This document summarizes a presentation given at the Lean Healthcare Forum in 2006. The presentation discusses why lean principles are applicable to healthcare, focusing on reducing waits and improving information flow through linear processes like emergency admissions. It provides examples of applying lean to optimize hearing aid processes, initially reducing contacts from 4 to 3 and the process time from 705 days to 60 days. The presentation notes that lean efforts should start with important but limited areas, and have sufficient buy-in, while avoiding pre-set targets that could undermine the work.

1. Lean Healthcare Forum 2006
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2. 2
“Lean on Me”
Jan Filochowski
NHS Trouble Shooter and Turnaround Advisor
Senior Associate, Judge Business School, Cambridge
Talk for Launch of the Lean Healthcare Forum
January 25th, National Motorcycle Museum, Birmingham

3. 3
Why Lean?
• A fascinating, convincing story
• A different way of seeing,
organising and managing work
• Robust and durable but not too
dogmatic: there for the long-haul

4. 4
Why Health?
• Long linear processes
• Characterised by long waits
(widely spread) blockages
• Information flows of vital
importance

5. 5
Success and failures in using
lean
• Choose something important BUT
• Don’t make it overambitious
• There must be sufficient “buy in” at a senior
managerial level and amongst key
implementers
• Preset target savings will torpedo the effort
• Don’t try to impose: bottom-up not top-down

6. 6
Some areas of actual and
possible application
• Hearing aids (important but
limited)

7. 7
Hearing Aids - Before
Patient
Information
Decisions
Time
4D
15m
365D 336D
15m 30m
30m
GP C A A

8. 8
Summary of Process: 1
Before
No. of
Contacts
4
Time of
Contacts
90
mins.
Time of
Process
705
days

9. 9
Hearing Aids - 2000
Patient
Information
Decisions
Time
4D
15m 30m 30m
GP A A21D 35D

10. 10
Summary of Process: 2
Before 2000
No. of
Contacts
4 3
Time of
Contacts
90
mins.
75
mins.
Time of
Process
705
days
60
days

11. 11
Hearing Aids - 2000 (oops!)
Patient
Information
Decisions
Time
4D
15m
21D 4-42D 35D
15m 30m 30m
GP GPorCA AA
15m
21D

12. 12
Summary of Process: 3
Before 2000 2000 oops
No. of
Contacts
4 3 5
Time of
Contacts
90
mins.
75
mins.
105
mins.
Time of
Process
705
days
60
days
101
days

13. 13
Hearing Aids - 2001
Patient
Information
Decisions
Time
4D
15m 45m 30m
GP A A21D 35D

14. 14
Summary of Process: 4
Before 2000 2000 oops 2001 prop
No. of
Contacts
4 3 5 3
Time of
Contacts
90
mins.
75
mins.
105
mins.
90
mins.
Time of
Process
705
days
60
days
101
days
60
days

15. 15
Some areas of actual and
possible application
• Hearing aids (important but
limited)
• Emergency admissions
• 18 week end to end target

16. 16
Some things I haven’t liked
(not lean)
• Redesign as a self-evident mantra
• The patient pathway as “the answer”:
it isn’t, it’s one pathway
• Completeness and detail as the
objective

17. 17
Some things I’ve particularly
liked (1)
• Focus on the real goal
• Goes for simple answers:
complexity the enemy
• Rightskilling rather than upskilling
• Capacity as an enabler (of flow) rather
than an absolute constraint

18. 18
Some things I’ve particularly
liked (2)

19. 19

20. 20

21. 21
Some things I’ve particularly
liked (2)
• Kaizen (a relentless algorithm)
• Imperfection is intrinsic to our
efforts, so let’s work with it

22. 22
“Many people dream of success.
To me success can only be achieved through
repeated failure and introspection.
In fact, success represents the 1- percent of your
work which results only from the 99 percent that
is called failure”
by Soichiro Honda

23. Lean Healthcare Forum 2006
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