Introduction Quality improvement is not only an important aspect of health care delivery; it is also used in other industries Quality improvement - an active, continuous process by all stakeholders (patients, tax payers, healthcare providers) to improve the quality of health care Different models(tools) have been developed overtime to effect quality improvement- TQM,BPR,FADE,PDSA,SIGMA, AND LEAN PRINCIPLES
History Conceived in the automobile industry in 1950s
Popularized in automobile industries by early 1980s
Introduced into the healthcare sector (U.K.USA, AUSTRALIA, EUROPEAN COUNTRIES) by 1990s
Recently, in NHS, lean thinking is widely used by most hospitals. One of its early users is Royal Bolton Hospital Pathology department (August 2005)
Trigger Internal Increased incidence of hospital acquired infection and avoidable injuries Constraint in hospital capacity and space Excess pressure on the staff leading to low morale Increasing waiting list and queues
Political and public concerns
Economic- huge financial deficit incurred by NHS
Why LEAN Management
What is Lean? It is creating a culture of value and eliminating waste in order to maximize quality of service.
Lean process involves : “…determining the value of any given process by distinguishing value-added steps from non-value-added steps and eliminating waste so that ultimately every step adds value to the process” (Institute for Healthcare Improvement 2005: 2)
The 5 Lean principles
- Value Stream
Lean thinking categories of waste and health care examples Correction (defects): Adverse drug reactions Readmission because of inappropriate discharge Waiting: Waiting for doctors to discharge patients Waiting for test results Transportation: Central equipment stores rather than ward based stores for commonly used items
Lean thinking categories of waste and health care examples Over processing: Asking patients for the same information several times Inventory: Waiting lists Excess stock in stockrooms Motion: Unnecessary staff movement to obtain information or supplies Overproduction Requesting unnecessary laboratory tests Keeping beds or slots free ‘just in case’ (Adapted from NHS Institute for Innovation and Improvement: Going lean in the NHS (2007)
The Hierarchy of improvement Eliminate the non-value adding activity Reduce the size of non value adding activity. Combine it with another values adding activity.
Key lean management tools The 5S Sort – Remove Waste. Set– Set what remains in order. 1-2-3-4-5 Shine– Keep a clean environment that allows process flow. Standardise- Maintain good activity standards for teams and managers. Sustain – Audit and improve the quality attained.
NHS LEAN Implementation Principle The NHS has come up with 6 principles that should guide the lean thinking implementation Philosophy as the foundation. See the whole process. Level out workloads. Match demand with capacity. Lean is not mean. Work on flowing work through values streams mapping Get quality right the first time. Plan customer value into your process. Standardise tasks. No rigidity just lean- removing non-value adding steps in the process. Grow lean leaders and managers. This is necessary to sustain the gains off the implementation. Lean thrives when there is strong leadership support.
Value stream Mapping The following are the steps involved in mapping out values streams in an organisation so that lean principles can be applied
Map the process
Involve those who are involved in the process Ask why the queues and delay happens
Look to where demand is coming from and smooth it in to the process
Sustain value streams
Analysis of Organisational change What is organisational Change? According to Patrick Dawson, “it is a new way of thinking and working”(1994). This is exactly what lean management is about.
The five dimensions to Organisational Change Content/ Character of Change of the change – TQM, Technological change, BPR, Cultural Change. Temporal Dimension – rate or pace of change. Scale of change – incremental or transformational. Political Dimension – Change contested or accepted? Intentionality.
LEAN as a tool for organisational change
It is cultural change, with a view for total quality management.
It is slow pace but its gains appears soon
Incremental and transformational
It is political accepted tool in the NHS. Steve Mason, Audit Commission during the Cranfield round Table shows its acceptance in other sectors and introduction to the NHS.
It is an intentional tool employed by change drivers
Lean management It is a transformational process and not a transactional one. It employs the processualapproach. It is leadership driven and fits into the Katter's view of leadership change model It is a leadership process that engages the bottom-up approach.
Progress of Change QI tools are being appliedin the healthcare industry in otherparts of the developed world Bolton Hospitals NHS a reduction by one third of death rates for patients having hip operations reduced paperwork in the trauma unit by 42 per cent and a fifty per cent reduction in the amount of space needed by the pathology department. Aircraft technicians from the RAF were invited to help them develop lean techniques
Progress of Change The Pathology Department of the Royal Bolton Hospital, yielded a 70% reduction in wasteful activities; 40 per cent reduction in floor space needed; up to 90 percent reductions in the times taken to do its job – all achieved with less, not more, staff and with limited capital investment. ~Powell et al (Feb 2009)
Sample collection after LEAN BEFORE AFTER
Stocks and Supplies Before LEAN After LEAN
Pharmacy after LEAN
Progress of Change The NHS confederation/LEAN Enterprise Academy LEAN Healthcare Academy NHS Institute for Innovation and Improvement Lean Simulation Suitcase NHS Lean Implementation handbook draft Lean thinking plus Six Sigma.
Challenges Some challenges facing Lean have been identified (Young and Maclean 2009 ) These are Evidence Value Metrics Resistance
Conclusion But these challenges notwithstanding, many writers and journals have expressed optimism that Lean will not only work as a strategy but achieve better service delivery if fully implemented in the NHS
LEAN IS NOT... LEAN is not Mean LEAN is not Cost cutting LEAN is not restructuring