module. Knock-on consequences for assessments � extensions required which interfering with exam boards (about which more later!).

11. Noise! Note that yellow circle is where Admissions work actually began. Everything else was not originally within the scope of the project, but actually became the focus of it!Note that yellow circle is where Admissions work actually began. Everything else was not originally within the scope of the project, but actually became the focus of it!

12. BSc Clinical Practice Major differences between perceived and actual problem areas Much of solution actually lying within School�s own gift Academic decisions required in order to streamline processes Need to increase awareness of other stakeholders BSc Clinical Practice � 2 minutes � HEATHER Much of initial �blame� directed towards NHS and central registry. Host of work-arounds, lists and additional �forms� and letters. Current state mapping revealed major cause of problem to be outside of admissions process itself � decision-making about what to run, cancellations, treatment of students, as well as late submission of applications Need for greater dialogue with NHS about what to run and to end ad hoc decision-making within year Need to take whole programme approach, rather than module by module Required academic decisions, in order to achieve improvements. Also required greater understanding of non-negotiable standard university processes on part of NHS. Massive improvement in process once implemented with steady improvement thereafter. Problems not disappeared entirely because we can�t control NHS, but able to handle runners and repeaters much more easily. BSc Clinical Practice � 2 minutes � HEATHER Much of initial �blame� directed towards NHS and central registry. Host of work-arounds, lists and additional �forms� and letters. Current state mapping revealed major cause of problem to be outside of admissions process itself � decision-making about what to run, cancellations, treatment of students, as well as late submission of applications Need for greater dialogue with NHS about what to run and to end ad hoc decision-making within year Need to take whole programme approach, rather than module by module Required academic decisions, in order to achieve improvements. Also required greater understanding of non-negotiable standard university processes on part of NHS. Massive improvement in process once implemented with steady improvement thereafter. Problems not disappeared entirely because we can�t control NHS, but able to handle runners and repeaters much more easily.

13. Committees Committees (3 minutes � SHEILA) Approx 40 committees/ groups regarded as formal and part of committee structure Lack of clarity around responsibilities and decision-making authority with School Board frequently used as arbiter between competing committees Committees used for communication with memberships growing exponentially Committees (3 minutes � SHEILA) Approx 40 committees/ groups regarded as formal and part of committee structure Lack of clarity around responsibilities and decision-making authority with School Board frequently used as arbiter between competing committees Committees used for communication with memberships growing exponentially

14. Committees Simple mapping exercise undertaken � all names of staff in School along top, all committees down side � added up individual and total hours Approx 10,000 hours of staff time spent in committee (not including additional staff time required to travel between sites to get to said meeting!) Simple mapping exercise undertaken � all names of staff in School along top, all committees down side � added up individual and total hours Approx 10,000 hours of staff time spent in committee (not including additional staff time required to travel between sites to get to said meeting!)

15. Committees Major cultural change: committees for action, not communication Empowerment of thematic standing committees Encourage discussion rather than stifle it Professionalisation of committee secretary role Speed up decision-making processes Time savings Improvements achieved: Move to five standing thematic committees (plus approx 7 sub-committees) with delegated responsibility for decision-making in own areas of expertise School Board giving strategic steer but not taking operational decisions Memberships designed around expertise and relevance of role, not position in hierarchy Committee secretary training � expected to take more of steering role to aid management of agenda � content, prioritisation and inter-committee communication Day-to-day operational matters addressed informally wherever possible Not necessarily about saving time in any individual committee, but about over-all impact and quality of decision-making - e.g. SB from 825 � 150 hours per year; L&T from 315 � 360 (but has actually taken some major decisions this year about structure of pre-reg programme that critical to success of other lean projects) Improvements achieved: Move to five standing thematic committees (plus approx 7 sub-committees) with delegated responsibility for decision-making in own areas of expertise School Board giving strategic steer but not taking operational decisions Memberships designed around expertise and relevance of role, not position in hierarchy Committee secretary training � expected to take more of steering role to aid management of agenda � content, prioritisation and inter-committee communication Day-to-day operational matters addressed informally wherever possible Not necessarily about saving time in any individual committee, but about over-all impact and quality of decision-making - e.g. SB from 825 � 150 hours per year; L&T from 315 � 360 (but has actually taken some major decisions this year about structure of pre-reg programme that critical to success of other lean projects)

16. Placements Placements (3 minutes � SHEILA) Studentts on pre-registration programmes spending 50% of time on placement so major aspect of School�s work. Issues around allocation, communication with NHS and maintaining accurate audit information in highly dynamic context.Placements (3 minutes � SHEILA) Studentts on pre-registration programmes spending 50% of time on placement so major aspect of School�s work. Issues around allocation, communication with NHS and maintaining accurate audit information in highly dynamic context.

17. Placements Lack of shared understanding of priorities and challenges amongst stakeholders Challenge of getting from current to future state in a mission-critical live process Student Records System issues Managing expectations Critically appraising evidence and acting proportionately Major crisis area according to Sheila�s wheel exercise but completely different understandings of nature of problem between students, academic staff and support staff. Again, issues not just about process, but about information driving process and lack of clarity about who decides what, when and how communicated Live process � needed to appoint project officer to facilitate implementation SIMS � initial lack of understanding of scope of project � bad reaction from REGIS Nature of NHS that will always be changes, but need to have clear principles driving how place so that students accept what given Major challenge in the NHS going through wholesale reorganisation in Wales during 2009/10 so threw up huge number of operational challenges and delayed ability to implement project in accordance with original timescales. Importance of maintaining sense of proportion about challenges and about continually seeking hard evidence. Ensuring that system was no designed around worse case scenarios that actually arise fairly rarely. Major crisis area according to Sheila�s wheel exercise but completely different understandings of nature of problem between students, academic staff and support staff. Again, issues not just about process, but about information driving process and lack of clarity about who decides what, when and how communicated Live process � needed to appoint project officer to facilitate implementation SIMS � initial lack of understanding of scope of project � bad reaction from REGIS Nature of NHS that will always be changes, but need to have clear principles driving how place so that students accept what given Major challenge in the NHS going through wholesale reorganisation in Wales during 2009/10 so threw up huge number of operational challenges and delayed ability to implement project in accordance with original timescales. Importance of maintaining sense of proportion about challenges and about continually seeking hard evidence. Ensuring that system was no designed around worse case scenarios that actually arise fairly rarely.

18. Exams and Assessments Exams and assessments (3 minutes � HEATHER) Resourcing? Performance? Volume? Lack of whole School focus? Current state mapping � difficult because of resistance within team and lack of overview Data collection vital � showed system to be unadministrable Exams and assessments (3 minutes � HEATHER) Resourcing? Performance? Volume? Lack of whole School focus? Current state mapping � difficult because of resistance within team and lack of overview Data collection vital � showed system to be unadministrable

19. Exams and assessments Number of pieces of work coming in at same time Number of different stages in process all expected to administer at same time Different ways of doing things for different programmes � for historic reasons only Not compatible with what needed to be supplying REGOS Treating REGOS as something other than the next part of the processNumber of pieces of work coming in at same time Number of different stages in process all expected to administer at same time Different ways of doing things for different programmes � for historic reasons only Not compatible with what needed to be supplying REGOS Treating REGOS as something other than the next part of the process

20. Exams and assessments Unravelling real issues in a very complex process Major academic changes required to achieve administrative changes Tails and dogs Local issues threatening progress Clear need for major rethinking of way in which assessments actually scheduled Major academic review � changed approach to marking of assessments, timing of release of results, frequency of exam boards Balance between individual curriculums and over-all school structure. Easier with 10 exam boards per year to present a structure into which must fit, without admin seeming to drive academic endeavours. Challenges of performance issues not gone away but becoming clearer. Clear need for major rethinking of way in which assessments actually scheduled Major academic review � changed approach to marking of assessments, timing of release of results, frequency of exam boards Balance between individual curriculums and over-all school structure. Easier with 10 exam boards per year to present a structure into which must fit, without admin seeming to drive academic endeavours. Challenges of performance issues not gone away but becoming clearer.

21. Common themes People know what is and is not working Processes not independent of academic context Managing scope versus failing to address core issue Dealing with issues that extend beyond own sphere of influence Central importance of senior support and embedding in culture Common themes (2 minutes � HEATHER) Trusting people to know what isn�t right and what is right critical to successful Lean project � the people that do it, know it best However�.processes have to be understood in the context in which they operate. Don�t exist to run processes, exist to service functions of University. Tail can�t wag dog. Academic context needs to determine room for manoeuvre. Can�t have perfect process that don�t actually service School business. Huge amount of overlap between processes and risk of keeping finding new issues to address. Importance of noting all issues, deciding whether to address or not. But at same time, not ignoring issues that central to success of process. Difficult balance to achieve in practice. Particular challenge of dealing with issues that beyond own sphere of influence, i.e. where big problem identified is with a process set down elsewhere. Particular challenge for Schools in dealing with central processes that don�t work for them. But found frequently that not helping ourselves with failure to recognise that we are part of a bigger organisation� Central importance of senior support � can�t be underestimated. Also needs to be embedded in culture�.so Common themes (2 minutes � HEATHER) Trusting people to know what isn�t right and what is right critical to successful Lean project � the people that do it, know it best However�.processes have to be understood in the context in which they operate. Don�t exist to run processes, exist to service functions of University. Tail can�t wag dog. Academic context needs to determine room for manoeuvre. Can�t have perfect process that don�t actually service School business. Huge amount of overlap between processes and risk of keeping finding new issues to address. Importance of noting all issues, deciding whether to address or not. But at same time, not ignoring issues that central to success of process. Difficult balance to achieve in practice. Particular challenge of dealing with issues that beyond own sphere of influence, i.e. where big problem identified is with a process set down elsewhere. Particular challenge for Schools in dealing with central processes that don�t work for them. But found frequently that not helping ourselves with failure to recognise that we are part of a bigger organisation� Central importance of senior support � can�t be underestimated. Also needs to be embedded in culture�.so

22. Creating a Lean culture Management training Bite-sized lean Induction and appraisal Continuous improvement Application of lean thinking to academic decision-making Creating Lean Culture (3 minutes � SHEILA) Sheila�s wheel as key visual symbol but need to operationalise Lean thinking across School on day-to-day basis Need to maintain momentum, so sending all administrative managers on Lean Skills for Managers programme � able to lead project in own area, involve own staff and think critically about own operational practices. Importance of having clerical staff buy-in as they operate the processes day-to-day � hence development of Bite-sized Lean programme � 3 half days run by Lean Team. Staff working in groups on own small continuous improvement project. Getting people to understand that Lean not �time and motion studies� but opportunity to address things that really bug them about way things are done. Effective and evaluated well. Also encouraging and embedding Lean through support staff appraisal and induction processes � encouragement of improvement suggestions. Heather meets with all new staff as part of induction process to stress importance of Lean thinking and encourage them to use their fresh eyes to highlight areas for improvement that they see. Finally, importance of applying lean thinking to all major decisions � e.g. new BN curriculum � thinking about how decisions about structure of programme, assessment patterns, start dates etc impact on the teams that need to service these decisions. Major opportunity to ensure that don�t create another monster � biggest challenge yet for Lean School Project�?! Creating Lean Culture (3 minutes � SHEILA) Sheila�s wheel as key visual symbol but need to operationalise Lean thinking across School on day-to-day basis Need to maintain momentum, so sending all administrative managers on Lean Skills for Managers programme � able to lead project in own area, involve own staff and think critically about own operational practices. Importance of having clerical staff buy-in as they operate the processes day-to-day � hence development of Bite-sized Lean programme � 3 half days run by Lean Team. Staff working in groups on own small continuous improvement project. Getting people to understand that Lean not �time and motion studies� but opportunity to address things that really bug them about way things are done. Effective and evaluated well. Also encouraging and embedding Lean through support staff appraisal and induction processes � encouragement of improvement suggestions. Heather meets with all new staff as part of induction process to stress importance of Lean thinking and encourage them to use their fresh eyes to highlight areas for improvement that they see. Finally, importance of applying lean thinking to all major decisions � e.g. new BN curriculum � thinking about how decisions about structure of programme, assessment patterns, start dates etc impact on the teams that need to service these decisions. Major opportunity to ensure that don�t create another monster � biggest challenge yet for Lean School Project�?!

23. "It is amazing how much people can get done if they do not worry about who gets the credit." Harry S Truman

24. Questions or comments?