Lean Enterprise Academy > Healthcare > Our Lean Healthcare Journey
One of LEA’s missions is to help to transfer lean thinking from sector to sector, by working with pioneers to adapt the approach and to create early examples to prove the concept. Over a decade ago Daniel Jones and David Brunt began walking round hospitals to understand the process flow in healthcare. We even carried out some initial pilots that showed promise that lean could work in healthcare. However at that time no one was interested, so we moved on to other things!
A few years later Daniel was invited to visit Flinders hospital in Adelaide, Australia, one of the early lean pioneers, and talk at their first lean healthcare conference. At the same time he met with David Fillingham as the NHS Modernisation Agency was being would up. David went off to run his own lean hospitals experiment in Bolton, UK and we jointly organised an ad hoc UK Lean Healthcare Network to connect people doing lean and to raise awareness in the NHS. These Lean Healthcare Forums were very well attended and led to many hospitals beginning their own lean journeys.
At the same time Daniel decided to bring together the growing number of lean hospitals across the world and organised the first Global Lean Healthcare Summit in Stratford, UK in 2007. This was the beginning of a truly global lean healthcare movement.
However Daniel also concluded from his experience in other sectors that the initial round of rapid improvement events could well run into the sand if they were not connected to deliver real hospital wide benefits. So we would have to conduct our own experiments to deepen our knowledge of lean healthcare and to tackle the core problems facing hospitals.
After visiting and being very impressed by the work Marc Baker and Ian Taylor had done at J&J Daniel was delighted to hear that they were now conducting the first truly end-to-end experiment at Gwent NHS Trust. This led to us working together on a second experiment at Portsmouth NHS Trust and then to working to support several other hospitals. It also led us to reflect on these early experiments and write up the findings in Making Hospitals Work. We are now building a lean healthcare team for the next stage of the lean healthcare journey.
Marc Baker and Ian Taylor first joined forces whilst working for the medical devices and diagnostics division of Johnson and Johnson. Manufacturing was at a single site in South Wales and the customer base was worldwide. They had a new blood testing system in development and a couple of mature lines of business which were coming to the end of their life cycles. The new system was launched late and was the manufacturing system was not able to deliver ‘right first time on time’.
The products had a limited shelf life and took 55 days to get through the system. (most of the time the products were in cold storage while samples were being reworked and waiting). Imagine how much stock had to be in place with this level of performance and a worl-wide customer base! To make matters worse the product had a finite shelf-life! As customers became aware of these supply issues they started ordering larger batches of products to protect themselves from our poor performance. This made the situation worse. This division was making large losses. And these new products, needed to to grow the market could not be made because they were always on backorder: this situation could not go on.
The senior management of the company flew to our plant to discuss and decide it’s fate. They decided to make the new product (and the company) work. There were redundancies, indeed the, then existing, management team of the manufacturing site were removed. At this point Marc was invited to join the new management team as the lead for the Improvement efforts and Ian was persuaded to leave the Automotive Industry to join the company where he became a Value Stream Manager. The company had been trying improvement approaches before this but this had never really been ‘mainstream’ part of the management agenda. Now this was being placed right at the heart of the business!
Within 3 years this new approach had turned around the business:
During this time there was very little money spent on new equipment and the staff numbers pretty much stayed the same.
During this time Marc and Ian’s work became known to a local healthcare provider Gwent Hospitals Trust (a large trust with 14,000 employees) who themselves were pursuing a program of improvement led by Ken Robertson. Staff from this Trust were invited to come and tour the plant and to share our stories. The visitors from the Trust were amazed to find that every day, at the plant, an equivalent number of tests were being conducted in their Quality Control department as in their Path lab, but with only 10% of staff.
Ken suggested meeting with their Executive team, resulting in a 12 week Masterclass for the Executives and senior clinicians & managers. This was run before every board meeting. During this time Marc and Ian were invited to conduct a review of the Trust’s lean approach as they felt that they were not gaining enough traction with regard to lean across the Trust.
Marc and Ian, assisted by Ken and his team, employed their own particular brand of a problem solving which combined lean thinking and Six Sigma to conduct this review. The review revealed that this Trust were very early adopters of lean thinking in healthcare and were employing the rapid improvement event (RIE) approach. In fact it transpired that over a period of three years they had conducted 86 RIEs! Upon further investigation it turned out that these 86 RIEs had consumed £1.9 million in people hours and yet had only delivered 10% of the planned deliverables.
A new approach was required. Marc and Ian were asked by the Trust’s Chief Exec to offer an alternative. The answer was to adopt an end to end value stream approach. Marc and Ian were given, initially, a small Acute General Hospital, within the trust, in which to conduct their first experiments. This is where their apprenticeship in healthcare began. At first they were not really allowed anywhere near the clinical areas so we devoted our time to sorting out their Clinical Consumable Goods resulting in a cost saving of £1,000 per ward, per month.
Due to their scientific, patient-centric, approach they gradually gained acceptance and extended their work to the clinical areas, the acute medical value stream in particular including the hospital’s own local rehab hospitals. Here at the acute site they helped them increase patient throughput by 47% whilst at the same time closing 20 beds. Applying the same approach at one rehab hospital they helped them increase patient throughput by 58%. During this period planning accuracy, in other words the Patient receiving exactly what was planned for them (On Time and In Full) rose from 41% to 86%.
The approach and the results began to trigger interest across the entire trust and in their other two large Acute General Hospitals in particular. At first Marc and Ian were, understandably, very reluctant to migrate to these larger hospitals until they were satisfied that their experiments were successful and had truly learnt from these experiments what worked and what didn’t work so well.
Satisfied that they had, they eventually did transfer part of the team to the largest hospital in the trust at the request of the Chief Exec who was concerned over the hospital’s A&E performance. Here by applying their Door to Door Value Stream approach this hospital met it’s A&E compliance target for the very first time.
This in turn led to a second experiment at Portsmouth NHS Trust and then to working to support several other hospitals in the UK. Their book making Making Hospitals Work is a progress report, so far, on their six years of working in healthcare.
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