Annex 4 - compilation of approaches

Lean in healthcare

Lean thinking is an approach to improvement developed at Toyota in the 1950s to create the Toyota Production System. It is a strategic approach that focuses on dramatically improving flow in the value stream and eliminating waste. It initially came to prominence in health and care systems through The Productive Series: Releasing time to care, a programme developed by the NHS institute for Innovation and Improvement.

Lean is typically a team process involving many people across an organisation. The Virginia Mason Medical Center in Seattle, Washington has been using lean management principles since 2002. By working to eliminate waste, they have created more capacity in existing programmes and practices so that planned expansions were scrapped, saving significant capital expenses. Using lean principles, staff, providers and patients have continuously improved or redesigned processes to eliminate waste, reduce rework and improve quality. Five UK Trusts are now piloting Virginia Mason's approach.

Lean thinking is founded on five principles designed to:

  • specify the value desired by the patient
  • map the value stream and identify those steps that do not create value
  • create a smooth flow through the value-added steps
  • establish pull between the steps
  • seek perfection so that the number of steps and the amount of time and information needed to serve the patient are minimised.

In essence, it focuses on improving patient flow, reducing opportunities for error, developing standards and engaging teams in improvement. It is increasingly used in conjunction with Six Sigma.

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