Undoubtedly, Lean is ready to make a big impact in the field of health in the coming years and many healthcare organizations in both the public and private sectors are already studying how they might apply to the way patients and administrative processes.
While most of Lean tools are familiar to those in the health sector, particularly the aspects of the process analysis, the real difference leaning bring a change in the way activities are implemented improvements rather than the use of appropriate tools.
Many people in the health sector are looking for people with skills in lean manufacturing to guide you through the maze of implementing Lean, including helping the organization to prepare lean and perform activities specific improvements, including value stream events, rapid improvement events etc. Along is the need to develop the internal capacity of organizations to make improvements themselves, achieved through the development of lean internal facilitators (or agents of change).
However, as we know, all health problems can be linked to a problem encountered in the manufacture and there are significant differences in the approach needed to make a successful breeding program for more people familiar with the main the Improving Lean Manufacturing.
This article reviews some of the main differences we found in lean pioneer of the transformation of the health and Lean share structure we have developed activities to ensure that the organizations supported improvements rather than "landings" isolated Lean.
Interestingly, our work to date also provides a useful learning that can be applied in reverse - New Health in the making!
The same, but different
As already mentioned, Lean will make a big difference in the health and help them achieve their operational and financial objectives, but must be applied with sensitivity in organizations that have been "beaten" by the initiatives and legislation and cynicism was not abusive toward "This new initiative called Lean.
As in many manufacturing companies first embark on a journey of improvement, employee health are concerned about being skinny vehicle to cut jobs. This feeling was not helped by the recently published NHS guide to the Lean Healthcare has chosen to use a chainsaw as the main logo was provided by a lead service improvement in the (Strategic Health) SHA as the " Slash & Burn 'guide health.
Questions of this kind, and the use of production-oriented terminology, photos and case studies when working with employees in the health sector, has the effect of building the internal resistance and leads with comments like "My patients are not cars" made by a renal consultant recently found us.
Other differences can be seen in the attitude to risk in the health sector. In manufacturing, if you make a mistake with Lean can increase the risk of accidents, but it's probably only reduce productivity or profits. Health, similar mistakes can impact on patient safety (including increased morbidity or mortality) and can attract media attention.
Making this even more complex scenario is the fact that the "care pathway" that patients often experience interact and overlap so that the flow of manufacturing value does not, with patients switching between channels and specialties depend on your specific needs and treatment plans.
The management of these processes and pathways is complicated by the need to balance clinical concerns (such as patient safety and best practices) with the concerns of enterprises "(availability of resources and finance) and often uncomfortable balance reach between clinicians and managers of the organization on these high matters.
Although this type of complexity is no stranger to manufacturing, where there is a constant need to balance the cash flow of sales (for example), the fact that the balance sheet and risk management to health is obtained if Leads shared a very different style management - being more consultative and inclusive production, slowing decision making and involves an analysis much more than many manufacturing decisions, and the need to test things first skeptical doctors.
This constant need for balance between clinical and operational concerns led to one of the biggest differences we found, namely the difficulty involving the right people for the right amount of time to make those lasting improvements. This is not a new problem in the health sector with many improvement initiatives that fell within the scope of changing priorities, allocation of enough people to process improvement or just be able to move the focus to the action quickly.
A final difference between manufacturing and health we thought it useful to emphasize is simply the difference between what we consider to be of added value in the customers' both sectors. Giving comfort and counsel a patient is very popular (for example, a nurse accompanying a patient taken to the theater), but is not easily translated into the equivalent manufacturing.
A holistic approach
To counter these problems, the introduction of Lean in healthcare requires a comprehensive approach that takes into account the following:
1. Understanding customer value
While the patient is obvious customer (and most importantly) in a process, it may not be the only client in a healthcare environment; with others, including (for example) a Primary Care Trust, which commissioned a hospital to perform an activity in a patient and will be charged by the activity.
However, in the exploration of what customers think of the added value found some customers (patients) in the health sector have been conditioned by their experiences to date. In one example, we were talking to a patient who attended the weekly clinics as part of their treatment plan and was forced to wait at every appointment for a maximum of two hours. When we talk about what they like and whether a reduction of the waiting time would be beneficial, said they expected the expected value and have more access to free coffee and the best magazines to read!
2. Scope effect
The identification of an urgent need for the improvement process is absolutely essential. The need to improve productivity or finances often resulting in initiatives to improve health care, but an imperative based economies rarely involve people on the other side of the road.
Often a requirement success will focus on improving patient outcomes and goals of public health law (such as performing a delivery time of 18 weeks maximum referral from a physician for the initiation of treatment) and the need for best practices in the participation rate. Because of the importance of this step in the process, we have shown what we believe are the key elements necessary to achieve a successful improvement project in the text box otherwise. Note that to be really able to determine the extent of improvement based on Lean with representation all the way - even if, as is often the case, this means including people who have never regarded themselves as colleagues, as before, and the GP and Hospital Porter sat side by side in a span of a recent session.
3. Sponsorship
Leading a Lean project that stretches as wide avenues patients requires a high degree of influence skills. Trying to improve a simple administrative process as an output of the patient, for example, could require the proponent to liaise, cajole and drive change by various stakeholders, including physicians, consultants (the true guardians of NHS), service staff, medical secretaries, pharmacy staff, information technology, social services and carriers!
Lean sponsor belief will be tested daily by a large group of stakeholders to their ability to maintain enthusiasm and motivate agents of change is essential. The secret weapon at their disposal once the session is complete range is an urgent need for agreement will create "purpose of clarity." Eventually, if enough people with the same time engaged enough positions, followers begin to rise.
4. Awareness and Capacity Building
Given the concerns of many healthcare leaning will be used to eliminate jobs, it is essential that communication has given thought "absolutely necessary" - which is thin, which is not, and what will happen . Running with awareness will need to focus on developing the capacity of individuals within the organization to enable them Lean improvements.
In addition to initial awareness, it is also necessary to establish communication activities to report on progress, involve others in the design of new processes and ensure that the organization integrates the above improvements ( or next) move to the next challenge.
Our experience shows that, early in the process many people think of Lean as almost "process mapping" and there is a degree of cynicism about this in many areas. This is overcome quickly, but can be very demoralizing when he found for the first time and confusion about Lean supports the need to develop a broad awareness within the organization of the Lean can really offer.
In terms of capacity, many health organizations are willing to build internal capacity to develop organizations such as Lean. The performance improvement teams are popping up all over the place and found that much of our work has focused on using these teams change agents to acquire facilitation skills and leadership attributes that allow them to produce But not only the change that is sustainable.
5. End 2 End Agreement
We have already mentioned that one of the means bearing on health is different from Lean Manufacturing is that the tracks (current value) interact in a different way. Another problem is often isolated by the events in a region which has an unexpected impact (and often negative) upstream or downstream of the path. Given the risk associated with changes in different parts of health, we believe it is essential to develop an understanding of how the route operates from 2 End End and check your critical constraints, the performance of current operations and the impact of likely changes may have also before trying to create a "future state" appropriate plan and implementation.
6. Integration of change
Like making a large percentage of lean health projects will help us achieve the results that organizations expect and many of these problems are related to the difficulty of integrating the changes. So, after receiving the support of an improvement program and achieving the changes (targeted improvement teams, rapid improvement events, etc.), it is essential to carry out the activities that help to incorporation of changes, including:
Advertising and communication of how the new systems / workflow
Celebrating improvements
Comments achievements Progress (Gates) Return on what has already been done
check to ensure that the changes do not slip back to the "old"
Other events and activities (as a success often generate new success)
Development continues Exchange Agent
In March, the visible sponsorship.
No Magic Bullet
When we opened this short article, we mentioned that Lean is set to have a major impact on health, as it can meet the needs to improve efficiency and reduce delivery times and costs, but its application is different from the way the improvement activities are carried Manufacturing and risks and threats to success than in other sectors.
We do not claim to have a monopoly on good ideas on how to address these points and I wrote this article based on actual experience to make improvements to a variety of health organizations. We welcome comments on their experiences.
In closing thought Lean professionals worldwide who seek to be (or already are) involved in health care - whatever the operational benefits that are possible, no one wants to achieve at the expense of patient safety - and it addressed both the needs of Lean Healthcare really comes term operational and clinical life.
Mark Eaton MSC MBA CEng MIET IMF
Mark has been an IOM member and chairs the Development Group's operations. He is a frequent theme make a lasting improvement speaker and has worked with the military, the NHS, local authorities and manufacturers for over 10 years in the breeding programs.
Simon Phillips MA FRSA
Simon is a member of the Royal Society of Arts and manufacturing and has spent many years helping industry leaders and their organizations to adopt new ways of working. He recently received the National Award for Training and has worked in all sectors in the UK, Europe, South Africa and the USA ..