LEAN
staff had told her that through using Lean methodology, they were able to challenge impractical processes in a way that they had not felt empowered to do so before.
Although many trusts which have adopted Lean methodologies have reported positive results, there have been concerns that Toyota’s very public embarrassment may have tarnished the Lean brand. National Health Executive asked Dr Zoe Radnor for her view
T
his has not been a good year for
Toyota. Much publicised debacles have called into
question the company’s methods and even their senior executives have admitted that there have been problems.
Toyota doesn’t just make cars, it makes ideas. In 1950, it formulated the Lean methodology which has, in many cases, revolutionised healthcare by streamlining processes within the system.
So do Toyota’s problems pose a threat to the use of Lean methodology in the NHS? Not according to leading Lean expert Dr Zoe Radnor.
“We need to consider firstly the difference in the way that Lean in being applied in both the public and private sectors, along with what it has achieved in the NHS.
“For example, there have been cases of hospitals having processes which necessitated seventeen forms being filled in just to admit someone to a ward. Through applying Lean principles to their processes, staff have been able to bring back that number of forms needed down to two.”
Dr Radnor also explained how 16 nhe
“For some NHS staff is it has been less a case of dealing with the low hanging fruit of inefficient processes but more the rotten apples on the floor! Other examples include recruitment processes, where forms have to travel the equivalent of two or three miles in going through the approval process.
People have known that these processes were crazy, but have never felt comfortable in challenging them and if Lean is giving them the opportunity to do that, then that is fantastic.”
Another issue which some commentators have focused upon is the idea that using Lean methodology will mean people losing their jobs, which is a particularly sensitive issue given the current restructuring going on in the NHS. However, these concerns are simply unfounded, says Dr Radnor.
“During my time working on the evaluation of Lean transformations, I have only come across a handful of compulsory redundancies occurring because of the application of Lean methodology. It is not Lean which is cutting jobs it is the spending cuts. Lean actually gives an approach which can help manage the fall out of the cuts.
“In my experience, the vast majority of Lean related head count reductions have been facilitated through either voluntary redundancy or natural wastage or contracts not being renewed.
“The myth that using Lean will cut into your core staff is
simply not true and when you consider some of the wasteful processes which some trusts have been engaging in, you realise that if they do need to reduce headcounts, it is because they had additional staff in the first place. These situations are endemic in the idea that ‘if something is wrong with the system, throw resources at it’, rather than approaching it with a different methodology.”
Dr Radnor also believes that Toyota’s experience earlier this year throws up some interesting questions about how the NHS is planning to deliver services.
“When cross examined on its problems, Toyota identified that it had lost sight of its commitment to quality, choosing instead to focus on reducing cost. Given the current state of NHS finances, I think that this poses some interesting questions about how we approach making improvements to healthcare. In my experience, if an organisation concentrates on quality, then costs tend to reduce anyway and many cost saving exercises just incur more spending further down the line.
“I also question whether Toyota’s use of what we call Lean, and they call The Toyota Way, is the same as in the NHS, because putting aside its recent problems, the company has traditionally used it as an improvement tool – not an efficiency tool in the way that certain NHS organisations have which, in my opinion, is more worrying.
“Just because an organisation engages in a few ‘rapid- improvement’ events, doesn’t mean that they have used Lean as an improvement tool to improve quality, rather just to cut back on low hanging fruit. I think that this is where Lean sometimes gets a bad name.”
Whilst some organisations Sep/Oct 10
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