where does lean healthcare begin and end

1 Lean Enterprise Academy www.leanuk.org

Where Does Lean Healthcare Begin and End?

Daniel T Jones

ChairmanLean Enterprise Academy


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

• Danger of jumping to structural solutions• 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


Point Kaizen

• This is where many have begun with lean • Many examples of rapid improvement events and

Kaizen breakthroughs in pieces of the system• From this we learn that we can change things

quickly • The initial gains are in quality, safety and delivery• But the gains are limited unless they can be linked • They are difficult to sustain without the right

support from clinicians and management• Basically this is learning to improve what we have• But we begin to develop problem solving skills


Value Stream Kaizen

• The next step is to learn to see and to redesign patient journeys from end-to-end

• Tracking the steps, time, quality, interactions and experience of each of the actors involved

• This reveals many opportunities for improvement – some we can act on now and others later

• We also see new demands on support processes• We need to ask the right questions to arrive at our

first future state – achievable in months• But who will lead and manage this value stream

redesign on an ongoing basis?


Test Test Test Test Test

Value 100 mins Time 610 mins Duration 31 weeks

Booking List Secretary To Come List Follow Up

Refer Outpatient Pre Op Admit ProcedureDischarge Follow Up

Value 100 mins Time 330 mins Duration 31 weeks

GP GP


The Lean Hospital

• Is difficult to see right now!• We need a much clearer picture of the types of

flows through a hospital• Not by specialties, or by how they entered the

hospital• But by common demand patterns, process routes

and resource requirements• Then we can decide how to separate these flows,

what equipment and resources to dedicate to them and how to reorganise support activities

• But is this the future? • System Kaizen takes us beyond the hospital


Beyond the Big Box

• General Hospitals, like big stores, big factories, big warehouses, big hub airports, are a legacy of the era of mass production and consumption

• The business model is based on economies of scale and specialisation and a belief that there is “one best way” to compete most efficiently

• Should we not be redesigning the whole healthcare system on lean principles?

• Backwards from the consumer rather than forwards from our existing assets?

• Learning from other examples of lean service delivery and retailing


Lean Consumption

Lean thinkers define value from the perspective of the consumer and the provider: -

• Solve our problem completely.• Don’t waste our time.• Provide exactly what we want.• Provide value where we want.• Provide value when we want.• Provide the value we really desire.• Solve our complete problems permanently.


The Convenience Revolution

• The most significant change is in retailing: -• Tesco has led this revolution by : -

• Knowing who its customers are and what they want

• Building a range of formats to match their circumstances and

• Creating a fulfilment system based on rapid replenishment to serve them all

• The next steps lie in innovative ways of combining convenience and home shopping - not Big Boxes!


Changing Consumers

• How is healthcare consumption changing?• Changing Context – one-off treatments, chronic

conditions, end of life care etc.• Changing Circumstances - patient patients or

time poor consumers - high or low involvement • Changing Experiences – informed and choosing

on safety, waiting times, convenience, customer satisfaction, not just on outcomes

• Different types of demand - no “One-best-way” of delivering diagnosis and treatment even for the same problem


Alternative Formats

• As we map end-to-end patient value streams we can see a growing number of alternative delivery routes: -• On-line, help-line, self-help• Primary care • Other community locations• District Hospitals• Units specialising in particular treatments• National Centres specialising in rare problems

• In many cases these need right-sized equipment which does not yet exist

• Where are the lean healthcare entrepreneurs ?


Redesigning Supply Systems

• So far we have paid less attention to redesigning the supply chains that feed the healthcare system with drugs and supplies of all kinds

• Many of these supply chains are 200-300 days long, unnecessarily costly and wasteful

• The good news is that many of these products are now also being supplied through supermarkets

• And they are having to learn how to make and deliver exactly what is needed in days

• The next challenge is to engage the equipment suppliers to design right-size tools for lean


Lean Action Framework

Purpose Process People(Value) (Management)

SystemKaizen

ValueStreamKaizen

PointKaizen


Lean Action Framework

Purpose Process People(Value) (Management)

System Context & Collection of PolicyKaizen Demand Processes Management

Value Circumstances Value Stream Value StreamStream & Delivery Redesign ManagementKaizen Channels

Point Consumption Improving DevelopingKaizen Experience Capability Problem

Availability Solving


Conclusions

• We are just at the beginning of the lean healthcare journey

• These process spectacles are very powerful and lead to some surprising conclusions

• But the seeds have been planted across the globe• The journey will be bumpy – but we know that

extra cash and slash and burn are not the answer• We need to share stories, experiences and maps• And share our visions of new ways of relating to

consumers and organising healthcare


Where Does Lean Healthcare Begin and End?

Daniel T Jones

ChairmanLean Enterprise Academy

where does lean healthcare begin and end

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