Making Hospitals Work

Two years ago we organised the first Global Lean Healthcare Summit in Stratford. This was both an inspiring and sobering event. We all glimpsed the huge potential of lean to improve the working of healthcare and also began to realise how much hard work it would take to make this a reality.

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For our part we quickly concluded we would have to roll up our sleeves and conduct our own experiments to learn what it would take to create a truly lean hospital. Two years later after deep involvement in two hospital transformation projects in the UK we have produced our own progress report in the form of a new lean workbook called Making Hospitals Work: How to improve patient care while saving everyone’s time and hospitals’ resources. We hope this will set the scene for the next phase of the lean healthcare journey.

Experience in other sectors tells us that the power of engaging staff in rapid improvement events has to be seen within the context of the end-to-end patient journey through the hospital and beyond, and by looking at the work done by the many shared resources used by each clinical pathway. Our action research led us to focus on two important value streams followed by patients admitted to most general hospitals, the emergency medical and elective surgical value streams from admission to discharge, plus the key enabling support activities.

It also became clear that an end-to-end perspective has to be led from the top, in a way that complements and focuses bottom-up improvement activities. This workbook outlines the A3 method our fictional top management team uses to define the core problems facing the hospital, to learn to see these value streams and analyse where and why they are broken, to come up with the possible countermeasures and create an overall action plan for realizing a future state for these value streams. It also introduces the role of the value stream manager in gaining agreement from each of the departments on the right actions to take.

The A3 planning process used in the workbook follows Deming’s ‘Plan, Do, Check, Adjust’ cycle that is used by Toyota for planning and problem solving at every level in the organisation. This is the same scientific method applied to management problems that doctors use to diagnose and treat medical problems. Think of it as evidence based management to complement evidence based medicine.

This book draws on practice rather than theory. We have tried and tested all the building blocks described in this workbook ¡n isolation and in combination and we know they all work. It also describes how lean tools have to be modified for a situation where the patient is at the same time the ‘product’ being diagnosed and treated and the customer experiencing the process.

Over time it is quite possible to eliminate unnecessary waiting time for patients, remove the overburden on clinical staff so they can spend more time caring for patients, while freeing up the capacity to treat more patients by significantly reducing length of stay. It confirms that lean is the most promising way for healthcare systems to meet growing demand without escalating costs.

John Toussaint from Thedacare described the book as ‘entertaining, sobering and inspiring” while Jack Billi from the University of Michigan and David Fillingham from Bolton said ¡t is a “must read for healthcare leaders”.

We will bring together the team to launch this new workbook at the one day Lean Healthcare Transformation Summit on 10 July at the QEII Conference Centre in central London. Please take a look at the Summit agenda and details of the contents of the book on our web site at (or ring LEA at +44 1600 890590) and bring it to the attention of your colleagues and senior management team. I hope you enjoy the book and can join us at the Summit.

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