Don't mention Lean in Health and Social Care

Lean can be a 'don't mention it' topic. If I had a pound for every time someone said to me, 'Lean doesn't work in health and social care,' I'd have enough money to park in an NHS car park for a year. Well, maybe six months, the pounds don't stretch as far as they used to.

There are several misconceptions about Lean in the healthcare sector. Many people I've spoken with over the years see Lean as a complex concept beyond their comprehension, as a set of rigid techniques and foreign terms, or simply as a method to increase workload by putting things closer together. If I added the sentence, "It's great for making cars, but health and care isn't a factory, it's about people", then I could probably stretch to that year in the car park. 

One crucial aspect that often goes unnoticed is that Lean is fundamentally about people. It's about fostering a culture of engagement and empowerment for all. It's about creating an environment where anyone who identifies an issue is trained and trusted to address it without seeking approval. It's about adopting principles that promote a different mindset, always prioritising the customer's needs and preferences, and avoiding wasted time and effort in meeting those needs. 

Prof Brian Dolan OBE once told me the only thing that matters in health and care is time, and the true currency of our systems should be how much time we take from the people we look after. We never know when we, or those we care about or care for, are in their last 1000 days of life. Time is always precious. But it's even more precious for older adults. Did you know that large-scale studies have found that up to 52% of over-85s die within one year of hospital admission? The numbers are frightening. But, to save our patients' and service users' time, we must value and prioritise our colleagues' time as well. Suppose a clinical process wastes just 15 minutes each day. That's over 90 hours, over 2 weeks, of wasted clinical capacity each year. And wouldn't it be nice if wasted time was only 15 minutes a day for one person on a shift? Things are tough in health and social care, and they always will be, but there is capacity if we look the right way in the right places.

Talking about time and how precious it is. Write down the last three digits of your mobile phone number. Now, imagine that number is how many days you have left to live. How many of those precious days would you be happy to waste away from your family, away from your home, waiting for something you didn't need to wait for? I'd bet some of that car park money you'd say 0. I've worked in over 60 hospitals and health systems in England and have never been anywhere where people didn't wait unnecessarily for something. And for me, that's why Lean principles don't just work in health and social care; they could be a core part of its future. 

Implementing something like Lean doesn't require learning a completely new way of thinking. Many Lean principles and techniques are so ingrained in our everyday lives that adoption isn't as far-fetched as you may think. Stopped at a traffic light recently? Or filled up your car when the petrol light has come on? That's visual management. Is your kettle in the same room as your fridge? Maybe you keep some towels near your shower or bath? That's movement waste reduction. What about shopping? I'd wager that you don't buy a months worth of milk, bread or vegetables at once. Of course not, because they would go off. That's inventory management. 

My point here is that Lean can work in Health and Social Care. And so could every other improvement technique out there. That's why it's just one option in our toolbox. It's great for some situations and some cultures, but not others. What's needed is an understanding of the principles behind the methods. You need leadership alignment, and alignment and communication from ward to board. You need staff engagement, empowerment, and ownership. You need psychological safety and supportive governance. You need to ensure you're working on the right challenges to solve the right goal in a way that engages the hearts and heads of your staff (hint - this probably isn't a performance target). 

I hope you've enjoyed this quick read. If it's hit something inside you, leave a comment or share with someone you think might like to read it.

And if you're stuck on your improvement journey or need help tackling that big, complex problem that just won't disappear, contact us here at Nexus for a chat.