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November 2018
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The proven Lean route to healthcare improvement

Lean methodologies that have revolutionised manufacturing are achieving impressive results in hospitals. Many healthcare managers are using the principles, systems and tools of Lean to stretch limited resources, improve the quality of patient care and safety, eliminate errors, reduce waste, cut delays and reduce the length of patient stays.

Lean provides, perhaps, the best opportunity to achieve gold standards of healthcare- offering a proven route to better care, better quality and lower costs- and succeeding where a raft of political initiatives have failed to make their mark.

Some people argue that healthcare is a totally different environment to industry and that Lean cannot be transported successfully to a patient focused environment. But a factory and a hospital actually have more in common than is first apparent. Both environments run complex processes where the scope for errors, quality problems, poor communication, waste and the failure to put the customer first is colossal.

Why Lean Healthcare?

There are huge advantages to using Lean in healthcare because it determines a new culture and system of checks and improvements- providing a sustainable methodology to continuously improve services. The NHS has a long history of trying to improve services against aggressive goals, but it lacks a sustainable methodology to achieve those goals and avoid the need to constantly set new ones. Everything that happens in healthcare – procedures, appointments, bills – is a process. The challenge is to improve and continuously do it better time and time again.

Lean healthcare involves a radical rethinking of working procedures in hospitals and elsewhere and a long-term commitment by management at the highest levels.

In hospital operational areas (wards, theatres, diagnostic departments, outpatients, etc) lean can achieve many tangible benefits, including reducing patient waiting times and faster preparation of operating rooms. It enables an organisation to discover the reasons for poor quality, for poor delivery, for poor management.

Whatever the challenge, the truly lean organisation can harness the ideas of its people to deliver even better care, and world class performance- freeing up clinician time to spend more time with patients, indeed to -End Waiting, Change Lives.

Lean implementation and principles

When our lean practitioners go into any organisation they identify all of the process inputs to work out where value is being added for the patient and where it’s not. This is similar to a medical diagnostic process where the symptoms are identified to understand the current condition and issues. Next step is to work with the relevant team to develop solutions for eliminating all the non-value added steps within the process. The aim is to cut out those factors that are a waste of time, money or resources. In a healthcare setting, it needs to be totally focused on putting patients first.

Good Lean practice is not based on finding quick, temporary solutions, but instead concentrates on how the work is done and how to eliminate the root causes of delays and other impediments to flow. It is easy to blame human error, but in the healthcare sector humans have to work within often highly complex systems, and it is usually the systems themselves that are the cause.

Five key steps to Lean can be applied to healthcare and these are:

1. Specify value in the eyes of the customer

Patients expect to receive the best care and service that can be provided, free of errors. This means identifying best practice in every step of the patient journey, both information and physical flow, and then rigorously applying gold standard work. This could mean always labelling samples at the bedside, applying care bundles rigorously, or eliminating opportunity for transcription errors by using IT effectively.

2. Identify the value stream

It is useful to start at the end of the process and follow the activity right back to the beginning. This is because the process of discharge often holds up the whole healthcare system, whether this is blocked beds, or follow up appointment processes.

3. Make value flow

No manufacturer would ever run every asset in the value chain at 100%. Customers would never contract to use all the capacity of every supplier, as they know this would guarantee failure the moment there is a small change in demand. But hospitals often run their wards at 100% occupancy. To enable patients to flow safely, there has to be unused capacity. This is actually more economic because the hidden waste in dealing with the errors, cancelled appointments, initiative lists, missed targets and lost activity is eliminated. This means turning the traditional accounting on its head, and focusing on giving value to the patients rather than on measuring activity and cost.

4. so the customer can pull.

When a service is capable, adequate and available, with good flow, it is possible to move to a system that is pulled by patient demand, rather than pushed onto the patient. The possibilities of this are very exciting: No need for outpatient appointments and waiting list procedures, just turn up at a convenient time.

5. Continuously improve in pursuit of perfection

Visual management is essential to show what has been achieved and how to improve. This ensures patients can easily see what has been done to make their service better. The Lean organisation will challenge every team to have a daily review, and write on the wall what the staff will do to make tomorrow even better than today.

The difficulties or challenges encountered in achieving each of these steps will vary from institution to institution depending on the inherent work culture and conditions but every step is essential and must be addressed if improvements are to be gained and sustained.

The Manufacturing Institute has partnered blue-chip enterprises, healthcare and public sector organisations in the UK and Europe over the last 15 years and has helped all these different sectors to understand their individual needs. Their more recent work with more than 15 NHS Trusts is helping to transform the care given by hospitals such as Stockport NHS Foundation Trust; Blackpool Fylde and Wyre NHS Foundation Trust ; Southport and Ormskirk Hospital NHS Trust; West Middlesex University Hospital NHS Trust and Royal Devon and Exeter NHS Foundation Trust. More information about these Lean initiatives and others can be found at www.manufacturinginstitute.co.uk/Healthcare

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