The BBC Radio 4 programme “In Business” last night (January 7th 2007) investigated how some parts of the National Health Service (NHS) in the UK have begun looking at Lean manufacturing techniques and how they can be applied to improve the efficiency of the service.
The state-funded NHS is notorious for being plagued by waste and inefficiency. Weighed down by bureaucracy, waiting times for patients continue to be unacceptable despite numerous attempts over many years at cost-cutting and re-structuring. Increasing funding and incentives hasn’t worked either. Recently the Government set a 4 hour maximum target for the waiting period of patients. But even this seemingly generous target is proving difficult to meet, and as a result some parts of the organisation are finally looking at the processes involved.
“Rethinking healthcare from the point of view of the patient can’t be a bad idea.”
The presenter of the show, Peter Day, pointed out that convincing people that a methodology born in a manufacturing business can greatly benefit the NHS has proved to be difficult, as people do not like the government-funded health service being compared to a business. However, as healthcare has a process and a customer – the patient – then many people believe that Lean principles are relevant.
Several health trusts around the UK are running Lean events in order to highlight inefficiencies and waste, and communicate how they can be improved through collaboration with and involvement of staff at all levels. But the programme showed that adoption of Lean techniques is slow, with strong opposition despite the potential benefits.
Carol Makin, Consultant Surgeon and Clinical Director at the Wirral Hospital Trust, has been instrumental in the Lean trials, but admitted there has been resistance. “When you introduce this technique, there will be resistance to change. If we want to take this forward then we need to develop a system. Just doing a rapid improvement workshop does not constitute a Lean event: it’s the first step on a long path, you need to keep it going.”
“A health system needs to be designed that serves the demand as it appears…”
David Fillingham, Chief Executive of the NHS Trust in Bolton, talked on the show about the gradual deployment of Lean techniques he has implemented. ”The key is involvement,” he said, talking about resistance to change. “You have to work closely with front-line staff, trade unions and staff associations, and that’s one of the things we’re working very hard on in Bolton, looking to agree a framework for the changes so that the changes are positive for the staff.”
Many health service professionals remain resistant to the idea of yet more change as they say the patient experience has greatly improved in recent years, and more specifically that the techniques used in manufacturing aren’t relevant to their industry: an argument used in the service industry before organisations such as Tescos showed that Lean tools can be successfully applied wherever there is a process and a customer. One disappointing aspect of the programme was that it did not go into detail about these tools, and how they can be beneficial.
As frequently seen with the deployment of a new process improvement methodology, the programme implied that it will take some time for Lean thinking to take hold at the NHS. But despite this, there is hope that the focus will be shifted within the organisation towards improving processes and satisfying customer needs. Professor John Seddon, Lean consultant and author of Freedom from Command and Control made the point on the programme, saying: “A health system needs to be designed that serves the demand as it appears, as opposed to designing a system that has arbitrary targets to meet.”
In Business ended by postulating that despite the oppostition, Lean techniques can only be good for the NHS. “Rethinking healthcare from the point of view of the patient can’t be a bad idea,” said Peter Day. “Come to think of it, rethinking everything from the point of view of the customer cannot be a bad idea either. Mass production is running out of steam.”
A podcast of the programme can be found on the by clicking here.
