Lean Thinking

Exceptional care and expert clinical decisions delivered and made by our highly skilled staff are very often lost within the poor processes that support the system. Patient pathways become laborious and the working days of staff are made increasingly difficult due to the demands of fire fighting a broken process. Morale plummets. If systems were established to support us rather than work against us, we would have more time to care for our patients.

Lean is rapidly becoming the improvement methodology of choice in healthcare. Since the first international Lean Healthcare summit of June 2006 in the UK and the launch of the NHS Confederation Report Lean Thinking for the NHS by Dan Jones and Alan Mitchell, Lean Enterprise Academy UK, we have seen countless Trusts attempting Lean implementation, some teaming with management consultancies to provide external support, and numerous conferences providing an insight into the principles and tools of Lean and the celebratory promotion of early successes at sites.

So, is Lean a replacement for traditional process improvement initiatives? Is it just another ‘tool’ to use on projects? Is it the latest management fad? The answer is no. The principles of Lean enable us to understand patient and process flow, ensuring a safer, quality service is delivered by a confident and motivated team.

While typical quality or process improvement approaches seek to identify specific problems and employ tools to improve it, a Lean transformation seeks to change the underlying operational thinking and philosophy of the organisation. A Lean organisation seeks to improve its services by attaining patient and information flow, striving for high quality through ‘expecting’ a “right first time” mindset among its employees - coaching and empowering them to solve problems that would inhibit this everyday. The ultimate aim is for all staff to eliminate risks to our patients by delivering a defect free service. This is done by putting in countermeasures to problems and finding permanent solutions to their root cause. Removing the defects at each step of the process increases the quality of our work.

Understanding what is ‘waste’ within our services - and how to remove it - assists us in providing increased ‘value’ to our patients. Systematically eliminating waste from our processes will improve our services by improving flow; quality and safety will improve as defects are eliminated; end to end turnaround times will be reduced; cost will probably reduce – even with increased investment – as cash releasing efficiencies are made and cash savings are turned to reinvestments; and morale will soar as staff remove the barriers to flow by relentlessly attacking problems every day. More time will be spent providing direct care for our patients if Lean implementation is done right!

Staff time utilisation on tasks that directly attribute to patient care rather than fire fighting a broken process will increase as Lean enables dramatic changes by making us consider the work that we have to do that directly benefits our patient. Using the array of tools available within the Lean management philosophy, staff are then able to take control of their work environment.

Key to implementation is defining the right measures and collecting the right data. Acting upon the right data to improve the process will deliver the right results. Visual management and standard work are key guiding principles that show the ‘flow’ of patients, staff, information and material through our processes. Visual data needs to be accessible to everyone for a culture of continual improvement to be embedded into all parts of the system.

Contrary to the current healthcare frenzy, Lean is not a series of kaizen events. The purpose of kaizen (or rapid improvement) events is to tackle a specific issue that the usual daily problem solving, PDCA cycle and A3 thinking cannot cope with, or that requires collaboration of a specific core team; or that simply is a complex issue that needs a speedy resolution. Making the bold step towards a Lean organisation is not merely running one kaizen event after another. Certainly, there will be a lot of enthusiasm fostered and many ‘quick wins’ assured, but for true sustainability and transformation to occur, improvements must be made at the strategic, value stream and daily work levels. Lean is not simply ‘flavour of the month’ topic.

Some transformations will take time to implement; most have immediate impact in the ability for staff to spend more time with patients. The key steps toward ‘getting it right’ are:

1. specify value – from the customers perspective (customers are the downstream process which we serve, not just our patients)
2. identify the value streams – at organisational level
3. make the value stream ‘flow’
4. seek to ‘pull’ work through the system (through the patient pathway)
5. pursue perfection by aiming for continual improvements to the system – every day.

For a presentation on the philosophy and principles of Lean click HERE.

So, Lean appears to be straightforward enough, but is it easy? No. It takes hard work from all staff; from creating a shared vision by the leaders to changing the work habits of each individual to create and sustain a Lean culture. Cultural transformation begins when people start thinking how to do things differently. Repeated positive actions lead to positive habits. A Lean organisation has a culture that supports team-based process improvement. But this sort of transformation takes great leadership to accomplish. It takes the sort of leadership that think and communicate strategically, whilst being able to coach and develop their teams daily. Without a surgeon to perform mind replacement and unable to employ only geniuses, the Lean leader must challenge, encourage and empower their teams every day.

The rigour of daily discipline that Lean implementation expects will transform healthcare services. However, cultural transformation is definitely required. For those of you still enthusiastic to be champions of the leadership team, don’t forget, the key part of cultural transformation starts – with yourself!