Guest blog: Could LEAN save our NHS?

lean thinking libre albert einstein 2

So, a snap General Election looms. We can expect snap decisions about what’s wrong with the NHS and snap decisions about how each party will put it right. These will inevitably include the call for more money and more staff.

Now I’m not saying that the NHS couldn’t make good use of more money and staff. What I am saying is that it doesn’t matter how much money and staff you throw at it, if it’s not being run properly, it won’t make much difference.

And there lies one of the key issues. After around 50 years’ experience in and around the NHS, I can assure that I have seen waste (and still do) on a biblical scale.

There have been several erudite reports about the potential savings that could be gained from reducing waste, whilst reducing variation and actually improving quality of services. I’m thinking about reports such as the Carter Review of Operational Productivity and The Kings Fund report on the NHS Productivity Challenge – there are others.

Like me, you may question the complete accuracy of some of the data they use. The NHS references costs and the like, but nevertheless they all point to the potential to save millions, if not billions of pounds.

So why hasn’t the NHS adopted the wisdom evident in the aforementioned reports? Particularly at a time when many NHS Trusts are embarking on Cost Improvement Programmes (CIP) to reduce costs.

Because managers are too busy putting out fires; chasing targets; avoiding penalties; protecting their own skins? Because the merry-go-round of senior Trust posts does not allow for developing long term, consistent strategies?

Why aren’t proven good practices at one place adopted universally? Is it because of attitudes such as, it wasn’t invented here; you don’t understand that we’re different; we’re special; we tried that once and it didn’t work?

I believe it is all of these things. As Albert Einstein famously said “We cannot fix our problems with the same thinking we used when we created them”.

Giving more money to the NHS won’t work unless it’s used differently and the staff are given the time to work through the best ways to do this. It’s about time the politicians realised that NHS staff are the experts. They know what’s wrong and are best placed to put it right. We need to give them the time and space, and yes, some money, and allow and furthermore encourage them to use a different way of thinking.

For me the obvious route is to adopt Lean thinking or perhaps you prefer the term Continuous Quality Improvement thinking. There are still those for whom (quite wrongly) Lean just means Japanese motor manufacturing and so they turn away from learning more. That may be where most of our current learning comes from but 12th century Venetian boat builders also used some Lean thinking.

In my eyes, Lean gives a vehicle to contain and organise the thinking and tools required to make improvements in a systematic, incremental way.

It calls for consistency of purpose over a long timeframe. A stop to all the short term fixes we will hear about during the upcoming election campaigns. A stop to political interference and a start to creating a culture that allows the experts (the staff) time and space to apply structured improvement methods.

The two major pillars of (Toyota) Lean are the relentless elimination of waste from the system and respect for people and society, that includes staff, patients and carers.

Over the next few blogs I intend to work through what I mean by the ‘waste’ and how you can identify it and reduce it.

David Hamer is a biomedical scientist and a quality improvement consultant.