The document discusses the application of lean principles in healthcare, emphasizing the need to enhance patient flow and streamline operations within emergency services and bed management. It outlines five principles for implementing lean philosophy, including specifying value from the patient's perspective and achieving smooth patient journeys. Progress has been made in reducing length of stay and improving case efficiency, but further development is needed to optimize outcomes.

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The Impact of Lean inThe Impact of Lean in
HealthcareHealthcare
BenBen GowlandGowland, Director of, Director of
Service Improvement andService Improvement and
Quality, Mayday HealthcareQuality, Mayday Healthcare
NHS TrustNHS Trust

3. 33
Applying LeanApplying Lean
IDEA ProgrammeIDEA Programme
Emergency Services CollaborativeEmergency Services Collaborative
Bed Management (patient flow)Bed Management (patient flow)
programmeprogramme
MaydayMayday

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VolumeLow High
IDEA: Operations need to be designed
somewhere along this line
Low
High
Variety

5. 55
VolumeLow High
Biggest win are high volume low variety
value streams
Low
High
Variety

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Abdomen PainAbdomen Pain
Minor Rx DischAssessment
DischTreatmentInvestigationsAssessment
?theatre DischTreatmentInvestigationsAssessment Admit

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Introducing Lean Philosophy in Healthcare:Introducing Lean Philosophy in Healthcare:
Use the ‘five principles’ as a reference point:Use the ‘five principles’ as a reference point:
–– SpecifySpecify valuevalue from the standpoint of thefrom the standpoint of the
patientpatient
–– Identify theIdentify the value streamvalue stream for every patientfor every patient
groupgroup
–– Make the patient journeyMake the patient journey flowflow
–– So the patient can beSo the patient can be pullpulleded
–– As you manage towardsAs you manage towards perfectionperfection

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Emergency Services CollaborativeEmergency Services Collaborative
Minor Injury /
Illness
Acute Assessment
Medical Admission
Surgical Admission

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Bed Management programme:Bed Management programme:
Use the ‘five principles’ as a reference point:Use the ‘five principles’ as a reference point:
–– SpecifySpecify valuevalue from the standpoint of thefrom the standpoint of the
patientpatient
–– Identify theIdentify the value streamvalue stream for every patientfor every patient
groupgroup
–– Make the patient journeyMake the patient journey flowflow
–– So the patient can beSo the patient can be pullpulleded
–– As you manage towardsAs you manage towards perfectionperfection

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Medical Admission
Flow analysis tool:Flow analysis tool:
Patient stepsPatient steps
Information stepsInformation steps
ControlControl –– clinical and managerialclinical and managerial
4 characteristics of smooth flow:4 characteristics of smooth flow:
•• Small batch sizes (e.g. reduction in size of ward rounds)Small batch sizes (e.g. reduction in size of ward rounds)
•• Linked processes (e.g. admission and discharge)Linked processes (e.g. admission and discharge)
•• Setting the pace (e.g. use of predictors and escalation)Setting the pace (e.g. use of predictors and escalation)
•• Overall coOverall co--ordination (e.g. regular bed meetings)ordination (e.g. regular bed meetings)

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MaydayMayday -- Reducing length of stayReducing length of stay
Day surgery
Elective surgery
Emergency surgery
Emergency Assessment
Emergency short stay
Emergency Admission

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Results (12/04Results (12/04 –– 12/05)12/05)
Length of stay from 8 days to 7 daysLength of stay from 8 days to 7 days
Day case from 52%Day case from 52% -- 61% ‘trolley’61% ‘trolley’
Admission on day of surgery every specialtyAdmission on day of surgery every specialty
ElectiveElective LoSLoS 5.15.1 –– 4.5 days4.5 days
Non elective surgery (excluding T&O) 6.4Non elective surgery (excluding T&O) 6.4 –– 4.94.9
daysdays
T&O 14.4T&O 14.4 –– 12.9 days12.9 days
Medicine 7.8Medicine 7.8 –– 6.2 days6.2 days
Closed 78 bedsClosed 78 beds

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Summary and ChallengesSummary and Challenges
Progress on value streamsProgress on value streams
Scratched the surface on flowScratched the surface on flow
Nowhere near pullNowhere near pull
Only starting to realise the potential benefitOnly starting to realise the potential benefit
Need to build delivery of outcomes fromNeed to build delivery of outcomes from
the startthe start

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Contact DetailsContact Details
Ben.gowland@mayday.nhs.ukBen.gowland@mayday.nhs.uk
0208401321202084013212

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