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In an attempt to transform services and improve value for money a lot of healthcare organisations have turned to Lean as the basis of their improvement efforts. It is not a new concept in fact its origins can be traced back to the 15th Century when the Venetian Navy introduced a ‘flow line’ for the production of war ships. Most people though would trace its history from its implementation within Toyota where is acquired the name of the ‘Toyota Production System’ and this became ‘Lean’ in the book ‘Lean Thinking’ that was published in 1996.

However, whilst the history of Lean in manufacturing is well established, it has only been over the last five or so years that Lean has found its way into the healthcare sector. The initial focus of Lean in healthcare was very ‘point’ focused, such as fixing low level problems in a pathology lab or dealing with theatre capacity. When organisations realised that such a low level approach was unlikely to lead to changes that lasted, the focus changed to ‘end to end’ clinical pathways, but in the early days this meant from the start point till the end point for a patient within a single organisation.
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As Lean has matured, more people have started to experiment with pan-health economy Lean and this is where Lean moves from being a tactical tool to a strategic approach. It is still early days for the larger projects but there are already signs of success that significantly outweigh the many problems any form of transformation activity within the healthcare sector will experience.

In particular, because Lean consultants generally use a lot of jargon and even today use a lot of manufacturing related examples, it can be very off-putting for front-line healthcare staff. Even more damaging though is when Lean is used as a punishment because a team are under-performing or where the leadership team have hidden motives.

Lean can also experience problems after implementation if the focus is not on turning the changes in the process that have been achieved (such as new referral process) into a change in behaviour (which is achieved when people no longer realise that the process is ‘new’). With a lot of the early adopters of Lean focusing on the exciting parts of Lean, such as ‘Rapid Improvement Events’, the aspects of successful programmes that really make the difference have been forgotten, such as making sure that the Lean programme aligns with the organisational objectives, engaging frontline staff and dealing with any problems that arise along the way through some form of ‘Continuous Improvement’ process.

Healthcare organisations are already experiencing many of the problems that manufacturers have had to deal with for several decades, namely how to turn great ‘brown paper’ plans into real changes and then how to make those changes stick. It may not be surprising to realise that up to 75% of Lean programmes will never deliver long-term change, instead consisting of a series of exciting (yet ultimately wasteful) Rapid Improvement Events, and that is the same in healthcare as it is in manufacturing.

The choices for healthcare organisations going Lean is either to do it properly and ensure that the changes stick, which can be very demanding of management time, or trying a few isolated projects where the benefits ultimately drift away.

The key to success is to ensure that you adopt an approach to Lean that is flexible for your organisation and not rigidly imposed by a management consultancy to suit them and also to develop the internal capability of your staff as quickly as possible so that they can take the reins for your improvement programme. Ensuring all of this works is where the leadership team need to ensure that the targets they set for their Lean projects will deliver the organisational objectives and that everyone, from the boardroom to the wards, understands what needs to be done, why and by when.

This article was taken from Training Bulletin and is run by a company called amnis if you wish to get more details on this follow this link Accelerated Lean Skills Programme.

UK researchers claim that antidepressants get to work immediately to lift mood, contrary to current belief.
The researchers state that although patients may not notice the effects until months into the therapy, they work subconsciously. According to Oxford University Researchers the action is rapid, occuring within hours of taking the drugs.

Dr Michael Thase, a psychiatrist from the University of Pennsylvania, said the findings challenged conventional wisdoms and were potentially “paradigm-changing”. “The highest research priority is to confirm that the rapid effects observed in this study are predictive of eventual clinical benefit.”

He said it was possible that switching off the negative thoughts was a crucial part of the therapy.

Alternatively, it might merely be a sign that the drug was beginning to work at the cell level in the brain.

Paul Farmer, chief executive of Mind, said: “This research may contribute to our understanding of how our bodies respond to antidepressants, but the changes recorded can’t always be felt by patients and it can be some weeks before they begin to feel the symptoms of depression easing.

“We must also remember that the side-effects of medication can often be felt straight away long before the benefits really kick in, and this will always affect people’s experiences in the initial stages of treatment.”

Over 50% of adults feel that school sciences lessons should teach both evolutionary theory and creationism alongside each other. The survey was carried out in 10 countries which were:

• Argentina
• China
• Egypt
• Great Britain
• India
• Mexico
• Russia
• South Africa
• Spain
• USA

Of those surveyed over 7,000 knew of Darwin’s work already. In the survey people were asked which statements were closest to their own opinion about how evolutionary theories should be taught in science lessons in schools. The highest proportion agreeing that evolutionary theories alone should be taught was in India, at 49%, followed by Spain (42%).

Darwinism is a controversial theory as it challenges religious explanation for life on earth. However it seems that alot of people feel that it is good to have the two opposing theories taught alongside each other which would suggest that society has progressed and nows feels that both theories are valid and have equal credibility. It shows a tollerance of differences, this could be due to the fact that due to immigration and now countries are becoming more multicultural, if you attempted to teach all of the religious theories it would take a very long time.

Research has suggested that a drug used to treat cancer can stop contractions and may prevent premature labour. This research was carried out by a team from Newcastle University, they tested the drug Trichostatin A on tissue taken from 36 women undergoing a caesarean. They claim that it worked by increasing the levels of a protein that controls muscle relaxation.

Preterm labour and birth is the single biggest cause of death in infants in the developed world, around 1,500 babies die in the UK every year. There are a number of drugs which are used to attempt to stop early labour but research has shown them to have serious side effects.

The researchers got permission to take samples of the muscles of women undergoing caesarean sections at the Royal Victoria Infirmary in Newcastle. They exposed the muscle to TSA, a dfrug used to treat cancer, and measured the effects on both spontaneous contractions and those induced by the labour drug, oxytocin.
They recorded an average 46% reduction in contractions for the spontaneously contracting tissue and an average 54% reduction in the oxytocin induced contractions.

Professor Jane Norman, a spokeswoman for the Royal College of Obstetrics and Gynaecology (RCOG), said: “At the moment, it’s not possible to treat preterm labour effectively. We only have drugs that delay it by 24 hours or so – not enough to deliver the baby safely. There are experts who say that until doctors understand the cause of premature labour there is no way to develop a successful a treatment.

Of course as with any research there are those who feel that premature labour and birth can’t be or shouldn’t be prevented as the body has started labour early for a reason therefore doctors shouldn’t mess with nature. However mothers who have lost a baby because they were born prematurely would disagree and would claim that their child’s life should have been saved.

A study done by the University of Kansa suggests that failing memory may not be the first signal for the onset of Alzheimer’s disease. Their research showed that a decline in thinking and learning skills may be warning signs years before a diagnosis, it is thought that spatial skills, those used for completing jigsaws are the first to fail.

This research holds the key as current drugs are more likely to have a significant impact if given when the disease is still in its early stages. It is thought that approximately 700,000 people in the UK have dementia, with levels expected to soar in coming years as the population ages.

If techniques can be developed in order to detect the disease when it’s in the early stages, it can dramatically improve the quality of life for those who suffer from dementia and those who care for them. However, there is still the potential for it to have a negative impact as some people may become depressed and could also potentially be misdisagnosed. In some cases ignorance is bliss.

American researchers have found that children can be taught to use their imagination to tackle frequent bouts of abdominal pain. It is thought that the technique works particularly well due to their fertile imaginations. The research suggests that 1 in 5 children suffer with frquent abdominal pain with no identifiable cause. There were 30 children aged between 6 and 15 in the study half had 20 minute sessions of “guided imagery” this is where the patient is prompted to imagine things which will reduce their discomfort. The other half had the mainstream care.

It is thought that the treatment is very positive because it is inexpensive and is able to be self administered, which potentially opens the door for easily enhancing treatment outcomes for a lot of children sufering from frequent stomach aches.

This technique is an amazing breakthrough because this means that children can be treated by other means instead of drugs which is definately a positive. Also it means that more children can be treated without massive waiting lists which can be a definate plus for the NHS and the parents of the children who are suffering from abdominal pain and there is nothing they can do

In order to get some psychiatric patients to take their medication doctors are resorting to paying them. A trial involving 68 patients suffering from either bipolar or schizophrenia was carried out and the patients received £15 for every jab of anti-psychotic drug. If they take all of their medication they could potentially get £720 a year.

However there is opposition to this proposal; the charity, Mind feel that people should take the medication for health benefits not money.

Statististics show that patients not taking their medication is a big problem and increases relapse risk and NHS costs. It is estimated 33% of schizophrenics fail to take their prescribed medication. Professor Priebe, one of the experts conducting the study explains that they chose £15 as it is a small amount which they think will act as an incentive.

It is thought that patients who miss 1-10 days of oral anti-psychotic therapy are at greater risk of a patient being admitted to hospital, they say. The statistics show that this increase is nearly double that of a patient who never misses a day.

Whilst this concept seems like a good idea to an extent, it is not without it’s problems such as patients disregarding their well being in exchange for cash. Also although the drugs are only administered to those who need them it will put more financial strain on the NHS. If a patient refuses to take the oral medication that is their choice. As the saying goes you can lead a horse to water but you can’t make it drink.
If a patient is incapable of taking the medication then measures should be taken to rectify this, but I don’t agree with paying somebody to take their medication.

It is already a widely accepted theory that the Mediterranean diet, protects against heart disease and cancer. However spanish researchers have found that it may also help to prevent depression. Their findings showed that depression was less likely to develop in those who have a diet high in fruit, vegetables and cereals and low red meat. The study was carried out over 4 and half years.

The findings showed that those who were adhered to the diet were exsmokers, those who were married and older idividuals.They were more physically active and showed higher energy intake.

This study seems to show that healthy eating is good for your mental health which would make sense as if you have a healthy lifestyle it will boost your energy and also if you’re more active there is increase in the endorphines in your bloodstream which improve your mood. However it is thought that a larger study may be needed to further prove this theory.

The question is how long before there is a theory that disproves this one?

Research carried out by a Swedish research team suggests that well-educated woman have a positive influence on both their own and their partner’s chances of a long life. The statistics showed that a if the woman only has a school education then her partner had 25% greater chance of dying earlier than the man whose partner had a university education. It is thought that the reason for this is that educatated women are more likely to understand the health messages their family needs. When the roles are reversed it is the male’s income and social status that affect women’s lifespan.

One theory put forward is that women tend to take on the responsibility of feeding the family so a more educated woman will be more aware of better eating habits. It is also is thought women who are better educated tend to receive better healthcare and their partner benefits from this.

I don’t know if this is purely the case in Sweden where the research involved 1.5 million participants all of which were swedish; but I don’t really agree that the better educated women increase the life of the male. I think that it is simply a case of common sense that if you eat well and have an active lifestyle then you will in theory live longer. Plus is some scenarios due to having a high powered job I would have thought that their life may be shortened due to stress related illnesses.

The Government say that swine flu vaccinations will begin in the UK next week (21/10/2009).

The first group to be vaccinated is those in hospital, pregnant women and those with existing health problems. After these people have been vaccinated GPs will start to call in patients from priority groups.

There are four priority groups:

• 1. Individuals aged six months to 65 years with underlying health problems and the immuno-supressed, which includes chemotherapy patients.
• 2. Pregnant women
• 3. Household contacts of people with compromised immune systems
• 4. Individuals aged over 65 with health problems