What is Lean?

Lean is the process of identifying the least wasteful way to provide value (better, safer care, with no unnecessary delays at lower cost) to our customers.

Value must always be determined by the customer

We spend 75-95% of our time doing things that increase our costs and create no value for the customer

Lean is being used across healthcare

Theatres

Sterile Services

Pharmacy

Wards

Radiology

Pathology

Lean is being used across healthcare Mental Health Primary care Physiotherapy Finance Ambulance Services Outpatients .

Critical success factors Lean must be part Staff must be of long term Trust empowered to strategy make improvements This is not a FAD!!! Dedicated service improvement resources accelerate change Focus on the system. then apply the tools Get results quickly – deploy a series of rapid improvement events Board commitment and clinical leadership is essential . the flow that creates value.

Consistent processes = reliable. safe and quick healthcare services DELAYS .

Leaders need to shift the current thinking CURRENT • Provider first • Waiting is acceptable • Errors are to be expected • Add resources • Reduce cost • Problems not visible • maximise use of capacity • Functional management FUTURE • Patient first • Waiting is unacceptable • Defect free processes • No new resources • Reduce waste • Problems visible • minimise cost of capacity • End to end processes .

Matrons Departmental and ward plan Rapid improvement events Daily problem solving Service managers and sisters Service improvement team with above Everyone Adapted from Getting The Right Things Done – Pascal Dennis .improvement at all levels – who leads on what Long term vision 3-5 year strategy Chief Executive and Board Senior leaders (clinical and managerial) Yearly strategy and operational Departmental leaders -Heads of plan Service .Lean .

if we can convert 10% of non value adding time to value adding time = 24mins extra value adding time This is the equivalent to 38 extra nurses (23 mins *800 nurses = 18400 extra value adding minutes) . redoing things) Now. 50 % of time is value adding = 240 mins per shift 50 % of time is non value adding = 240 min per shift (searching for things. chasing results.Convert non value adding time to value adding time to improve productivity Number of nurses per Trust = 800 Length of a shift = 480 minutes Typically. unnecessary movement.

Top Leadership’s “commitment to Lean” journey START SHORT TERM TOOLS Are top leaders committed to a long term vision of adding value ? No Lean Tools Six Sigma Tools Theory of Constraints Cost Improvement Programmes Supply Chain Tools Are top leaders committed to developing and involving teams and partners from he whole system ? Yes No No Yes • Leadership background • Ownership structure • Promote from within? • Environmental pressures • Experience with Lean Will there be continuity in the top leadership’s philosophy? Yes BEGIN LEAN JOURNEY Adapted from The Toyota Way – J Liker .

What do Lean Leaders need to do? • 10 things to improve safety. eliminate delays and reduce length of stay – and generate more income (profit) and lower costs . improve quality.

Learn by doing (PDSA) and empower staff to improve P-D-S-A Cycle . Embed problem solving approach in frontline staff.Practical steps leaders must do 1.

Identify core value streams main patient journeys and eliminate waste Pharmacy or elsewhere Social services Long term care Discharges Deaths Home ER & EAU Radiology Pathology ‘Tests’ Specialist clinic Specialist clinic Specialist clinic Specialist clinic theatre Quick Sick: specialist ward rehab > 3 / 52 GP theatre ITU 1 to 10 days Pre op assess Day case unit (inc Endoscopy) Follow up Source – Kate Silvester .2.

continued Assessment Assessment Assessment Assessment Advice/R Minor Investigations Investigations Disc h Disc h Treatment Treatment Treatment Disch Admit Disch Disch Assessment Investigations Assessment Investigations Admit ?theatre Treatment Admit Continuing care Source – Kate Silvester . Identify core value streams (main patient journeys and eliminate waste) .2.

daycase and theatre work together to design the new improved system Chief Executive asks questions and challenges teams .Practical steps leaders must do 3. Participate in rapid improvement events Current State Future State Future State – staff from Preoperative assessment.

Make it part of your strategy Blue Sky Categories .Practical steps leaders must do 4.

4. Organisation BLUE SKY Safety Quality New Product/ System Blue Sky Policy Deployment Activity Environment Master Schedule Cost Resp WK 14 AB WK 15 Target WK 16 WK 17 WK 18 Agree WK 19 WK 20 WK 21 WK 22 WK 23 Aud Delivery People cat Item Accident Reduction SAFETY 40% Reduction Develop Safety Rules Brief All Members Audit Accident Reporting 100% Accidents BS Write Procedure Brief All Members Start Detailed Schedule Target 40% Reduction AB Resp Activity WK WK WK WK WK WK WK WK WK WK 14 15 16 17 18 19 20 21 22 23 Brief All Agree Members Audit Aud Near Miss Culture 100% Incidents Reported cat JB Develo Item Accident Reduction Accident Reporting QUALITY SAFETY 100% Accidents BS Write Procedure Brief All Members Start A detailed schedule contains the activities and responsibilities to achieve the set vision targets. Make it part of strategy (continued) A vision is translated from Blue Sky to Master Schedule into a detailed schedule. Near Miss Culture 100% Incidents Reported JB Develo QUALITY .

Organise by value streams (patient journeys) – not be departments . Leadership must commit to long term learning.Practical steps leaders must do 5.appoint value stream managers responsible for the whole value stream .

88 1 10 19 28 37 46 55 Observation 64 73 82 91 0 .Delays in specimen reception 50 Before change 1 After Change 40 1 1 Delay in minutes 30 20 10 UCL=3.54 _ X=0. Measure the change (before and after) Hereford Hospitals .Biochemistry .Practical steps leaders must do 6.

Theatre TE Case Study Background BEFORE LEAN AFTER LEAN .

More appropriate stock levels – based on clinical need BEFORE LEAN AFTER LEAN .

There were some surprises! BEFORE LEAN AFTER LEAN .

Identifying opportunities for big financial impacts – get results Metric Before change 62 minutes Up to 2 hours After change 38 minutes Ideal state 30 minutes Improvement 40% reduction Saving £££ a year 2 beds a day ££££££ * A&E targets met Turnaround time (from receipt to results available) 8. Adapt and make relevant for your environment.Practical steps leaders must do 7. Grow and develop your own Lean culture. Adapted from The Toyota Way – J Liker .

Practical steps leaders must do 9. Develop leaders and coaches and to increase capability 10.Use experts for teaching and for getting quick results Neil Westwood coaching Endoscopy staff Adapted from The Toyota Way – J Liker .

• Senior managers must spend time in the workplace – listening and observing Ask Why. Focus on the work and staff and ask questions Learn and revisit Standard Work. • Respect your people – and people’s time!! • • • • • Learn how the work gets done by getting involved and doing. .3 Simple things for Leaders to do Go See. • Use the “Why?” technique daily Show Respect. but as a teacher/coach and process owner/designer. Use Value Stream Maps to expose the WASTE Think of yourself not as a firefighter.

Lean Leadership issues Must read Page 292 Take 45 minutes to read and explain what Lean leaders need to do .