Lean in Healthcare

Dr Nicola Burgess writes,

Derived from studies of the Toyota Production System, the concept of Lean has been credited with universal applicability across all sectors from manufacturing to service, and in public and private sectors. Since 2001, Lean has progressively been adopted by healthcare organisations in various ways, for various reasons and to various degrees of success. Despite the promise of Lean to enhance quality of products and services through the elimination of non-value-adding activity, and thereby a reduction of overall cost, many organisations who attempt to adopt Lean, fail to successfully implement and subsequently fail to sustain Lean practices across the organisation.

 In healthcare, many reasons for implementation failure exist, from an expectation that Lean will ‘plug the financial gap’ to a lack of engagement from middle managers… ‘A manager’s focus is compliance’, ‘are we hitting our targets; are we doing what is expected of us?’, and resistance from clinical professionals: ‘we’re not Toyota and we don’t make cars’ and ‘we’ve been doing this for years, if there was a better way don’t you think we would have done it by now?’

 A few healthcare organisations have been successful at implementing Lean across the organisation and even reaching beyond the organisational boundaries to primary and tertiary services. Sustainability, however, appears vulnerable to shifts in the political and financial context. My recent research by (2016) reveals how sudden changes in the political and/or financial context of healthcare organisations can quickly derail even the most prolific of Lean implementations. So, how can organisations adopting Lean sustain implementation and mitigate the effects of a fast moving political and fiscal context? 

 At a more micro level, the power base of professional workers remains a crucial factor in the adoption of new management practice and the implementation of new ways of working. The capacity of professionals to influence the fate of implementing change programmes per se is significant and presents an important area for research.  Research is needed to understand how we might mitigate such barriers to Lean implementation and sustainability of Lean within professional contexts to realise an organisation-wide service improvement effect.

lean in healthcare

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How NOT to design a service satisfaction survey

A follow on from my experience with the service network that fixed my MLC (remember that?). When I picked my car up I was asked to fill out a short survey on how my customer experience was. The questions – and my thoughts about them – went something like this:

1. How was your customer experience today? Today it was great. I got my car back, it worked, and I hadn’t had to pay any money. However, the total experience was less than great.

2. How was your service advisor today? As before. Marvellous. He had told me I could get the MLC back early, had checked out another possible fault and got a price on some new tyres for me. But remember… Services are delivered by more than one party. Let’s figure out how they ALL performed…

3. How would you rate us for value for money? It was free, gratis, I paid nothing. But why there was no option to say that this was warranty work on the form?

I also noticed that the scales were colour coded. Bright, solid green for very good, solid red for very bad. Surely human nature draws us to respond in the positive? The survey was also filled-in in front of the service advisor. Surely, off-line provides a better response? So, what can be done to improve the reliability of these surveys? Here’s a few suggestions:

1. Focus on the TOTAL experience, otherwise people will break it down into times and the full picture won’t be revealed.

2. Acknowledge that there’s a network, find out who the customer came into contact with, and how each of them rated. This was a dealer survey but surely Premium German Car Maker would be interested in how THEIR service network is performing?

3. Remove ambiguity. Let the customer say if it’s a warranty claim or their own hard earned cash that they have parted with. Surely whether someone pays or not will absolutely influence their perspective?

4. Minimise bias. Don’t colour code things and don’t get people to fill these things in live. It absolutely creates bias, but try to get the form filled-in in a way that creates opportunities for improvement. I am not precisely sure how to do this but it does not involve an opportunity to win an iPad…

I’m not anti-survey, I’m anti bad survey. They should be designed so that action can be taken where performance is sub-standard and without this design, an opportunity for improvement can be missed.