Skip to 0 minutes and 4 secondsAMRIK SHOAL: It can help you to identify where the bottlenecks are. It can identify where waste is. And it can help to eliminate that waste. It can eliminate bottlenecks and provide, if you like, a much more smoother flow of patients and information through the system. The barriers are no different to the barriers that we identified from our 20 years of research in manufacturing.

Skip to 0 minutes and 35 secondsAnd I can reflect on a lot of that research, not only implementing lean, but implementing many other types of improvement initiatives-- quality, business process re-engineering, even some advanced manufacturing technologies. The top three or four barriers, I would say, are leadership from the top, engagement of senior leaders in the improvement initiative, and their real understanding of what it is that you're trying to implement, understanding what lean is and understanding how it will benefit the organisation. So senior leaders and senior management teams themselves have to understand what this change programme is, what it involves, what investment will be necessary, understanding what's involved in the actual implementation phases. That's clearly one of the most important success factors.

Skip to 1 minute and 39 secondsThe second one that we've identified is really having sort of a champion, a champion who's going to provide the day-to-day facilitation and leadership, take part in training that needs to be undertaken, and really lead the programme on a day-to-day basis. And we've seen organisations, both in the services sector and in the manufacturing sector, where programmes have failed because their champion left the organisation for whatever reason. And where we've seen high success come about has been where there has been ongoing top management commitment over many years, just chipping away slowly at what needs to be done, facilitating the change, being involved in training, being involved in the assessment that needs to take place, and so on.

Skip to 2 minutes and 35 secondsAnd that really is, I believe, the most critical success factor. So the third one is really, I believe, not only soft talk, if you like, but really looking at the real tools, if you like, that needs to be implemented and utilised to make the necessary improvements, which are some of the improvement tools, if you like. There are lots of tools that need to be used in making improvements and carrying out projects. And if those tools are not utilised, then it just becomes a talk, that we want to change, but nothing really changes unless you actually do something. I'd say the facilitators are no different to what I've already mentioned, it was what the critical success factors are.

Skip to 3 minutes and 29 secondsSo the facilitators have to be a strong champion, an entrepreneur, we refer to in our latest project. You have to have enough resources committed to undertaking the training, to learning the tools, to applying the tools that will result in improving the quality of the services provided, if you like, eliminating waste, eliminating waiting times, making the whole process much more visible. And where lean has been now applied in manufacturing companies and along the supply chain, through lean in organisations have become much more visible. Supply chains have become much more visible. So it's having visibility of what you do.

Skip to 4 minutes and 24 secondsSo for example, in wards, white boards are used to list the patients and where they are, what needs to be done, whether or not they've had a particular test or not, and what needs to be done tomorrow. So all of those things enable visibility of your processes. It helps to identify ways, and it streamlines the processes. So I'm taking a very operations management view of what lean is and how it can improve the processes.

Barriers to lean implementation

Here we consider some of the barriers and facilitators to lean implementation in healthcare. Please watch the short interview clip with Professor Amrik Shoal, Monash University.

In previous steps, we have seen how, despite having massive potential to reduce waste and improve healthcare outcomes, lean is often very hard to implement and sustain. Historically, the success rate of transformation is poor, with perhaps less than 10% of Lean implementation projects in the UK reporting a successful outcome.

The specific literature on healthcare is replete with small scale examples of Lean implementation that involve the application of quality improvement tools with limited organisational reach. This research also highlights many barriers and possible obstacles to change, some of which arise from the particular features of health organisations (see Week 2).

A typical problem is that, often there is ambiguity over who is in charge, coupled with transitory leadership which makes it hard to plan ahead or ensure continuity in lean projects. The presence of multiple stakeholders (clinicians, managers, patients), each with different perspectives and priorities, can also make it hard to define value or even clarify who the ‘customer’ or end user might be. As in other contexts, lean may be highly political, associated with a blame culture or even as an initiative that is imposed top down. For this reason there may be extensive resistance towards lean, even in situations where it is recognised that the tools and techniques associated with it could improve things. Lastly, as in manufacturing, a primary inhibitor of Lean implementation may be the traditional mind-set of the functional organisation where groups of professionals prefer to operate within their own specialisms or silos.

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Leadership for Healthcare Improvement and Innovation

The University of Warwick

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