by Daniel T Jones of Lean Enterprise Academy shown at the 2nd Redesigning Care Summit in Adelaide in March 2006

1. 1 Lean Enterprise Academy www.leanuk.org
Where Does Lean Healthcare
Begin and End?
Daniel T Jones
Chairman
Lean Enterprise Academy

2. 2 Lean Enterprise Academy www.leanuk.org
Lean Thinking
• Lean Thinking derives from observing best
practice organisations, not from theory
• It has a long history – Toyota the leading example
• Their example shows us the power of a relentless
focus on creating brilliant processes
• From them we extracted the principles for
designing lean processes
• And how to manage them through a scientific
approach to problem solving close to the source
• It is a path that will separate the sheep from the
goats – it not a magic recipe or a quick fix!

3. 3 Lean Enterprise Academy www.leanuk.org
Process Thinking
• We traditionally see an organisation as a
collection of departments or activities, managed
separately and with time buffers between them
• Performance is improved by setting targets, by
switching managers and by restructuring
• Danger of jumping to structural solutions
• Lean thinkers see an organisation as a collection
of customer, provider and support processes
• The task is to identify the value in each process,
to see and manage the end-to-end flows and to
synchronise the support flows

4. 4 Lean Enterprise Academy www.leanuk.org
Point Kaizen
• This is where many have begun with lean
• Many examples of rapid improvement events and
Kaizen breakthroughs in pieces of the system
• From this we learn that we can change things
quickly
• The initial gains are in quality, safety and delivery
• But the gains are limited unless they can be linked
• They are difficult to sustain without the right
support from clinicians and management
• Basically this is learning to improve what we have
• But we begin to develop problem solving skills

5. 5 Lean Enterprise Academy www.leanuk.org
Value Stream Kaizen
• The next step is to learn to see and to redesign
patient journeys from end-to-end
• Tracking the steps, time, quality, interactions and
experience of each of the actors involved
• This reveals many opportunities for improvement
– some we can act on now and others later
• We also see new demands on support processes
• We need to ask the right questions to arrive at our
first future state – achievable in months
• But who will lead and manage this value stream
redesign on an ongoing basis?

6. 6 Lean Enterprise Academy www.leanuk.org
Test Test Test Test Test
Value 100 mins Time 610 mins Duration 31 weeks
Booking List Secretary To Come List Follow Up
Refer Outpatient Pre Op Admit ProcedureDischarge Follow Up
Value 100 mins Time 330 mins Duration 31 weeks
GP GP

7. 7 Lean Enterprise Academy www.leanuk.org
The Lean Hospital
• Is difficult to see right now!
• We need a much clearer picture of the types of
flows through a hospital
• Not by specialties, or by how they entered the
hospital
• But by common demand patterns, process routes
and resource requirements
• Then we can decide how to separate these flows,
what equipment and resources to dedicate to
them and how to reorganise support activities
• But is this the future?
• System Kaizen takes us beyond the hospital

8. 8 Lean Enterprise Academy www.leanuk.org
Beyond the Big Box
• General Hospitals, like big stores, big factories,
big warehouses, big hub airports, are a legacy of
the era of mass production and consumption
• The business model is based on economies of
scale and specialisation and a belief that there is
“one best way” to compete most efficiently
• Should we not be redesigning the whole
healthcare system on lean principles?
• Backwards from the consumer rather than
forwards from our existing assets?
• Learning from other examples of lean service
delivery and retailing

9. 9 Lean Enterprise Academy www.leanuk.org
Lean Consumption
Lean thinkers define value from the perspective of
the consumer and the provider: -
• Solve our problem completely.
• Don’t waste our time.
• Provide exactly what we want.
• Provide value where we want.
• Provide value when we want.
• Provide the value we really desire.
• Solve our complete problems permanently.

10. 10 Lean Enterprise Academy www.leanuk.org
The Convenience Revolution
• The most significant change is in retailing: -
• Tesco has led this revolution by : -
• Knowing who its customers are and what they
want
• Building a range of formats to match their
circumstances and
• Creating a fulfilment system based on rapid
replenishment to serve them all
• The next steps lie in innovative ways of combining
convenience and home shopping - not Big Boxes!

11. 11 Lean Enterprise Academy www.leanuk.org
Changing Consumers
• How is healthcare consumption changing?
• Changing Context – one-off treatments, chronic
conditions, end of life care etc.
• Changing Circumstances - patient patients or
time poor consumers - high or low involvement
• Changing Experiences – informed and choosing
on safety, waiting times, convenience, customer
satisfaction, not just on outcomes
• Different types of demand - no “One-best-way” of
delivering diagnosis and treatment even for the
same problem

12. 12 Lean Enterprise Academy www.leanuk.org
Alternative Formats
• As we map end-to-end patient value streams we
can see a growing number of alternative delivery
routes: -
• On-line, help-line, self-help
• Primary care
• Other community locations
• District Hospitals
• Units specialising in particular treatments
• National Centres specialising in rare problems
• In many cases these need right-sized equipment
which does not yet exist
• Where are the lean healthcare entrepreneurs ?

13. 13 Lean Enterprise Academy www.leanuk.org
Redesigning Supply Systems
• So far we have paid less attention to redesigning
the supply chains that feed the healthcare system
with drugs and supplies of all kinds
• Many of these supply chains are 200-300 days
long, unnecessarily costly and wasteful
• The good news is that many of these products are
now also being supplied through supermarkets
• And they are having to learn how to make and
deliver exactly what is needed in days
• The next challenge is to engage the equipment
suppliers to design right-size tools for lean

14. 14 Lean Enterprise Academy www.leanuk.org
Lean Action Framework
Purpose Process People
(Value) (Management)
System
Kaizen
Value
Stream
Kaizen
Point
Kaizen

15. 15 Lean Enterprise Academy www.leanuk.org
Lean Action Framework
Purpose Process People
(Value) (Management)
System Context & Collection of Policy
Kaizen Demand Processes Management
Value Circumstances Value Stream Value Stream
Stream & Delivery Redesign Management
Kaizen Channels
Point Consumption Improving Developing
Kaizen Experience Capability Problem
Availability Solving

16. 16 Lean Enterprise Academy www.leanuk.org
Conclusions
• We are just at the beginning of the lean healthcare
journey
• These process spectacles are very powerful and
lead to some surprising conclusions
• But the seeds have been planted across the globe
• The journey will be bumpy – but we know that
extra cash and slash and burn are not the answer
• We need to share stories, experiences and maps
• And share our visions of new ways of relating to
consumers and organising healthcare

17. 17 Lean Enterprise Academy www.leanuk.org
Where Does Lean Healthcare
Begin and End?
Daniel T Jones
Chairman
Lean Enterprise Academy