Imagine the scene. There's a blinding white light, the glow of satisfaction, the sheer joy of having finally achieved the Holy Grail that is a world class, highly efficient and highly effective healthcare organisation. In this place there are no dissatisfied patients, no objecting clinicians, there are no hospital acquired infections and achieving government targets is a cinch! Simply put you're on top of the world and to paraphrase the great Mel Brooks ‘Its good to be the King!' (History of the World Part 1).

But then you wake up and realise that it had all been a dream whilst you patiently waited at the Lean launch meeting. This is the very same meeting that you called at the last minute, you arranged the room (at the last minute), you called everyone (everyone unfortunately meant managers only) and you knew what you wanted (but nobody else did as you failed to take the time or effort to define, create and then communicate a business improvement strategy). Eventually some people turned up, confused but willing to hear what you had to say. ‘We are going to be Lean, you have until Easter' you screamed (aggression was confused for enthusiasm), ‘now off you go, I'll see you then, oh and by the way please don't upset anyone, don't miss any of your targets and please, please remember that you are managers so don't get your hands dirty!'.

A few months later you're now distraught as nothing happened, well nothing positive anyway. Managers are grumpy and overworked, staff are frustrated because the departments are in a state of continual flux and the Chief Executive is terribly disappointed because you promised him Lean by Easter. You pull yourself to one corner and ask yourself where did it all go wrong?

There have been many individuals, businesses and organisations that have fallen foul of probably the most obvious I told you so in history - ‘No Pain, No Gain!'.

It's a very old but very appropriate maxim. ‘Oh but hindsight is a wonderful thing' I hear you scream. It is, but it's like the other old maxim ‘if you put your hand in the fire it's going to burn' (no more maxims I promise). There are many, many healthcare and non healthcare organisations that have realised that to start on the Lean journey is not going to be an easy one. It takes time, lots of effort, organisation and most of all a team effort. There are equally, and perhaps arguably far more that have learnt this lesson the hard way i.e. through bitter experience.

I have almost 15 years experience of implementing Lean in various sectors both tactically and strategically. I can tell you that I am seeing similar ‘issues' being raised again and again regardless of the sector. Probably the most apparent errors that organisations, and over zealous managers make, are to take shortcuts. For example ‘we don't really need to involve all team members - the managers will suffice'. Then there's the classic of underestimating just how much time and preparation is actually required. Let me save you time and heartache - ready - there are no shortcuts and you must involve everyone (at the appropriate times obviously). Lean requires many essential elements but I suppose the main two elements are to involve and talk to all your employees. It's amazing how many good ideas come from the least expected sources. Finally, chart your improvement path in a coherent and well communicated improvement strategy. If you don't know where you're going don't be surprised if you don't get there! (sorry that definitely is my final, final cliché). Any improvement journey is a going to be fraught with numerous issues, concerns and crises. The skill is to identify potential risks / issues and to mitigate against there impact quickly. Where issues arise unexpectedly it is important not to point the finger and create a blame culture.  Remember if it were easy you would have done it a long time ago! If there's no pain, there'll probably be no or little gain.