lean: a transformation journey

by James Clement

It’s not often that we look into the future with absolute clarity and know what lies ahead of us but one thing is absolutely certain: the NHS is facing large budget cuts. We can also safely say that there are certain outcomes that we all want for our hospitals: we would like to see an environment where the patient journey is seamless, their length of stay is reduced, their waiting times are short, the staff treating them are motivated in their work and errors and mortality rates are at an acceptable minimum level.

You could be forgiven now for laughing out loud at what does appear to be a contradiction in logic – just how do we achieve the high standards that we require with lower budgets? There is an answer and it isn’t Lean, despite what some Lean experts and Six Sigma black belts may have you believe. At least it isn’t Lean in its traditional guise.

If you have ever tried to implement Lean within a healthcare setting or you have done your research on what Lean tools and techniques you would use, you will know that the Lean methodology identifies what you have to do. So, for example, you have to analyse and review core patient flows in and out of the hospital and as part of that process, you will look at tasks such as patient handover, patient waiting times, patient plans, departmental working hours etc. In addition you may also look at core management processes and the supply chain governing supplies into the hospital.

All good so far and doing this will no doubt highlight for you where the waste is and where might be some of the priority areas that you should tackle first. What next though? How do you know how best to fix the issues that you have identified and how do you know if what you have identified are causes of waste or symptoms of a bigger picture that needs to be understood before you design your transformation journey? Because that is what this is if it’s going to change behaviours, drive momentum and create lasting change. Understanding the Lean tools and trying to implement them in isolation will be an uphill struggle unlikely to deliver a tangible saving and extremely unlikely to deliver the broader outcomes we desire and need.

Our research across a broad range of private and public sector organisations tells us that Lean programmes often fail to deliver on their objectives.

A recent Egremont Group survey with HR professionals discovered that:

  • 2/3 of its respondents had been involved in a recent cost cutting programme but…
  • … only 1/3 said that as a result they had efficient processes which drove maximum value for their end customers
  • 95% went on to say that issues are still not dealt with by those whom the issue effects at grassroots level but instead are often escalated up the hierarchical ladder

This is symptomatic of Lean improvement programmes where the focus has been on the task and tools, rather than the end game and the behaviours, culture and capability affecting the task. Any improvement programme must be considered and designed in the context of how the organisation operates and what drives it to behave in that way. It needs to address the climate and behaviours in an organisation to create a culture of continuous improvement. Only then will you be able to focus on achieving the outcomes that you have identified.

Based on the principle that a process alone cannot change an established way of working, Egremont Group applies Lean tools and techniques within the context of an organisation’s operating model, looking at the connections and interplays with strategy, people, process, systems, learning, partners and suppliers. In addition, we design all of our work using our proprietary approach to change: the DNA of Change. This looks at what forces hold us back from changing at an organisational and individual level and what counter forces help us to move forwards and continuously improve.

Our approach has a track record of success resulting in transformational change with significant cost reductions, lasting culture change and an average RoI of 1:10.

There is no silver bullet to success in a Lean programme but looking at the context in which you apply Lean process will help you to achieve the virtuous circle of passionate and inspirational leaders motivating engaged staff who, in turn, are supported by efficient processes and are caring for looked-after patients, helping the hospital to meet its targets. In short, our approach to Lean transformation can help you to learn to work together better to deliver more and improved care for less resources. With impending budget cuts, why wouldn’t you turn this into an opportunity to change the way hospitals are run for good?

To find out more, get in touch with James Clement: jamesclement@egremontgroup.com / +44 (0) 20 7298 7878