From Boards to Wards: Overcoming Barriers to Adopt Lean

The Government introduced Lean to the NHS in 2005 with the aim of bringing the focus back to activities that matter to patients and clinicians, while minimising activities that cause them stress and get in the way of care. Three years on, some parts of the NHS struggle to adopt Lean thinking and processes because changes in working practices haven’t been addressed strategically and people at all levels have not been effectively engaged. Melanie Bryan, Public Sector Practice Director at ABeam Consulting, discusses these challenges and the importance of a holistic approach to change management in enabling NHS organisations to reap the benefits of Lean.

The NHS Confederation has estimated that across the health service staff spends about nine times more time on non-value-add activities than those activities that focus on patient care. Moreover, a recent study by the Royal College of Nursing found that an increase in paperwork is preventing nurses from devoting sufficient time to caring for patients. The survey, conducted across more than 1,700 nurses, revealed that the majority of standard nurses waste a fifth of their time on non-essential administrative tasks such as filing and photocopying. Furthermore, nine out of ten nurses reported that the amount of paperwork has actually increased in the last five years.

One of the greatest challenges facing the NHS today is how to put patients’ needs at the top of the agenda when there are financial and timeframe targets to be met. Designing processes around meeting the targets rather than patient needs leads to inefficiency that in turn adversely impacts the patient. Minimising the burden of non-essential paperwork on nurses by hiring more ward clerks is an example of efforts made to address this – but adopting Lean practices across the entire organisation will prove a more effective cure.

As a first step, hospitals need to conduct a rigorous assessment of all tasks to determine whether they are necessary and eradicate those that do not add any value to the patient. Streamlining only certain components of any process within a hospital environment in isolation will not be successful in the long-term. To illustrate, reorganising the way in which blood samples are handled within a ward and delivered to a laboratory may simply mean that the specimen waits somewhere different and longer for the next stage in the process. A thorough Lean assessment will enable hospitals to determine how clinicians can dedicate more time to patient care, and at the same time improve efficiencies.

While there are Lean success stories within the NHS, some hospitals have struggled to streamline processes in the long-term. The main barrier is that they have embarked on the Lean journey without a clear strategy. In order to succeed, Lean needs to be implemented strategically, from the top down. The board needs to develop a holistic business case for Lean and ensure that everybody - middle management, doctors, consultants, nurses and clerical staff -understand and support the approach.

The board also needs to ensure that staff at all levels understands the impact that the Lean journey will have on them personally – change needs to be made real and achievable. People will need to change their way of thinking, becoming actively involved in identifying and implementing changes that make a positive difference to their working lives and patient care. Any changes to working practices and the expected positive outcomes need to be communicated clearly across the entire organisation. Clinicians are unlikely to have much of a relationship with board-level decision makers, so middle management must act as a link between the ward and the board, driving Lean changes to meet both targets and the needs of the patients.

A thorough reassessment of working practices and a strategic introduction of Lean have delivered huge benefits for a number of hospitals in the UK and abroad. For example, in one hospital in Scotland the average waiting time for a first appointment for cancer patients has been reduced from 23 to 12 days and their overall hospital journey has been cut by six steps. The waiting time for endoscopies has been reduced considerably too: now over 90 per cent of outpatients undergo the procedure in two weeks – previously less than half of patients used to get their appointment in this timeframe. Staff at the hospital has reported that the changes to working practices have been easy to sustain, and that any hiccups can be corrected more quickly and easily than before because Lean processes are more straightforward.

It is possible to deliver high-quality patient care within the NHS while meeting target demands of the Government – and it does not have to require laborious restructurings, massive cash injections or huge investments in infrastructure or IT. If implemented holistically, within a strategic framework, and concentrating on adding value to patients, Lean processes can help transform NHS hospitals into beacons of best practice and patient care.

¹ http://www.leanuk.org/articles/lean_thinking_for_the_nhs_leaflet.pdf ² http://www.rcn.org.uk/newsevents/news/article/scotland/give_nurses_more_time_to_care,_says_rcn ³ Dr Zoe Radnor, Paul Walley, Andrew Stephens, Giovanni Bucci: Evaluation Of The Lean Approach To Business Management And Its Use In The Public Sector, Warwick Business School