Further Resources: Service Improvement Tools and Technques
Lean
Why do ‘Lean’?
Lean looks at the whole system and therefore runs across organisation departments. Due to the greater need of efficiency with the emergence of 18 weeks, Lean can be used to help reduce ‘waste’ within the system, reducing the cycle time of processes and adopting a pull (rather than push) system.
It can operate at all levels – frontline, operational and strategic and the methods can be applied from tidying a department to changing a whole service.
Lean is a way of thinking about work and incorporates many of the techniques we already use. The toolkit is heavily centred on process analysis and flowcharting/mapping techniques, rather than being data driven.
There are five steps in Lean implementation which are outlined below with pointers and resources for you to use.
Keeping it simple
Once Lean knowledge has been gained the key is to implement the Lean techniques as part of the whole system rather than an individual process and to start simply by eliminating waste wherever possible.
Principle 1 – Specify Value
This can only be defined by the customer (patient) and it is only meaningful when expressed in terms of a specific product. Tools used to help specify the value include:
- Questionnaires.
- Kano Charts.
- Interviews.
- Diaries.
Principle 2 – Identify the Value Stream
Identify all the steps in the value stream for each product family, eliminating every step, every action and every practice that does not create value.
The main tool used within this principle is process mapping.
Principle 3 – Flow
Make the remaining value-creating steps occur in a tight and integrated sequence so the product will flow smoothly toward the customer.
Note: this also considers flow across departments etc which will have influence on 18 weeks.
Principle 4 – Customer Pull
As flow is introduced, patients should be able to pull value from the next upstream activity. This should enable patients to have appropriate care at an appropriate time.
Principle 5 – Pursue Perfection
By implementing the Lean principles and techniques the process can be continually improved as the true processes required become more visible.
Helpful hints on how to implement Lean
The Lean tools/principles support the previous sections of service improvement and used together will help improve your service.
- Get the Lean knowledge.
- Ensure good clinical leadership and line management.
- Encourage the board to focus on value streams and provide the board with reports which support the whole process from the customer’s perspective.
- Look at capacity and demand analysis and feedback to all relevant individuals (remember to look at the actual v planned capacity and the various types of demand).
- Complete detailed process maps include times etc at each stage.
- Encourage staff to work together and solve problems quickly, a clear method of communication is vital especially when problems arise.
- Start the discussion process of standardising tasks.
- Share the work you are doing and advertise success.
Main considerations
- Everyone involved should have the opportunity of Lean training.
- Have clear aims so everybody understands.
- Timescales need to be realistic – consider various types e.g.
- Do it now.
- Rapid Improvement Events (seven week cycle).
- Projects.
- Start simple.
- Good preparation and follow up is vital.
- Communicate, communicate, communicate.
Relevant external resource links
Lean web site: www.lean.org
Health Management Specialist Library - Lean Thinking www.library.nhs.uk/healthmanagement/ViewResource.aspx?resID=126358&tabID=290&catID=4031
Further information on all service improvement tools and techniques are also available at: www.institute.nhs.uk
