BBC Radio Program on Lean Hospitals


    BBC – Radio 4 – In Business

    COMING MID 2008, A NEW BOOK ON LEAN HEALTHCARE – “Lean Hospitals: Improving Patient Safety, Quality, and Employee Satisfaction,” by Mark Graban

    Here is a nice program from the BBC, can listen in streaming audio or it can be downloaded. Go 1 minute in from the start of the file, as the first minute is apparently the end of the previous program.

    The host visits an NHS hospital and focuses on some of the work done by the UK Lean Enterprise Academy and Dan Jones.

    The program provides a nice overview of lean concepts put into use in the hospital.

    About half way in, there's a great quote about patient waiting time, I'm paraphrasing:

    “The queue is to healthcare today what it was to manufacturing in the 1970's…. the queue was an asset that allowed you to keep employees fully utilized. But, the downside is that the queue is incredibly stressful and it costs a lot to manage, wasting resources and wasting people's lives.”

    I've seen that dynamic first hand. The doctor is usually the high-priced asset that needs to be utilized, so we keep it busy by building up “WIP” (work in process) inventory, in this case, it's people.

    About 21 minutes in, the host takes us back to the hospital emergency room, two months after the week long kaizen event (“rapid improvement workshop”) had taken place. The reviews were actually somewhat mixed:

    A doctor, the director of emergency care, who had helped organize the event said (I'm paraphrasing):

    “Perhaps we didn't do enough groundwork before hand in terms of bringing the department with us, so they understood what we were trying to do and that we were really there to help them. When you say lean manufacturing, it depends on to whom you use the phrase… some still won't have gotten what we were trying to do that week.”

    This is one reason why I don't think a kaizen event (or many kaizen events) will make any workplace “lean.” You have to involve employees, and that takes time. Truly changing to a lean culture takes time. A kaizen event can't do that, I think, so in a way the doctor's response doesn't surprise me too much.

    The host also talked with a surgeon who had been on the kaizen team:

    “I thought it was very useful, an eye opener… during the course of the week, it was obvious we could apply these ideas to make work flow better. But, there were pockets of resistance along the line, people were protecting their territory… we need people to understand change has to take place.”

    That's the role of leadership, to help create the pull for lean methods…. to get people motivated that lean will benefit the patients and to help eliminate the fear that might cause employees to think lean would hurt them or end up costing them their job.

    The consultant said that the hospital needed to come up with a way to make lean a program, after the two “experiments” with kaizen events, to create a “lean team.” That's what the consulting organization I'm a part of does, we don't do flashes of kaizen events, we actually train employees to make lean changes as an on-going effort, and to coach managers and leaders how to sustain it, not as an “event” but as a way of doing things every day.

    The consultant also said (and I agree with her on this) that the kaizen event is just the first step on a long path toward lean. I hope the hospital (and the rest of the NHS) can get there.

    The Lean Enterprise Academy has a healthcare page, which includes a nice whitepaper on applying lean to the NHS.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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