From Toyota to St Thomas’s – Employing Lean principles to reduce outpatient waiting times
by: Stephen Blackmore
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Summary:
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Whilst the government continues its relentless drive to ensure that all NHS patients are seen within 18 weeks of referral, for many outpatients the REAL waiting starts the moment they arrive at the hospital on the day of their treatment. By adopting a Lean systems approach, hospitals are generating significant reductions in outpatient waiting times, as well as identifying a wide range of service improvements and savings.
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They said it couldn’t be done. It may have made Japan’s auto industry the envy of the Western world, but employing Toyota’s Lean systems approach to the NHS just was not going to work. After all, people are not cars. You can’t just adopt the process and expect it to have an impact in a totally different environment.
But that is precisely why it has worked. As history now shows, Lean principles can be applied to virtually any process-driven environment. The NHS is no exception. Specifically hospitals, with their complex network of services, treatments and resources all striving to deliver the best possible experience for their patients, could not be more perfectly placed to reap the benefits of a Lean systems approach.
The fundamentals of Lean are entrenched in modern business folklore (simply put, it focuses on dramatically improving value-add activities by identifying and eliminating areas of waste). Translated to a healthcare environment, the five Lean thinking principles can be characterised as:
1. Specify value from the standpoint of the patient – what really matters to them in relation to the services provided?
2. Identify the value stream for every patient group - identify which steps add value and improve quality for the patient.
3. Make the process and value flow - align healthcare processes to facilitate the smooth flow of patients and information.
4. Pull at the patient’s rate of demand - every step in the patient’s journey needs to “pull” people, skills, materials and information towards it – one at a time, as needed
5. Manage towards perfection - continuous quality improvement of processes.
But how do these principles directly affect waiting times? The answer really lies in Step 1 (‘Specify value’). Given that ‘waiting to be treated’ is consistently rated high on the list of common complaints received by the NHS Information Centre, designing an improved value stream to address this issue dramatically reduces the bottlenecks, areas of waste and duplication that cause waiting in the first place.
With ‘minimal waiting time’ established as a core value for the patient, the Lean approach then scrutinises each stage of the ‘patient pathway’ during treatment and seeks to differentiate between those activities that increase patient flow (‘value add’) and those that cause delays (or waiting). This will be typically be achieved via a combination of detailed interviews with all the individuals who interface along the patient pathway, first hand observations and close examination of all the inter-related processes and systems that contribute to treating a patient from the moment they arrive at outpatients to be treated. The root causes of the delays are then explored and challenged. Whilst some delays will be unavoidable (waiting for blood results to be returned, for example), unnecessary delays need to be removed from the pathway.
Ultimately, the Lean approach seeks to establish a patient pathway that is devoid of any unnecessary waiting. Of course, such aspiration requires a tightly coordinated and determined effort from all the individuals working within the patient pathway. But the results are usually instant. Furthermore, reducing patient waiting times will inevitably have a significant effect on overall productivity and utilisation of resources, both of which directly impact the bottom line. Crucially though, the patient experience is greatly improved.
With such wide-reaching benefits, the only question is – why hasn’t the Lean approach been adopted universally across every hospital in the country?
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Author Details:
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Stephen Blackmore
Senior Consultant
CPC Ltd.
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