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Skip to 0 minutes and 5 seconds So what is Lean? So Lean originated from Toyota, the motor company. And it is sort of a journey of a development that started back in the 1960s at a time when Ford and GM were producing cars at the rate of many hundreds, many thousands per week and per worker. And Toyota really had very little stake within the market. But they also had very little in the way of resources. So following the war, they didn’t have any materials, they didn’t have any staff, and they didn’t have any money. So the challenge really for Toyota at the time was how do we compete with the American manufacturers when we haven’t got any money?

Skip to 0 minutes and 51 seconds We can’t go and purchase the mass production systems that Ford have, so we can’t hope to compete on that scale. Added to that, actually their market didn’t demand the same car. They wanted variety. So they wanted smaller passenger cars. And they wanted more variety, which a mass production system doesn’t allow you to have. So this was the sort of conundrum that they were faced with at the time. So they had to come up with a different way of producing.

Skip to 1 minute and 22 seconds So part of the story behind this production system is that actually, the engineers from Toyota would go to the manufacturing plants in Detroit and study it and try to understand what elements of that production system they could copy and what they had to adapt. And one of the things that they saw was actually the flow, so the heartbeat of the operation, the fact that everything was very nicely paced. And that was something that they really wanted to copy. But obviously, they couldn’t afford to buy these mass manufacturing plants. They couldn’t afford the machinery. But the other thing that they saw when they were there was that actually, there was a lot of waste.

Skip to 2 minutes and 9 seconds So there was a lot of cars that were half-made, there was a lot of waiting, there was an awful lot of material that was needed and obviously they couldn’t afford to do that either. But they viewed it as not about cutting the cost production, they viewed it as something that wasn’t necessary, it didn’t add any value. So from their perspective, it was a case of how do we create cars only that there is a demand for, so only when a customer makes a demand for a product, that is when we produce. So that is very different from the mass manufacturing approach where we just made thousands and thousands of cars, pushed them into the market and hope they sell.

Skip to 2 minutes and 54 seconds So it’s a very radical departure from this mass manufacturing model. Now the really interesting thing about this history is that actually Toyota grew to become number one manufacturer of cars, but it did so over time by producing cars that cost less, that used less materials, less of everything, less space, less automation, less money, but at the same time, was able to produce cars that were of the highest quality. OK? So it really is the holy grail, if you like. So what does an improvement method that came from car manufacturing have to do with healthcare? And well, people are not like cars. I’m not going to argue that.

Skip to 3 minutes and 42 seconds But what we have here is a system that sought to eliminate waste so that entwined with that, it’s about delivering value at every step and making that value flow. So the crux of the Toyota production system… well, there are two foundations really. So one is that we must eliminate waste continuously and in a systematic manner. OK? And we have, over time, developed a series of tools that helped us to identify and eliminate waste. The other important foundation is disrespect for people. OK? So the idea being that if we don’t respect our workers, then we are actually creating more waste because they become overburdened, they become disengaged, and so on.

Skip to 4 minutes and 31 seconds The other point is actually these people that do the work are those that know how to improve their processes. So they see the waste, they know it, and they’re the ones that can improve the process and eliminate that waste. So respect for people is really intertwined with elimination of all waste. When we talk about waste, we have to be able to define value. And so within a healthcare context, we look to define value most often and from the perspective of the patient. OK? When we think about Lean methodology, the first principle of implementing Lean is to be able to define value from the perspective of the customer.

Skip to 5 minutes and 14 seconds So within a healthcare, obviously we have lots of customers or people and organisations that we might consider our customers. But within the hospital itself, we might consider the customer to be the patient. So we need to understand what it is that creates value to the patient and then design our processes around it. So the process of implementing Lean, therefore, always starts with the perspective of the customer. So what provides value from the perspective of the customer. Then we map all the activities in the process. OK? So what is involved in delivering this product or service to the customer, and which of those steps actually create value?

Skip to 5 minutes and 58 seconds Steps that we find to not contribute to value, we need to seek to eliminate those steps so that we can make the value flow. OK? And of course, within a health care context, we need to be able to pull the customer through the process so that our services and the way that we deliver our services responds to actual demand. And finally, when we’re implementing Lean, we have to pursue perfection. OK? So that’s the overriding philosophy, if you like, of Lean implementation is that we pursue perfection. So it’s an ongoing journey. It’s something that should become embedded within our daily work over time.

Skip to 6 minutes and 40 seconds To finish, I just want to share with you a quote from an interview with a Lean facilitator in a UK hospital. When I was asking her, what does it feel like to be doing Lean? What’s it feel like to be in a hospital where you are practicing Lean and using it as a methodology? And she said to me, ‘Sometimes it feels like we’ve got to operate faster. We’ve got to put the patients to sleep faster. We’ve got to treat them faster, then we’ve got to wake them up faster, and ship them out faster. Well, actually Lean isn’t about that at all. The great thing about Lean is it’s about giving staff permission.

Skip to 7 minutes and 18 seconds So you give them permission to sit-in a room, to review a process, to spot those changes, to make those changes, and to be listened to by your peers, by other people who are part of the process, but you might not have met them before, by your managers, and by executive staff as well, all in that one room, all listening to your ideas, all for improving processes’.

Introduction to lean in healthcare

Here we will introduce the concept of one of the most popular QI methods used in healthcare at the moment: lean. You should listen to the short lecture by Dr Nicola Burgess, Warwick Business School describing the basic principles of lean thinking and their application to healthcare.

Once you have viewed this lecture please read the supporting text attached below.

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This video is from the free online course:

Leadership for Healthcare Improvement and Innovation

The University of Warwick