Eliminate waste through matching supply and demand exactly
The value of the supply of products or services is always time-dependent. Something that
is delivered early or late often has less value than something delivered exactly when it is
needed. We can see many everyday examples of this. For example, parcel delivery companies
charge more for guaranteed faster delivery. This is because our real need for the delivery
is often for it to be as fast as possible. The closer to instantaneous delivery we can get the
more value the delivery has for us and the more we are willing to pay for it. In fact delivery
of information earlier than it is required can be even more harmful than late delivery because
Part Three Planning and control
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One of the increasing number of health-care services
to adopt lean principles, the Bolton Hospitals National
Health Service Trust in the north of England, has reduced
its hospitals’ mortality rate in one injury by more than
a third. David Fillingham, chief executive of Bolton
Hospitals NHS Trust said, ‘We had far more people dying
from fractured hips than should have been dying.’ Then
the trust greatly reduced its mortality rate for fractured
neck of femur by redesigning the patient’s stay in hospital
to reduce or remove the waits between ‘useful activity’.
The mortality rate fell from 22.9% to 14.6%, which is
the equivalent of 14 more patients surviving every six
months. At the same time, average length of stay fell
by a third from 34.6 days to 23.5 days. The trust held
five ‘rapid improvement events’, involving employees
from across the organization who spent several days
examining processes and identifying alternative ways
how to improve them. Some management consultants
were also used but strictly in an advisory role. In addition
third-party experts were brought in. These included staff
from the Royal Air Force, who had been applying lean
principles to running aircraft carriers. The value of these
outsiders was not only their expertise, ‘They asked all
sorts of innocent, naïve questions’, said Mr Fillingham,
‘to which, often, no member of staff has an answer.’
Other lean-based improvement initiatives included
examining the patient’s whole experience from start to
finish so that delays (some of which could prove fatal)
could be removed on their journey to the operating
theatre, radiology process were speeded up and
unnecessary paperwork was eliminated. Cutting the
length of stay and reducing process complications should
also start to reduce costs, although Mr Fillingham says
that it could take several years for the savings to become
substantial. Not only that, but staff are also said to be
helped by the changes because they can spend more
time helping patients rather than doing non-value-added
activities.
Meanwhile at Salisbury district hospital in the south of
the UK, lean principles have reduced delays in waiting for
Short case
Lean hospitals
5
the results of tests from the ultrasound department.
Waiting lists have been reduced from 12 weeks to
between 2 weeks and zero after an investigation showed
that 67% of demand was coming from just 5% of
possible ultrasound tests: abdominal, gynaecological
and urological. So all work was streamed into routine
‘green’ streams and complex ‘red’ ones. This is like
having different traffic lanes on a motorway dedicated to
different types of traffic with fast cars in one lane and
slow trucks in another. Mixing both types of work is like
mixing fast cars and slow-moving trucks in all lanes.
The department then concentrated on doing the routine
‘green’ work more efficiently. For example, the initial date
scan used to check the age of a foetus took only two
minutes, so a series of five-minute slots were allocated
just for these. ‘The secret is to get the steady stream of
high-volume, low-variety chugging down the ultrasound
motorway’, says Kate Hobson, who runs the department.
Streaming routine work in this way has left more time to
deal with the more complex jobs, yet staff are not
overloaded. They are more likely to leave work on time
and also believe that the department is doing a better
job, all of which has improved morale says Kate Hobson,
‘I think people feel their day is more structured now. It’s
not that madness, opening the doors and people coming
at you.’ Nor has this more disciplined approach impaired
the department’s ability to treat really urgent jobs. In
fact it has stopped leaving space in its schedule for
emergencies – the, now standard, short waiting time is
usually sufficient for urgent jobs.
Source: Rex Features