Lean food for thought

by Alex Gild

29 March 2018


Integrating care is the right response to the NHS’s challenges, but we also need evidenced approaches that assure operational efficiency, reduce waste and drive continuous improvement in safety and quality.

How can we grow organisational capacity to develop sustainable services and improve safety and quality of care? The NHS faces significant operational, workforce and financial issues and is grappling with a multitude of targets, programmes, constraints, risks and impacts. These are hardly the ideal conditions for developing a focus on improving quality of care for our patients.

Integrating care is a system response to the NHS’s challenges. It will help, but is not likely to address fully the capacity and skills needed for healthcare improvement. So, we also need to look for evidenced approaches that assure operational efficiency, reduce waste and drive continuous improvement in safety and quality of patient care. My organisation, Berkshire Healthcare NHS Foundation Trust, and others have been looking for the best way to do this.

We are looking to establish a new way of working – organisation-wide, front line to board – that enables the workforce to deliver quality improvement and aligns improvement effort directly to strategic goals.

On a recent visit organised by Catalysis, hosted by Marianne Griffiths, chief executive at Western Sussex Hospitals NHS Foundation Trust (WSHFT), my colleagues and I joined other interested parties to see the results of a remarkable improvement culture shift at WSHFT. This has involved four years of work that marks just the start of a never-ending journey implementing, embedding and working within a Lean management system (LMS), supported by changed leadership and management behaviours and the development of a continuous improvement culture.

The positive effects of culture development and the high levels of staff engagement in improving care for patients were palpable at WSHFT – as was the contribution of this new way of working to the high performance of the trust.

I know there is some distrust of Lean being purely about removing whole-time equivalent headcount to reduce costs, as has been seen in the banking sector. But that is not what is happening in this case. Process waste is removed and converted into increased value for patients.

I have also heard a ‘been there done that’ attitude to Lean and seen a tendency for it to be dismissed as a ‘fad’ in the NHS. But it’s hard to counter the core principles, adding value to patients by continuously improving processes and removing waste. And there is plenty of evidence that proves Lean’s applicability to health. The problem is often about sustaining the gains over the long term.

Even with successful improvement projects, the impact can fizzle out over time because there is no management system in place to scale up activity or to align the work with trust goals.

However, when an LMS is supported by a flip-change in traditional command and control leadership behaviours, it can be extremely powerful.

New leadership behaviours involve moving to improvement coaching and teaching, and the results can be highly engaging for staff, who are empowered to problem solve at the front line.

Seems ambitious, right? Well, it’s happening at WSHFT and we are just starting out at my trust. Both trusts are learning from the model developed by the Wisconsin-based ThedaCare hospital group over 10 years to achieve sustainable improvement.

There are other Lean frameworks that can be applied to healthcare, but what attracts me about this approach is its comprehensive nature.

It enables frontline continuous improvement and provides an LMS that aligns improvement activity to ‘true north’ strategic goals. These are married with the leadership behaviours and culture change needed to sustain improvement gains for patients.

This new way of working is not the only way forward, but it does offer a strategic long-term antidote to the pressures the NHS faces.


Healthcare Finance April 2018




The comment first appeared in April 2018 issue of Healthcare Finance. See the full contents here