the opportunities for lean thinking in healthcare

Lean Healthcare Forum 20061

2 Lean Enterprise Academy www.leanuk.org

The Opportunities for Lean Thinking in Healthcare

Daniel T Jones

ChairmanLean Enterprise Academy


Welcome

• To the first Forum of the Lean Healthcare Network • An independent network to help accelerate the

implementation of lean across the NHS • Building on the work of the pioneers of lean

healthcare in the NHS and across the globe• And the Lean Enterprise Academy’s experience in

spreading lean across many industries • Supported and advised by today’s speakers and :-

• NHS Institute for Innovation and Improvement• NHS Confederation• NHS Health and Social Care Information Centre


Today

• Who are we?• Hospital Trusts 91• Primary and Mental Health Care Trusts 20• Ambulance Service 12• Strategic Health Authorities 38• Other NHS Institutions 30• Consultants, Service Providers etc. 46

• Today’s tasks:-• Develop a common understanding of the lean

opportunities in the NHS• Lean more about implementing lean and creating flow • Collect views and share plans for future action


Lean Thinking

• Lean Thinking derives from observing best practice organisations, not from theory

• It has a long history – Toyota the leading example • Their example shows us the power of a relentless

focus on creating brilliant processes• From them we extracted the principles for

designing lean processes • And how to manage them through a scientific

approach to problem solving close to the source• It is a path that will separate the sheep from the

goats – it not a magic recipe or a quick fix!


Process Thinking

• We traditionally see an organisation as a collection of departments or activities, managed separately and with time buffers between them

• Performance is improved by setting targets, by switching managers and by restructuring

• Lean thinkers see an organisation as a collection of customer, provider and support processes

• The task is to identify the value in each process, to see and manage the end-to-end flows and to synchronise the support flows

• But what are the real flows in healthcare?


Seeing Value

• Each customer, provider and support process contains many steps: -• Which steps create value – solve the problem?• Which steps simply waste people’s time?• What is the experience like for each party?

• Do queues really help?• Do they change the amount of work to be done

or smooth demand?• Do they improve the utilisation of our most

expensive assets?• Can we distinguish between actual and created

demand?


Value Streams

• Mapping the combined customer and provider process reveals lots of waste and dysfunctions

• Steps that are not performed in the same way each time – with no standard and no review

• We can do a lot to remove ambiguities from how tasks are performed and find fail safe procedures

• We can also track root causes and redesign steps to eliminate errors

• All this helps to improve quality • But to find the stability to enable us to link steps

together to create flow we need to analyse the different types of work to be done


Finding Stability

• The flow of work through healthcare is complicated – yet much of the work is routine

• If we can identify this routine work and manage it separately we can begin the virtuous lean circle

• We can standardise the steps, synchronise them so the work flows through each step without interruption and flow in line with real demand

• We also discover as we do this we eliminate lots of scheduling and queues, we can plan ahead better and better utilise our assets

• And we free up time for experts to concentrate on solving the really complicated and rare work!


Making the Change

• None of this happens unless someone is responsible for rethinking the whole process

• Supported by all those involved in running the process

• Who together, with expert help, develop a future state plan

• Which shows where to conduct breakthrough improvement events and where to use lean tools

• This is actually an experiential and shared learning process – that goes on for ever!

• The only changes that last are the ones you do!


In Summary

• Lean Thinking embeds quality at source into every process – with big implications for mortality and medical errors

• It also frees up the latent capacity in current systems – without requiring new capital

• It releases more time to spend on solving the difficult cases – while going home on time!

• As you improve current processes you see new opportunities for designing alternative ways of delivering care – with quite different working practices and right sized equipment

• There is no one lean best way – but several!


The Opportunities for Lean Thinking in Healthcare

Daniel T Jones

ChairmanLean Enterprise Academy

Lean Healthcare Forum 200613

the opportunities for lean thinking in healthcare

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