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Lean Healthcare Forum 20061
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“Lean on Me”
Jan FilochowskiNHS Trouble Shooter and Turnaround Advisor Senior Associate, Judge Business School, Cambridge
Talk for Launch of the Lean Healthcare ForumJanuary 25th, National Motorcycle Museum, Birmingham
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Why Lean?
• A fascinating, convincing story
• A different way of seeing, organising and managing work
• Robust and durable but not too dogmatic: there for the long-haul
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Why Health?
• Long linear processes
• Characterised by long waits (widely spread) blockages
• Information flows of vital importance
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Success and failures in using lean
• Choose something important BUT• Don’t make it overambitious
• There must be sufficient “buy in” at a senior managerial level and amongst key implementers
• Preset target savings will torpedo the effort
• Don’t try to impose: bottom-up not top-down
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Some areas of actual and possible application
• Hearing aids (important but limited)
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Hearing Aids - Before
Patient
Information
Decisions
Time4D
15m365D 336D15m 30m
30mGP C A A
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Summary of Process: 1
BeforeNo. ofContacts
4
Time ofContacts
90mins.
Time ofProcess
705days
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Hearing Aids - 2000
Patient
Information
Decisions
Time4D
15m 30m 30mGP A A21D 35D
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Summary of Process: 2
Before 2000No. ofContacts
4 3
Time ofContacts
90mins.
75mins.
Time ofProcess
705days
60days
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Hearing Aids - 2000 (oops!)
Patient
Information
Decisions
Time4D
15m21D 4-42D 35D
15m 30m 30mGP GPorCA AA
15m21D
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Summary of Process: 3
Before 2000 2000 oopsNo. ofContacts
4 3 5
Time ofContacts
90mins.
75mins.
105 mins.
Time ofProcess
705days
60days
101days
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Hearing Aids - 2001
Patient
Information
Decisions
Time4D
15m 45m 30mGP A A21D 35D
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Summary of Process: 4
Before 2000 2000 oops 2001 propNo. ofContacts
4 3 5 3
Time ofContacts
90mins.
75mins.
105 mins.
90 mins.
Time ofProcess
705days
60days
101days
60days
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Some areas of actual and possible application
• Hearing aids (important but limited)
• Emergency admissions
• 18 week end to end target
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Some things I haven’t liked (not lean)
• Redesign as a self-evident mantra
• The patient pathway as “the answer”: it isn’t, it’s one pathway
• Completeness and detail as the objective
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Some things I’ve particularly liked (1)
• Focus on the real goal
• Goes for simple answers: complexity the enemy
• Rightskilling rather than upskilling
• Capacity as an enabler (of flow) rather than an absolute constraint
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Some things I’ve particularly liked (2)
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Some things I’ve particularly liked (2)
• Kaizen (a relentless algorithm)
• Imperfection is intrinsic to our efforts, so let’s work with it
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“Many people dream of success.To me success can only be achieved through
repeated failure and introspection. In fact, success represents the 1- percent of your work which results only from the 99 percent that
is called failure”
by Soichiro Honda
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Lean Healthcare Forum 200623