Lean on me

Is Lean just another fad or a sustainable way to improve the NHS, asks Neil Westwood

Lean thinking is an improvement approach originally developed by Toyota to streamline its car manufacturing processes and is being adapted through the work of the NHS Institute for Innovation and Improvement for a healthcare setting. It ultimately aims to deliver value to customers and sustain continuous improvement to a workstream. Lean thinking has been used to great effect in manufacturing and service sectors for decades and has produced significant results - improving quality, safety, productivity and reducing costs.

In a healthcare setting, it seeks to improve flow in the patient journey, eliminating all forms of waste and identifying the least wasteful way to provide value to customers – with no delays.

Over the last five years lean thinking has been successfully applied to healthcare processes across the world and more recently in the NHS, including services in Hereford, Bolton, Worcestershire and Shrewsbury. It’s about identifying which activities in healthcare add value to the patient and eliminating tasks that add cost but no value. Rather than add extra resources to solve problems and reduce waiting times, it’s all about using the existing resources we have in a more efficient and effective way.

Delays and waste have been significantly reduced in many areas, including wards, theatres, sterile services, pharmacy, admission and discharge, health records, radiology, catering services and NHS supplies. Back office functions, like finance and human resources, are also starting to apply lean thinking principles to improve their business processes and provide more reliable services.

The demand for lean thinking is extremely high at the moment. A recently launched introductory guide from the NHS Institute Going lean in the NHS attracted over 15,000 orders from over 600 NHS organisations in just six months.

More recently, at the end of September, the NHS Institute launched a practical lean thinking simulation game to teach NHS trusts and PCTs the principles of lean thinking. Teams of between 10-20 play the simulation for 2 hours and significantly improve performance and quality, reduce waste and lower costs. This is a great way to learn by doing. More information is available at www.institute.nhs.uk/lean.

Another lean thinking initiative from the NHS Institute is the Productive Ward, which is an innovative and practical programme of work that aims to increase the amount of time ward nurses in acute settings spend on direct patient care by releasing time back into care through streamlining processes. Productive Ward aims to allow for the safe and reliable delivery of care, helping patients get better more quickly and reducing length of stay.

The Productive Ward initiative increases the proportion of time nurses spend providing direct care to patients improving the experience of both staff and patients. Productive Ward enables nurses to organise their ward so that space works ‘for’ them rather than ‘against’ them – saving both time and effort. It is currently being testing in 10 hospitals – one in each strategic health authority, and more hospitals will be taking part in the New Year. More information is available at www.institute.nhs.uk/productiveward.

It is important to understand that lean thinking is not a quick fix solution or a fad. It is a well-proven business approach to delivering sustainable results. Lean is a long-term survival strategy that requires a change in the culture and thinking of an organisation. It is not about headcount reductions, a cost cutting exercise or the latest cost improvement programme.

Lean is not a short-term remedy for current year deficits. However it is very relevant to trusts in turnaround and when implemented in a systematic way, organisations will identify and eliminate waste. This will improve patient and information flow that will help deliver significant efficiency gains that will make NHS organisations more financially viable in the medium to long term.

Lean requires strong leadership and NHS leaders have a fundamental role to play in leading change in their organisations and building the support and capability required to develop a successful lean culture. Commissioners and NHS trusts need to work together to design sustainable healthcare services that will consistently deliver safe and reliable care at lower cost.

Leaders need to understand patient flows, information and financial flows through their organisations. And they need to move from traditional hierarchical management structures and individual departments working in isolation to a new a situation where teams understand the whole system and optimise the whole patient journey rather than optimising individual parts of a complicated healthcare system.

By understanding the whole patient journey and demand for services, resources will be used more effectively and better decisions will be made. Delays, mistakes and errors will be reduced, improving quality and safety. Productivity will increase, and extra capacity will be created allowing NHS staff to do more value-adding activities that improve patient care. Staff and patients will also benefit from a more stable and predictable environment and staff morale will increase and sickness rates fall, reducing agency staff costs. Lean is a win-win solution.

For more information visit www.institute.nhs.uk/lean

Neil Westwood is an associate in service transformation at the NHS Institute for Innovation and Improvement

“It is important to understand that lean thinking is not a quick fix solution or a fad. It is a well-proven business approach to delivering sustainable results”

“Lean is a win-win solution”