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.
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