There has been a growth in the use of Lean in Healthcare but is it always delivering the desired returns? Experts are being brought in to support Healthcare “Lean” programmes but are they leaving the organisations with robust new processes and the competencies to deliver Continuous Improvement? We see a premium for Trusts when their imported experts successfully transfer knowledge, develop staff skills and help enhance the right culture for leading and embedding improvement and experience is already showing that the focus on simple effectiveness does not automatically lead to long term improvements or the most effective processes.
The same is true outside healthcare for organisations in manufacturing where “Lean” has its roots but where it is nowhere near as ubiquitous as many assume. Indeed, many manufacturing companies that were “going Lean” fell by the wayside on their journey and the government continues to invest heavily in helping manufacturers to implement Lean more effectively and to develop the underpinning skills that are required to embed the change.
The NHS can learn from the experiences in manufacturing, not only of those who succeeded but also of those who failed to realise benefits. Already some of the problems experienced in manufacturing are becoming evident in healthcare. For example we have seen some organisations focusing solely on ‘Rapid Improvement Events’ (i.e. the implementation of the improvements) without preparing effectively (i.e. designing the improvements) or setting up systems to maintain and embed the desired new ways of working. This (error) approach to “Lean” can convert Rapid Improvement Events into ‘Rapid Ram Raids’ where:
o Improvements quickly occur BUT are not sustained.
o New risks are introduced (i.e. patient safety).
The organisation wide outcome is a loss of inertia, misunderstanding and lack of buy-in, etc, resulting in negative staff attitudes toward “Lean”.
Learning from manufacturing – Why has Lean not always delivered?
Some key reasons why Lean has failed to embed itself in some manufacturing companies are because the organisations have failed to:
o Set out an agreed vision and plan at the start
o Understand how the whole pathway functions prior to moving to ‘Rapid Improvement Events’
o Build sufficient internal expertise and relying too heavily on external consultancy support
o Engage the team effectively and a failure to recognise the need to change attitudes (cultures) at the same time as changing processes
Whilst these same “Lean” failure modes are starting to manifest themselves in healthcare organisations, there are specific ‘failure modes’ unique to healthcare which need to be considered.
It is obvious the way that processes are organised and operated contribute to the success of healthcare organisations in delivering an effective patient experience and high quality patient care. They also create a unique pattern of patient safety risks. Some risks are more obvious (e.g. infection) whilst others are less obvious or are hidden (e.g. failure to transfer information between organisations in a timely manner) which can lead to an adverse event occurring.
Current ways of working will include risk / patient safety management controls (e.g. checks and procedures) and changes to this ‘balanced system’ change both the performance of the area under scrutiny and the pattern of patient safety risks. Given many of the sources of these risks are less obvious there is a danger that changes introduced will also introduce unintended risks. These risks may occur outside the area changed as the change may result in unidentified “interface” changes leading to unexpected or unplanned changes elsewhere in the organisation.
For example, focusing improvement activities on Outpatients to increase throughput may place unacceptable demands on diagnostics increasing their risk of errors. The failure to include representation from these supporting / interfacing areas increased the likelihood of problems simply being transferred elsewhere in the organisation.
In looking to become a ‘Lean Healthcare’ success story it is important to consider who needs to be communicated with and how will they be involved, how you will manage the on-going process of improvement, how to change behaviours and cultures as well as processes and most importantly what unexpected risks your improvement efforts might be introducing. Having said that, done effectively and with due consideration for managing patient safety risks and with a focus on sustainability of improvements, using Lean can make a significant difference to your organisation’s performance.
In fact it could be said that doing Lean at the right time, in the right place and implementing it in the right way should lead to ‘Sustainable, Safe & Responsible Service Improvement’.