Lean Healthcare Forum 20061

Leading Improvement in the NHS:Can “lean” work in healthcare?

25th January 2006David FillinghamChief Executive

The NHS is full of committed staff who

struggle to deliver good care within a set of broken

processes

What can we do that will improve quality, morale and productivity in the

NHS?

Is “Lean” the answer?

Lean Thinking can give us…….

• Powerful concepts and tools• Evidence of transformation in other sectors• An organising philosophy and framework• Lean “buddies” – people able and willing to help

eg Simpler and LEA• “Respect for People” as a guiding principle

The Toyota Production System

PEOPLE

•Stability•J.I.T.•Flow

Tech

nica

l Managem

ent

Philosophical

•Go and See•Problem Solving•Project Management

•Customer first•Kaizen

Source: Gary Convinvia J.Liker

But……We need to “reinvent” lean for the NHS- Cultural acceptance and ownership- Defining goals, understanding

demand and flows- Our ‘raw material’ is also the

customer!

Early lessons from Bolton……

• What “lean” can offer the NHS• Lean Improvement, Lean Operations,

Lean Strategy• Dilemmas and challenges

Lean Strategy

Lean Operations

Lean Improvement

Lean Improvement

Every Bolton hospital employee will solve problems in their work and bring about improvements every single day

as the way they go about their job.

Lean Improvement at the Front Line

• Observations and Diaries (an NHS “Ohno” Circle!)

• 6S and Visual Management• Rapid Improvement Events• Leadership development at every level

6S•Sort - Separate needed from not needed

•Straighten - A place for everything…

•Shine - Clean and wash

•Standardise - Build into accepted routines

•Sustain - Discipline to ensure maintained

•Safety - Checking for hazards and defects

BEFORE

MIDDLE

AFTER

Visual Management

Rapid improvement events

• Seven week process• Week long events• Teams of 8-12 staff• Frontline involvement• Make rapid change happen• Learning by doing

Rapid Improvement Events July to December 2005

• 2 X Value Stream Mapping Events – Day cases and Trauma

• 4 rounds of RIEs with 4 teams in each- Day Cases (x2)- Trauma (x3)- Radiology (x2)- Pathology (x2)- Antenatal• C. 200 staff engaged

Trauma Pathway

• Aim: reduced mortality• Current state; ideal state; future state• Improve flow through A&E and Radiology• Trauma Stabilisation Unit• Discharge and MDT Working

Outcomes• 42% Reduction in paperwork• Better MDT working• Time to theatre for #NoF down to

under 48 hours• Faster recovery• Lower demand on rehab ward• Expected lower mortality rates

Leadership Development at Every Level

• Awareness Raising

• Rapid Improvement Events – learning by doing• Staff Side Involvement and HR policy• Leadership Programmes• A core task of all line managers

-Lean thinking days-The Hospital game-Visits and buddies

Lean Operations…….…………… managing cross cutting processes at a Trust wide level using lean principles

e.g.-Bed Configuration-Theatre Scheduling-Diagnostics-Information Systems

A Lean Approach to Bed Configuration and Theatre Scheduling

• Seeking stability and repetition• Abandoning traditional specialty constrained

thinking• Achieving a smooth flow of patients without

complex planning and rework• Aligning all support processes to minimise errors

and waste

Lean Diagnostics and Decision Making

GP requests

Inpatients

Outpatients

Redesigned the Lean Laboratory

Lean Healthcare Strategy

Rethinking the overall configuration of services using lean principles and analysis

Lean Healthcare StrategyAs a whole Health Economy• Understanding demand and high volume flows

(which 5% is our 50%?)• Fully understanding the current state

(lean healthcare consumption maps)• Visioning a future state

(Radical redesign of patient pathways)

Use of lean analytical tools and designPrinciples to accelerate change

The Future of Healthcare In BoltonPopulation Base

Individuals

10K

50-100K

250-500K

1M plus

Self-treatment and care

Family practitioner and primary careservices

District Services

Tertiary and Specialist Services

Locality Based Services

Com

munity P

rovision

Hospital Provision

Some Dilemas and Challenges

• “We’re too busy to do this”• “We’re not Japanese and we don’t make cars”• “This touchy-feely stuff is ok, but we’ve got

targets to hit”• “We’ll leave it up to the Service Improvement

team”• “This will go away in a month or two when the

Chief Exec reads another new book”

What we need to do“No Time” - Create dedicated time and resources

for frontline staff (this isn’t easy!)“Not Japanese” - Reinvent lean” for the NHS context

and culture“Not relevant” - Link lean to our biggest priorities and

problems especially safety and quality

“Not our job” - Make it a fundamental line management responsibility

“Flavour of the month”

- Be prepared for a long haul – stay focussed, resilient and optimistic

So, in conclusion, our early experience suggests:-

• “Lean” can work in healthcare• It can improve quality, productivity and morale• It can operate at all levels – frontline

improvement, operations and strategic• The people issues far outweigh the technical• Lean can bring energy, enthusiasm and

inspiration to hard pressed staff

Lean Healthcare Forum 200642