Project explores how healthcare estate can contribute to 'Lean' improvements

Three-year study will determine impact of buildings on services and efficiencies

The need for NHS trusts to reduce spending while improving services has led to the launch of a project exploring how the healthcare estate can play a key role in securing efficiencies.

The three-year initiative, which is funded by The Health Foundation, will look specifically at how to design in ‘Lean’ concepts when carrying out new-build or refurbishment schemes. It aims to help trusts reduce waste and improve processes by redefining space more effectively using ‘Lean’ methodology, which helps to create more value with fewer resources.

We take the view that processes are constrained by the space in which they operate and that by applying Lean to the design of space, it is possible to reduce waste and improve processes

Gary Prior, programme manager, said: “We take the view that processes are constrained by the space in which they operate and that by applying Lean to the design of space, it is possible to reduce waste and improve processes.”

The project will team up healthcare estates staff, clinicians and quality improvement staff, helping them work together to produce better designs and create more-effective processes.

Prior said: “By prioritising service flow, improving processes and reducing waste, the project seeks to improve patient experience, safety and the effectiveness of care.

“The project team aims to design, test and document a structured improvement event programme that brings together estates and quality improvement staff with clinicians to incorporate Lean principles into new or refurbished spaces and premises.”

By the end of the programme, estates and quality improvement staff will be able to facilitate workshops and co-produce designs with clinical teams that incorporate Lean principles. As a result, improved flow will lead to shorter waits and more efficient use of capacity; mistake-proofing and visual processes will improve safety by making it easier for staff to do the right thing and harder to do the wrong thing; and reducing waste will lead to more effective care.

There will be two pilot projects of 12 months each consisting of several interventions including a core design phase.

Because completely redesigning new or refurbished space can be challenging for the staff involved, the project is running a series of activities and workshops to take place before the core design of space event to maximise success. These comprise:

  • Training in Lean principles and tools for estates, clinical and administrative staff involved in the pilot project
  • Diagnostic and current state mapping to help sites identify their improvement opportunities and priorities
  • A ‘kaizen’ workshop to build positivity toward continuous improvement and maintain momentum for further change

These activities will raise attendees’ knowledge and skills, demonstrate that improvements are possible, and help them to prepare for change. After this the intervention will consist of a design of space workshop facilitated by estates and quality improvement staff and further kaizen workshops to test and refine the processes that will operate in the newly designed space.

Prior told BBH: “The NHS has been charged with saving millions of pounds, but still needs to deliver top-quality patient care.

“We believe a lot more can be done by changing the processes in line with Lean principles. But it is not just about how services are operated; it is also about the environment in which they are delivered. We want to see whether changes to the environment can have a significant impact on quality of service.”

I believe there is scope within the NHS for Lean to have a significant impact, helping to reduce costs as well as improve patient care and ensure services are efficient and fit for the future

The project is being led by the North East Transformation System (NETS). Hosted by Gateshead Health NHS Foundation Trust, NETS is an improvement collaborative made up of hospital trusts, commissioners and improvement networks. It is partnered by Gateshead Health NHS Foundation Trust; Tees, Esk and Wear Valleys NHS Foundation Trust; City Hospitals Sunderland NHS Foundation Trust; North East Ambulance Service NHS Foundation Trust; Newcastle University Business School; and various NETS coalition organisations.

Pilot sites will be chosen from around the North East of England and will cover acute hospitals, primary care and mental health facilities.

The learning gained will be used to develop a workshop manual, curriculum and materials to train others to replicate the intervention. This will help with future spread of the intervention.

“I believe there is scope within the NHS for Lean to have a significant impact, helping to reduce costs as well as improve patient care and ensure services are efficient and fit for the future,” said Prior.

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