UK health visiting: challenges faced during lean implementation

Abstract

PurposeThe purpose of this paper is to present the challenges identified during a lean implementation in a health visiting service within a large primary care trust in NHS UK.Design/methodology/approachFollowing a series of lean workshops a triangulated approach to data collection was adopted in order to determine the root cause of the challenges that were faced during this lean implementation. The three methods that were selected for qualitative analysis included semi‐structured interviews, document analysis and researcher participant observation.FindingsSix key challenges were identified from the data analysis. These were: high process variability; a lack of understanding of lean; poor communication and leadership; target focused; problems defining waste; and difficulty in determining who is the customer and what do they value?Practical implicationsAlthough this particular lean implantation had limited success, the research has highlighted a number of challenges which would have to be addressed prior to future lean exercises. This will assist other clinical and managerial staff to prepare for the challenges that may be faced during a lean implementation, and adapt their approach to future quality improvement.Originality/valueThe barriers to lean implementation could be overcome with upfront planning, transformational leadership, excellent communication, identification and sharing of best practice and, above all, a shared vision. There is no quick and easy solution to productivity improvement, community services, as in this paper, cannot expect to select lean tools and techniques and emulate the success seen elsewhere. If they wish to deliver world‐class healthcare in the face of constrained resources and greater demand, they need to adopt a long‐term vision.

Evaluating Lean in healthcare

“…This perceived pragmatic and fragmented approach resonates with a similar trajectory of Lean implementation in other sectors (Hines et al, 2004). However, there appears to be a dearth of empirical literature to evidence how Lean implementation is operationalized in healthcare besides a few isolated case studies that often describe a successful, but isolated project (see for example: Lodge and Bamford, 2008;Wojtys et al, 2009;Grove et al, 2010). Aside from these isolated case studies there is also a lack of evidence that supports the view that Lean can work in a hospital context and improve organisational performance (Young and McClean, 2008;Holden, 2011).…”

Uma análise das barreiras e dificuldades em lean healthcare

“…Embora muito já se saiba sobre as dificuldades de se aplicar Lean na manufatura (EMILIANI, 2000;ACHANGA et al, 2006;SIM;ROGERS, 2009;BHASIN, 2012;COPETTI et al, 2016) as barreiras, limitações e adaptações necessárias no setor hospitalar ainda guardam lacunas de investigação. Grove et al (2010) identificaram seis desafios para aplicar Lean em um serviço público de cuidado primário na Inglaterra: (a) alta variabilidade do processo; (b) falta de entendimento do Lean; (c) comunicação e liderança deficientes; (d) foco em metas nacionais; (e) problemas na definição de perdas; e (f) problemas na identificação dos clientes e seus requisitos de valor. Os autores afirmam que a chave para contornar estas dificuldades é estabelecer uma visão compartilhada de longo prazo, pois não há solução rápida e fácil para a melhoria de produtividade.…”

Lean-Agile Adaptations in Clinical Laboratory Accredited ISO 15189

“…Although focused on manufacturing, Lean has proved to help accomplish good results when applied to health care systems [5,6], although some authors like França [7] defend that in practice, the Lean methodology lacks from continuity in hospitals due to the absence of a continual process and gradual improvement. This paper believes that that, by itself, automation cannot offer the necessary levels of organization to address the needs of an efficient organization and maintain, at the same time, quality goals and customer orientation; this article applies the Lean methodology in the centralized laboratory.…”

“…At the same time, we believe it is necessary to apply complementary concepts from the Agile methodology as it brings specifically adaptive and demand-driven philosophy for our customers in the health care industry [3], managing sudden changes in the quantity and the characteristics of the commands or demand [8], the increase in the pressure to reduce costs [5], the increase of the pressure by competitors [9], the global market [1], the rapid growth of access to technology, the changes in wages, salaries and professional capabilities, the bio-ecologic responsibility, the scarcity of resources [10], the technology, the clients and the competitors [11]. Agile means using market and enterprise knowledge to benefit from profitable opportunities in a volatile market [12].…”