NHS Chief vows to cut waste and look to Toyota in efficiency drive

Pioneering techniques used by Toyota, Tesco, the Royal Navy and the Royal Air Force are being adopted by the NHS to cut out waste and increase productivity, according to a report -Lean thinking for the NHS.

As the NHS steps up its battle to improve value for money, trust chief executives admitted they must increase productivity before they can make the case for extra funding, according to a survey released today at the NHS Confederations annual conference.

Ninety-five per cent of the 203 chief executives who responded to the survey said that the NHS must increase productivity and cut waste before they can justify more funding in the governments next spending round. Getting better value for money from clinical processes and staffing were the areas where chief executives believed they could release the most resources, the poll found.

The report ‘Lean thinking for the NHS’ is published today by the NHS Confederation, which represents over 90 per cent of NHS organisations. Lean is the brainchild of car manufacturer Toyota, who has used it successfully for the last sixty years. It is a methodology designed to remove activities that don’t add value to the customer by redesigning how services work.

In health, this means for example making the patients progress from A&E to the operating theatre as quick and efficient as possible by taking out unnecessary processes and paperwork. This cuts costs, but more importantly, improves the service for patients and reduces mortality rates. It has been applied in many environments including Tesco.

Bolton Hospitals NHS Trust have seen impressive early results from Lean including a reduction by one third of death rates for patients having hip operations, reduced paperwork in the trauma unit by 42 per cent and a fifty per cent reduction in the amount of space needed by the pathology department. Aircraft technicians from the RAF have been to Bolton Hospital Trust to help them develop lean techniques.

Dr Gill Morgan, chief executive of the NHS Confederation said: Every organisation, public and private, has major problems with waste and inefficiency. The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tescos and Toyota. NHS managers want to be at the vanguard of modern techniques to improve patient care.

We know that our case for extra funding will fall on deaf ears unless we cut out waste in the system. Targets can be a useful tool, but if we are going to improve the service from the bottom up, we need something more. The pioneering work in Bolton and the Wirral hospitals show us what can be done. Lean works because it is based on doctors, nurses and other staff leading the process and telling us what adds value and what doesn’t. They are the ones who know.

David Fillingham, chief executive of Bolton Hospitals NHS Trust said:  When we started out, some people were very sceptical. But I have never seen anything that energises staff in this way. What makes Lean so powerful is that it engages the enthusiasm of front line staff.

Professor David Ben-Tovim, director of the team responsible for redesigning care at Flinders Medical Centre in Adelaide, South Australia, who have used Lean said: We have found that we can do 15 to 20 per cent more work, offer a safer service, on the same budget, using the same infrastructure, staff and technology. Everything has improved: costs, quality, delivery, service and staff morale.

The Royal Bolton Hospital Trauma Stabilisation Unit

Bolton has been working on Lean methods for nine months. The trauma team had difficulties in the care of some older patients who were admitted after a fall with a fractured hip. They tended to stay longer than at other hospitals and the death rate was higher than average. So following Lean, the team process-mapped the journey from end to end, talking to patients and other staff. They redesigned the entire process, which improved stabilisation and made access into theatre and discharge rates happen more quickly. The four key effects have been:

• Reduced length of time it takes a patient to get to theatre from A&E by 38 per cent (2.4 days to 1.7 days).
• Reduced paper work across the process by 42 per cent.
• Reduced total time patients spend in hospital by 32 per cent (34.6 days in 2004/05 to 23.5 days in 2005/06).
• Significant reduction in mortality by at least one third. In 2004/05 327 patients were admitted with fractured hips and 75 died (22.9 per cent). In the first half of 2005/06 there were 164 admissions of which 24 died (14.6 per cent).
• Improvement efforts in the NHS usually amount to gains of 3 or 4 per cent at the margins – these are improvements in the range of 30-40 per cent.

The Royal Bolton Hospital Pathology Department

Bolton Pathology Department employs over 100 people. Blood samples move through haematology, biochemistry, and microbiology labs and back again. The Bolton team used Lean and identified significant blockages in the system. Following the Lean production methods, the team are in middle of implementation and the expected outcomes are:

• Cut the time taken to process samples from between 24-30 hours to between two and three hours.
• Cut the number of staff needed (who are being redeployed).
• Cut the amount of space needed by the department by 50 per cent.
• Cut the number of steps needed to complete most tasks by 70 per cent.
• Cut the times taken to do most jobs by 90 per cent