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Introduction into Lean. and the Every Patient Matters Transformation Programme. Introductions/Objectives. Introduce yourself Why have you come along today?. Objectives. Explain what Lean is Describe the aims of the Every Patient Matters Transformation Programme

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Introduction into lean

Introduction into Lean

and the Every Patient Matters Transformation Programme

Section A

Introductions objectives


  • Introduce yourself

  • Why have you come along today?

Section A



  • Explain what Lean is

  • Describe the aims of the Every Patient Matters Transformation Programme

  • Be able to apply at least one Lean technique in your workplace

Section A

Introduction into

Introduction into..

Section A

Introduction into lean

  • Fire-fighting has become the norm

  • Patient’s are pushed through the system – no flow

  • Stressed out staff

  • Outdated processes

Why do we need Transformation?

Section A

Previous change initiatives

Previous ‘Change’ Initiatives

RUH 2010

Productive Leader (on-going)

Orthopaedic Lean Project

Productive Operative Theatre (TPOT)

Productive Ward

Section A

Improving quality

Improving Quality

  • Quality, Innovation, Productivity and Prevention

    • What are the programme objectives?

  • Perception is that it’s all about efficiency savings

  • Every Patient Matters falls under the QIPP umbrella and reports to PMO (programme management office)

Section A

Qipp projects

QIPP Projects

  • Acute Oncology

  • Ambulatory Care

  • Emergency Surgery Pathway

  • Theatre Scheduling

  • Outpatients

    And many more…

    Quality and the impact on patient experience is the most important factor to consider when scoping a project

Section A

Introduction into lean

Section A

Vision for transformation

Vision for Transformation

“To deliver the best possible care to ‘every patient’ involving all staff in

developing a culture of

‘continuous improvement’”

Section A

What is lean

What is Lean?

  • What do you think the term ‘Lean’ implies?

    “Lean is not an acronym, it is a collection of tools that assist in the identification and elimination of waste (e.g. queues, duplication, re-work, waits and delays) and focuses on the customer/patient”

Section A

History of lean

History of Lean

  • Lean thinking, developed from the Toyota Production System, has been applied in many competitive sectors.

  • It is about changing a business from the roots up; working to a set of principles to produce a culture of continuous improvement that will drive sustainable results.

Section A

Industry examples of lean

Industry Examples of Lean

Section A

Why use lean

Why use Lean?

  • Such thinking is increasingly being applied to health services in the UK and overseas to:

    • improve the quality of patient care

    • improve safety

    • eliminate delays

    • reduce length of stay

      while using no more resources

Section A

5 principles of lean

5 Principles of Lean

1. Value: Specify value, this must be defined by the customer/patient. Otherwise known as Voice of the Customer

2. Value Stream: Identify the value stream/patient journey and the processes that define it.

3. Flow: Align healthcare processes to facilitate the smooth flow of patients and information

4. Pull: Deliver care on demand with the resources needed for it.

5. Perfection: Develop and amend processes continuously.

Section A

Value stream mapping

Value Stream Mapping

  • Used to identify the processes involved in the value stream and which elements had value to the customer

  • Different from process mapping in that you identify value added and non value added steps for the customer and quantify time.

Section A

Introduction into lean

Section A

Introduction into lean

Section A

Lean principles exercise

Lean Principles Exercise

  • Exercise 1:

    In groups look at the value stream in front of you and complete the questions in the exercise sheet

Section A

5s a simple tool to start with

5s – a simple tool to start with

  • 5s is a good first lean technique to use back in your work area;

    • Sort

    • Standardise

    • Set in Order

    • Sweep and Shine

    • Sustain

Section A

Before and after pictures

Before and After pictures

Section A

5s principles

5s Principles

  • Engage others in your workplace with the 5s

  • Start small with your own desk!

  • Take photos before and after

Section A



  • Waste is anything other than the minimum amount of equipment, space, staff time, which are essential to add value to the product or service.

  • In Lean 7 types of wastes have been identified, there may be more that you can think of

Section A

7 types of lean waste

7 Types of Lean Waste

Section A

Waste exercise

Waste Exercise

  • Exercise 2:

    In pairs, spend 15 minutes thinking of NHS examples for each of the 7 wastes

Section A

Waste walk

Waste Walk

  • ‘Walking’ the process from beginning to end (or end to beginning);

  • Walking each step, watching what actually happens (as opposed to what you are told that happens or what is contained in a process flow chart or procedure);

  • Talking to the people who undertake each task to establish how it happens (and does it happen this way each and every time?);

  • Observing for ‘wasteful’ activities;

  • Developing a ‘shopping list ’of measures (data) required that will inform the investigation;

  • Photographs –anything and everything that appears relevant (do you require permission?);

Section A

Introduction into lean

“Best possible care through lean thinking is not a project, it is afundamental change to the way in which the hospital delivers its services to patients”

Section A

Lean awareness

Lean Awareness

200 RUH staff

Section A

Lean leadership

Lean Leadership

Section A

Culture and climate

Culture and Climate

“Change in an organisation calls for leaders to recognise and balance culture and climate dimensions.”

  • Culture can be divides into five components: values, beliefs, myths, tradition and norms.

  • Climate is the label used to describe the dimensions of the work environment E.g. organisation structure, leadership style, communication, historical forces.

Section A

Culture and climate exercise

Culture and Climate Exercise

  • Do we have a climate and culture that encourages change?

    Exercise 3:

  • Group 1 - Describe the current Culture and Climate of this organisation

  • Group 2 - Describe what the Culture and Climate of this organisation needs to be.

Section A

What do our leaders think

What do our leaders think?

  • Link to chief exec conference culture question

Section A

Factors to achieve desired culture and climate

Factors to achieve desired culture and climate

1. Clear Vision

2. Set of values in alignment with the vision

3. Accountability for both performance and behaviours with consequences when standards aren’t met.

4. High performing teams that work independently and put the needs of the organisation before personal needs.

5. Value added communication

6. Rewards/Recognition

Section A

Next steps

Next Steps

  • Get your colleagues involved in a 5s activity

  • Think of a problem that you think you could apply some lean principles too

  • Book yourself onto the two day change agent training

  • Discuss location for waste walk

Section A

Lean change agent training

Lean Change Agent Training

  • Two day change agent training follows this half day and includes;

    • Exercises and group work to demonstrate lean principles

    • Waste Walk in your department

    • Process mapping – value added, non value added

    • Human dimensions of change

    • Handbook provided with Lean toolkit incl. Transformation Approach

  • Please complete feedback sheets – be honest as you like!

Section A

Introduction into lean

Section A

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