A PRESCRIPTION FOR CHANGE:

Developing Lean Healthcare

Barely a week goes by without the media publishing a scathing report on some aspect of the UK’s healthcare system. Excessive waste and variation from defects are leading the National Health Service (NHS) in particu lar to draw much of the fire. Bed shortages, so-called super-bugs, staff strikes, financial overruns, hospital closures and long waiting lists have all taken their turn as recent media headlines.

Understanding Lean

Lean is an improvement philosophy based on the idea that everyone should strive to elimi nate waste wherever and whenever work is preformed. With roots in Toyota’s automotive manufacturing, Lean has evolved over the last four decades and has proven its applica bility in service environments and has been implemented to drive dramatic improvements within healthcare systems across the globe. Lean thinking is driven by the premise that the customer defines value, and anything that isn’t valued by the customer is consid- ered waste. Common examples of waste in healthcare include:

• Transportation: any unnecessary convey ance of patients, supplies or information
• Waiting: for available space, test results, expertise or information
• Rework: as a result of mistakes, lost information or defects
• Motion: unnecessary movement, such as searching for a supply, chart or medical record.
• Processing: including excessive steps, unnecessary authorisations (over-processing), or any interventions that slow down the process flow
• Overproduction: ordering too much or producing anything too soon
• Inventory: any more than the minimum required to get the job done is considered waste
• Intellect: any failure to fully utilise the time and talents of people, often associated with staffing and scheduling

Waste exists in many forms within healthcare systems, and Lean strives to eliminate waste and improve flow in value streams or patient pathways. To accomplish this goal, Lean uses a step-wise approach that first aims to specify value (from the customer’s perspective), then to understand demand by mapping the value stream, establish process flow, create pull and ultimately to strive for perfection. Common goals for Lean are to reduce process cycle time and improve flow. When a matter of minutes or even seconds can mean the difference between life and death, using Lean to improve process speed can deliver meaningful benefits.