September 11, 2020 Nick Downham

QI and Lean competency / accreditation frameworks

Are they worth the paper they are printed on?

Nick Downham – Sept 2020

© Cressbrook Ltd 2020 – All Rights Reserved

This article details the problems with standardised Quality Improvement (QI) and Lean Competency / Accreditation frameworks.

I often get asked about whether Lean and QI training needs to be accredited. Both in terms of the training I deliver and with regard to training delivered by others.

Commonly training companies use Lean Practitioner or QI Practitioner as a baseline training standard. Sometimes they even borrow from Six Sigma and use coloured belts as indications of levels of training standards. The NHS itself has a number of its own Quality Improvement competency frameworks.

I have, when driven by procurement requirements, run four or five day Lean masterclasses that meet and exceeded the content commonly required for NHS QI Practitioner and ISO Lean Practitioner level – against which ISO have created a standard called ISO18404. When I use this standard, I tend to add the additional requirement of completing a project into my practitioner level requirements.

Despite having great success when working with these frameworks, they are problematic.

The problem with standardised frameworks…..

Many are built on a tool based snapshot of Lean rather than the systems / management philosophy that Lean actually is. So, while you tick the box in terms of a list of content, you are generally left with little that is of use to your actual problem – because it is so generic.

Lean is fast moving, constantly changing and different in every setting. The frameworks rarely keep pace with the emerging new thinking.

By following a standardised, once size fits all approach you will end up with an atomised, tool based view, where the problems many organisations face are systemic. See my blog on common Quality Improvement Traps.

It is someone else’s view of what is required. This is the key. A standardised framework has always been designed by someone else – with little or no knowledge of the work an individual team or organisation does, risking generic delivery.

It assumes everybody’s work is broadly similar. Work and system conditions differ massively – requiring radically different applications of Lean and QI. In the same way aircraft repair and overhaul requires a very different application of Lean than high volume car making. Lean in an operating theatre is very different to Lean in community nursing which in itself is different to Lean in General Practice. See my blog on the very different types of work, and thus improvement approach, in healthcare.

Bespoke CPD based accreditation: providing structure without compromising the quality and effectiveness

Standardised competency frameworks provide organisations with a way of documenting the depth of training and some reassurance that a structured approach is being undertaken. Notwithstanding the problems stated above, these are valid aspirations.

The route I recommend to my clients to achieve these aspirations has two components:

The first is to gain a deep understanding of the work of the client before committing to specific training content. To look at their work with open eyes to begin to question the work and gain understanding to design their bespoke Lean training.

The second step is to then define a bespoke learning framework for their purposes. This reflects their work and their needs. This framework with content, learning objectives and outputs is then put through the CPD accreditation process. This double checks the course rigor and provides the organisation and participants with transferable certification and CPD points that can be officially used in their career progression.

This approach the improvement approach works for the organisation’s specific work and context – rather than someone else’s.

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