by David Fillingham of Bolton NHS Trust shown at the 1st Lean Healthcare Forum 2006 on 25th June 2006 ran by the Lean Enterprise Academy

1. Lean Healthcare Forum 2006
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2. Leading Improvement in the NHS:
Can “lean” work in healthcare?
25th January 2006
David Fillingham
Chief Executive

6. The NHS is full of
committed staff who
struggle to deliver good
care within a set of broken
processes

7. What can we do that will
improve quality, morale
and productivity in the
NHS?
Is “Lean” the answer?

8. Lean Thinking can give us…….
• Powerful concepts and tools
• Evidence of transformation in other sectors
• An organising philosophy and framework
• Lean “buddies” – people able and willing to help
eg Simpler and LEA
• “Respect for People” as a guiding principle

9. The Toyota Production System
PEOPLE
•Stability
•J.I.T.
•Flow
Technical
Management
Philosophical
•Go and See
•Problem Solving
•Project Management
•Customer first
•Kaizen
Source: Gary Convin
via J.Liker

10. But……
We need to “reinvent” lean for the
NHS
- Cultural acceptance and ownership
- Defining goals, understanding
demand and flows
- Our ‘raw material’ is also the
customer!

11. Early lessons from Bolton……
• What “lean” can offer the NHS
• Lean Improvement, Lean Operations,
Lean Strategy
• Dilemmas and challenges

13. Lean Strategy
Lean Operations
Lean Improvement

14. Lean Improvement
Every Bolton hospital employee will
solve problems in their work and bring
about improvements every single day
as the way they go about their job.

15. Lean Improvement at the
Front Line
• Observations and Diaries (an NHS “Ohno”
Circle!)
• 6S and Visual Management
• Rapid Improvement Events
• Leadership development at every level

16. 6S
•Sort - Separate needed from not needed
•Straighten - A place for everything…
•Shine - Clean and wash
•Standardise - Build into accepted routines
•Sustain - Discipline to ensure maintained
•Safety - Checking for hazards and defects

17. BEFORE

18. MIDDLE

19. AFTER

20. Visual Management

22. Rapid improvement events
• Seven week process
• Week long events
• Teams of 8-12 staff
• Frontline involvement
• Make rapid change happen
• Learning by doing

23. Rapid Improvement Events
July to December 2005
• 2 X Value Stream Mapping Events – Day cases
and Trauma
• 4 rounds of RIEs with 4 teams in each
- Day Cases (x2)
- Trauma (x3)
- Radiology (x2)
- Pathology (x2)
- Antenatal
• C. 200 staff engaged

24. Trauma Pathway
• Aim: reduced mortality
• Current state; ideal state; future state
• Improve flow through A&E and Radiology
• Trauma Stabilisation Unit
• Discharge and MDT Working

30. Outcomes
• 42% Reduction in paperwork
• Better MDT working
• Time to theatre for #NoF down to
under 48 hours
• Faster recovery
• Lower demand on rehab ward
• Expected lower mortality rates

31. Leadership Development at
Every Level
• Awareness Raising
• Rapid Improvement Events – learning by doing
• Staff Side Involvement and HR policy
• Leadership Programmes
• A core task of all line managers
-Lean thinking days
-The Hospital game
-Visits and buddies

32. Lean Operations…….
…………… managing cross cutting processes at
a Trust wide level using lean principles
e.g.
-Bed Configuration
-Theatre Scheduling
-Diagnostics
-Information Systems

33. A Lean Approach to Bed Configuration
and Theatre Scheduling
• Seeking stability and repetition
• Abandoning traditional specialty constrained
thinking
• Achieving a smooth flow of patients without
complex planning and rework
• Aligning all support processes to minimise errors
and waste

34. Lean Diagnostics and
Decision Making
GP requests
Inpatients
Outpatients

35. Redesigned the Lean
Laboratory

36. Lean Healthcare Strategy
Rethinking the overall
configuration of services using
lean principles and analysis

37. Lean Healthcare Strategy
As a whole Health Economy
• Understanding demand and high volume flows
(which 5% is our 50%?)
• Fully understanding the current state
(lean healthcare consumption maps)
• Visioning a future state
(Radical redesign of patient pathways)
Use of lean analytical tools and design
Principles to accelerate change

38. The Future of Healthcare In Bolton
Population Base
Individuals
10K
50-100K
250-500K
1M plus
Self-treatment and care
Family practitioner and primary care
services
District Services
Tertiary and Specialist Services
Locality Based Services
CommunityProvision
Hospital Provision

39. Some Dilemas and Challenges
• “We’re too busy to do this”
• “We’re not Japanese and we don’t make cars”
• “This touchy-feely stuff is ok, but we’ve got
targets to hit”
• “We’ll leave it up to the Service Improvement
team”
• “This will go away in a month or two when the
Chief Exec reads another new book”

40. What we need to do
“No Time” - Create dedicated time and resources
for frontline staff (this isn’t easy!)
“Not Japanese” - Reinvent lean” for the NHS context
and culture
“Not relevant” - Link lean to our biggest priorities and
problems especially safety and
quality
“Not our job” - Make it a fundamental line
management responsibility
“Flavour of the
month”
- Be prepared for a long haul – stay
focussed, resilient and optimistic

41. So, in conclusion, our early
experience suggests:-
• “Lean” can work in healthcare
• It can improve quality, productivity and morale
• It can operate at all levels – frontline
improvement, operations and strategic
• The people issues far outweigh the technical
• Lean can bring energy, enthusiasm and
inspiration to hard pressed staff

42. Lean Healthcare Forum 2006
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