Introduction into Lean
and the Every Patient Matters Transformation Programme
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Introductions/Objectives
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Introduce yourself
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Why have you come along today?
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Objectives
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Explain what Lean is
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Describe the aims of the Every Patient Matters
Transformation Programme
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Be able to apply at least one Lean technique in
your workplace
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Introduction into..
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Why do we need Transformation?
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Fire-fighting has become
the norm
Patient’s are pushed
through the system – no
flow
Stressed out staff
Outdated processes
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Previous ‘Change’ Initiatives
RUH 2010
Productive
Leader (ongoing)
Orthopaedic
Lean Project
Productive
Operative
Theatre (TPOT)
Productive
Ward
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Improving Quality

Quality, Innovation, Productivity and Prevention
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What are the programme objectives?

Perception is that it’s all about efficiency savings

Every Patient Matters falls under the QIPP
umbrella and reports to PMO (programme
management office)
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QIPP Projects
Acute Oncology
 Ambulatory Care
 Emergency Surgery Pathway
 Theatre Scheduling
 Outpatients
And many more…

Quality and the impact on patient experience is the
most important factor to consider when scoping a
project
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Vision for Transformation
“To deliver the best possible care to
‘every patient’ involving all staff in
developing a culture of
‘continuous improvement’”
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What is Lean?

What do you think the term ‘Lean’ implies?
“Lean is not an acronym, it is a collection of
tools that assist in the identification and
elimination of waste (e.g. queues, duplication,
re-work, waits and delays) and focuses on the
customer/patient”
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History of Lean

Lean thinking, developed from the Toyota
Production System, has been applied in many
competitive sectors.

It is about changing a business from the roots
up; working to a set of principles to produce a
culture of continuous improvement that will drive
sustainable results.
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Industry Examples of Lean
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Why use Lean?
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Such thinking is increasingly being applied to
health services in the UK and overseas to:
improve the quality of patient care
 improve safety
 eliminate delays
 reduce length of stay
while using no more resources

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5 Principles of Lean
1. Value: Specify value, this must be defined by the
customer/patient. Otherwise known as Voice of the Customer
2. Value Stream: Identify the value stream/patient journey and the
processes that define it.
3. Flow: Align healthcare processes to facilitate the smooth flow of
patients and information
4. Pull: Deliver care on demand with the resources needed for it.
5. Perfection: Develop and amend processes continuously.
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Value Stream Mapping
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Used to identify the processes involved in the
value stream and which elements had value to
the customer
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Different from process mapping in that you
identify value added and non value added steps
for the customer and quantify time.
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Lean Principles Exercise

Exercise 1:
In groups look at the value stream in front of you
and complete the questions in the exercise sheet
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5s – a simple tool to start with
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5s is a good first lean technique to use back in
your work area;
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Sort
Standardise
Set in Order
Sweep and Shine
Sustain
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Before and After pictures
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5s Principles
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Engage others in your workplace with the 5s
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Start small with your own desk!
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Take photos before and after
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Waste

Waste is anything other than the minimum
amount of equipment, space, staff time, which
are essential to add value to the product or
service.

In Lean 7 types of wastes have been identified,
there may be more that you can think of
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7 Types of Lean Waste
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Waste Exercise
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Exercise 2:
In pairs, spend 15 minutes thinking of NHS
examples for each of the 7 wastes
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Waste Walk
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‘Walking’ the process from beginning to end (or end to
beginning);
Walking each step, watching what actually happens (as
opposed to what you are told that happens or what is
contained in a process flow chart or procedure);
Talking to the people who undertake each task to establish
how it happens (and does it happen this way each and
every time?);
Observing for ‘wasteful’ activities;
Developing a ‘shopping list ’of measures (data) required
that will inform the investigation;
Photographs –anything and everything that appears
relevant (do you require permission?);
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“Best possible care
through lean
thinking is not a
project, it is a
fundamental change
to the way in which
the hospital delivers
its services to
patients”
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Lean Awareness
200 RUH staff
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Lean Leadership
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Culture and Climate
“Change in an organisation calls for leaders to
recognise and balance culture and climate
dimensions.”
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Culture can be divides into five components:
values, beliefs, myths, tradition and norms.
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Climate is the label used to describe the
dimensions of the work environment E.g.
organisation structure, leadership style,
communication, historical forces.
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Culture and Climate Exercise
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Do we have a climate and culture that
encourages change?
Exercise 3:
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Group 1 - Describe the current Culture and
Climate of this organisation
Group 2 - Describe what the Culture and Climate
of this organisation needs to be.
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What do our leaders think?
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Link to chief exec conference culture question
http://webserver.ruhbath.swest.nhs.uk/everypatientmatters/Lean/leader
ship/index.asp?menu_id=5
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Factors to achieve desired culture and climate
1. Clear Vision
2. Set of values in alignment with the vision
3. Accountability for both performance and
behaviours with consequences when standards
aren’t met.
4. High performing teams that work independently
and put the needs of the organisation before
personal needs.
5. Value added communication
6. Rewards/Recognition
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Next Steps

Get your colleagues involved in a 5s activity
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Think of a problem that you think you could
apply some lean principles too

Book yourself onto the two day change agent
training
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Discuss location for waste walk
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Lean Change Agent Training
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Two day change agent training follows this half
day and includes;
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Exercises and group work to demonstrate lean
principles
Waste Walk in your department
Process mapping – value added, non value
added
Human dimensions of change
Handbook provided with Lean toolkit incl.
Transformation Approach
Please complete feedback sheets – be honest
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as you like!
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