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Lean Keenness: transforming healthcare with Lean thinking

The National Motorcycle Museum near Birmingham, UK seemed an apt venue for a conference on a change philosophy pioneered by Toyota. Despite the early start to the Lean Healthcare Forum on the 6th of June, the buzz at coffee was palpable. This excitement continued throughout the event, though at times it verged on overzealousness.

Most impressive was Bolton NHS Trust's chief executive David Fillingham who described independently assessed reductions in mortality for the patient flows touched by Lean thinking.

I took part in a hospital process redesign based upon the principles of total quality management about ten years ago. This took its cue from systems like Six Sigma and was led by a multi-disciplinary team of NHS staff wielding simple modelling and statistical techniques.

Here, presenters seemed to hold simple techniques like brown paper modelling in low esteem, favouring Lean’s greater sophistication and action over analysis.

This has merit. Participants in change tend to over-model the current system, because they are more familiar with it, and to spend less time generating, modelling and implementing the future system. Nonetheless, changes must be based on sound evidence---which is where Six Sigma's statistical emphasis may have an edge over Lean.

In addition, Lean keenness sometimes went too far. In one session a trust leader treated any challenge like an affront. One of the delegates commented it was a case of “my way or the highway”. Lean practitioners need to take care. In the NHS such an approach will go down like a blue whale in a shoal of krill.

Patient outcomes must be paramount. I would endure poor organisation and dodgy structure if I were assured of the best outcome for my condition. None of the sessions I attended tackled this controversial area—which is a surprise as the relationship between Lean and Integrated Care Pathways is obvious.

In addition, few presenters made much of the potential role of information technology, only one delegate stating that IT was good for reducing cost. In fact, this view has little support. In my experience, costs are reduced and benefits magnified by hitching IT and process change together.

Given the NHS’s overspending and likely changes to its structure, the time has come for philosophies like Lean, especially if they are integrated with the systems NPfIT will deploy.


Read my article about transforming healthcare with IT and process change: Making NP Fit.

Link to the Lean Enterprise Academy.


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