Lean in the Bolton NHS Trust, England


Making lean thinking work in the NHS

Here's an article about a British hospital. I've seen the CEO, David Fillingham, speak about Lean and it sounds like they are really trying to embrace Lean thinking into the hospital's culture and strategy.

Fillingham has a book he has written about their journey, but the availability is still pretty spotty in the U.S. right now. The book is called Lean Healthcare: Improving the Patient's Experience (Healthcare Improvement) and I'm hoping to read it soon.

Bolton uses an “Event”-based strategy for Lean implementation… but it's also about changing the management system.

From the article, written by the CEO:

Energising weeks

Event weeks can be emotional and stressful for the staff involved as well as hugely energising. As one consultant geriatrician put it to me: “I didn't know we were doing this to patients.” Finding out about the problems in the service is the first step to fixing them but it can be an unsettling experience.

But leading a lean transformation of a hospital is about much more than running rapid improvement events. It requires a systematic approach to changing how the hospital works. In Bolton, we have developed the Bolton improving care system cycle to help us do this.

The more ambitious will want to use lean techniques to transform patients' experiences throughout their journey. In Bolton, we have already seen big improvements in safety and efficiency through the redesign of patient pathways in trauma, stroke services, cataracts and joint replacements.

We have now set out on a 10-year journey to transform everything the hospital does. This means applying lean principles in every part of the organisation. We have established an academy to give all 3,500 members of staff a lean mindset and skills. We are also re-educating leaders in a new approach to how they go about doing their jobs.

My general perspective is that a bunch of isolated kaizen events aren't going to make an organization Lean. But, you have a fighting chance with the right management attitudes and cultural shifts. It sounds like that's underway at Bolton.

Some of their results:

Trauma – fractured hip mortality cut by 50 per cent, length of stay down 33 per cent;

Pathology – test turnaround times three to 10 times quicker, 40 per cent floor space saving;

Cataracts – new one-stop shop established, patient visits cut by 50 per cent;

High-risk joint replacements – complications reduced by 85 per cent;

Laundry, estates, finance and many others – extensive cost savings delivered.


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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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