ABSTRACT
The English National Health Service (NHS) represents an exemplary context within which to examine the implementation of lean. Austere economic conditions, coupled with rising demand for services, means that healthcare organisations must do more with less. But doing more with less should never come at the expense of quality.Quality, defined broadly as encompassing the three dimensions of effectiveness of care, safety of care and patient experience (as in the Health and Social Care Act of 2012), is a critical aspect of healthcare that (should) share centre stage with efficiency. Efficiencies must therefore arise from improvements, and improvement requires change. But how do you effect change across a whole organisation? How do you overcome resistance to change in an organisation characterised by a dominant professional core (i.e. elite professionals seeking to maintain their professional jurisdiction)? And how do you mediate between the regulatory environment and corresponding managerial requirements for efficiency through financially incentivised performance based targets and the mandate for patient-centred care? In this chapter, we chronicle one hospital’s attempt to effect strategic change
across a whole organisation, to produce patient centred services that are effective, safe and efficient, through the implementation of an improvement system underpinned by lean.The case study highlights the importance of a whole system approach to lean implementation, and perhaps most importantly, the role of senior management in sustaining a whole system approach. This chapter proceeds as follows. First we outline the concept of lean and its
application to healthcare, following which, we provide details of the case study organisation and describe our research design. The case study showcases the evolution of lean in one hospital from a ‘few projects’ approach (Burgess and Radnor, 2013), to a ‘whole system approach’ led by the chief executive. Our findings highlight the influence of the chief executive in engaging the organisation in lean at multiple levels, proactively sustaining lean implementation across his six-year tenure.Given the significant influence of the chief executive in leading lean across the organisation, many regarded his departure as a ‘litmus test’ to the success of lean implementation – would it thrive and continue, or wither and fade? Thus, when the pioneering chief executive did leave the organisation in
2010, the lead author undertook further interviews with the incumbent chief executive to get views on the future of lean in the organisation. Our case study also highlights some impressive examples of service improvement
that has seen the organisation collect a host of prestigious awards for exemplary patient care including numerous Health Service Journal awards, one British Medical Journal (BMJ) award, one NursingTimes award, two Process Excellence Awards and several others. Finally, the authors conclude this chapter by bringing the story to present day where performance and financial crises in the year of 2012 led to regulatory intervention and the departure of many senior members of staff.We highlight the need for further research into the sustainability of improvement approaches when financial and performance crises hit.
