'Achieving Best Care' How One UK Hospital Implemented Lean

The principles of lean Six Sigma and Kaizen are efficiency drivers that can be deployed by businesses of all shapes and sizes, as well as being applicable to virtually every industry imaginable. Healthcare is one sector which arguably requires a much greater focus on customer, or patient, satisfaction than any other. In order to help health service providers to succeed in their aim of delivering the best possible treatment, a culture of process excellence will need permeate every level of organisation.

Sherwood Forest Hospitals NHS foundation trust has been working hard in this area through a partnership with Unipart Expert Services for the past three years, the Guardian reported recently. Once a division of British Leyland, before its privatisation in 1987, Unipart has re-emerged as a logistics and consultancy firm which helps to implement people-focussed improvement strategies in an industry plagued by intensifying cost pressure and ever-increasing demand.

Speaking to the newspaper, Ian Hall, the trust's director of service improvement, explained how a close working relationship between Unipart consultants and NHS staff involved in every aspect of patient care had allowed the trust to benefit from a complete operational and cultural transformation. The organisation, which runs King's Mill Hospital in Mansfield, Nottinghamshire, has established an approach to continuous improvement embodied by the phrase 'Best Care, Best People, Best Place'.


Mr Hall explained how, several years ago, before the partnership was formed, the trust had set up interviews with patients and staff about how their experience of the service and its working practices could be bettered. "From this, we came up with a set of pledges that involved reviewing the way we operate. We also looked at the concept of lean time working, which involves doing more with less," he said. The director claimed that strategies developed to boost the morale and motivation of staff, as well as enhancing the quality of care on offer, had garnered "very positive" responses.

"We wanted our management to drive passion among the staff and this is what we have achieved. Everyone is different, but our partnership with Unipart has helped us to achieve a positive culture in healthcare working environment," he explained to the Guardian's healthcare network. He defines the organisation's approach to best practices and process excellence with the acronym ABC, or 'Achieving Best Care'. This entails a holistic approach to driving efficiency and excellence in every aspect of the trust's operational activity.

But what is quite unusual about Sherwood Forest Hospitals' take on lean initiatives is that cost efficiencies take a backseat to the facilitation of better working practices among staff. Its focus is almost purely centred on improving day-to-day running of hospitals, with any resultant financial benefits a mere bonus. Most of this innovation has stemmed from smoother flow of information within the organisation, with practices monitored through Unipart's own Value Stream Mapping process.

The consultancy defines this as the removal of non-value added activity, with measures in place to ensure that the efficiency of staff operation and the quality of services they provide are affected as little as possible. The net result is staff performance being tracked on an hourly basis, allowing everyone at the trust, and not just those working at an executive level, to understand how well they are doing. Mr Hall stressed, however, that these indicators are very different to those seen in more finance-driven cultures.

"We don't want to go down that route. We use communication cells to review staff performance and achieve a process of continuous improvement," he explained. So far, the trust has rolled out its best practice strategy to areas that extend to everything from clinical services, out-patient departments and human resources. And while some may be eager to dismiss Sherwood Forest Hospitals' approach as a meaningless series of management mantras, the positive response from unions and improvement in working practices are clear proof that ABC has brought significant operational benefits to the organisation. The fact that it was recently voted Britain's most-improved healthcare employer speaks for itself.