Find information about a range of approaches to managing organisational change – from Action Learning Sets, to the 7s model.
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LEAN is a systems-based approach to change. The term refers to an organisation’s ability to do more with less and has two key pillars of the approach: Just-In-Time (‘continuous flow’), and Jidoka (‘intelligent systematisation’).
- Just-In-Time (‘continuous flow’) – seeks to minimise costs from end-to-end of the entire process through developing which meets the demands upon it in a continuous flow with minimum spare capacity.
- Jidoka (‘intelligent systematisation’) – also known as ‘automation with a human touch’, Jidoka is considered applicable to any situation in which human decisions are replaced with processes. It requires standardisation without removing employees’s ability to actively intervene as required, in order to absorb variety and attend to quality issues in real-time. Standardisation should thus only ever be used as a method for workers to improve processes (a means to an end), never a way for managers to impose rigid controls which drive out flexible responses to expressed customer need (an end in itself). It is the exact opposite of a call centre approach where workers follow a ‘cript’ and have no authority to address variation, which is considered ‘dumbed-down’ systematisation.
Since its primary application in automotive production techniques, LEAN has subsequently been applied in a range of service industries and those provided or funded by public sector.
Implementation Steps in LEAN
- Specify value from a customer (client) perspective: – this is a crucial first step in order to ensure that the organisation is designed to provide the correct service(s). Where services have a range of potential values and different perspectives in what value is most important it is recommended to design value streams around service users at each step of a process rather than around functional silos such as ‘day care’.
- Identify the value stream for each process and identify ‘wasteful’ steps that do not add value: – this requires mapping of all processes involved in providing a service. For example, all stages involved in provision of adaptations to assist home living to identify value-giving and wasteful steps in the pathway. Start and end points are agreed, for example diagnosis of a physical disability to provision of an aid. The mapping activity is undertaken by those who come in contact with the client throughout the process, initially looking at current practice on their own part of the pathway and subsequently coming together to identify wasteful steps.
- Make the product / service flow continuously and standardise the process to ‘best practice’: – this requires redesign of the process and elimination of the identified wasteful steps, such as waits for assessments to be undertaken.
- Introduce ‘pull’ between all steps where continuous flow is impossible: – where it is not possible to eliminate a wasteful step immediately bring in practices and capacity which ‘pull’ the client / customer to the next step in the process. For example, a reablement service which is aware of and able to respond to demand for people being discharged from hospital.
- Manage toward perfection: – systematically reducing waste within processes should become part of the organisational culture, so that non-value adding activity is constantly removed.
(Adapted from Burgess and Radnor, 2013: p. 222)
This could be simplified as focus on clients; design care around them; identify value form a client perspective and get rid of everything else (waste); minimise time waiting for care and throughout its course.
Strengths and limitations
Most implementations of LEAN within health and social care sectors have used lean principles and adapted these to suit the service and context. Key steps include a review of processes and / or assessment of capacity and demand, and linking the intended improvement activity to strategy. There are potential issues through the difference in workforce-manager relationships from that found in private manufacturing.
In relation to social care change, the terminology is often likely to seem unfamiliar to people accessing services, carers and other stakeholders. However through its focus on value for the the customer, engagement of staff and aspiration of on-going learning and improvement it does have a good fit with the principles of social care change. This will require a flexible and accessible approach to implementing lean.
- Arlbjorn and Freytag (2013) Evidence of LEAN: A review of international peer-reviewed journal articles, European Business Review, 25, 2, 174-205
- Brandao de Souza, L. (2009), Trends and approaches in lean healthcare, Leadership in Health Services, 22, 2, 121-39
- Burgess, N. and Radnor, Z. (2013) Evaluating lean in healthcare, International Journal of Health care Quality Assurance, 26, 3, 220-35
- Krafcik, JF (1988) Triumph of the lean production system, International Journal of Operations and Production Management, 30, 1, 41-52
- LaGanga, L.R. (2011), Lean service operations: reflections and new directions for capacity expansion in outpatient clinics, Journal of Operations Management, 29, 5, 422-33
- Liker, J. (2004) The Toyota way, New York: McGraw-Hill
- Moyano-Fuentes, J. and sacristan-Diaz, M. (2012) Learning on lean: A review of thinking and research, International Journal of Operations and Production Management, 32, 5, 551-82
- Ohno, T. (1988) Toyota production system, Portland, Oregon: Productivity Press. Translated from Japanese original, first published 1978Pedersen and Huniche, 2011
- Piercy, N. and Rich, N. (2009), Lean transformation in the pure service environment: the case of the call service center, International Journal of Operations and Production Management, 29, 1, 54-76
- Proudlove, N., Moxham, C. and Boaden, R. (2008), Lessons for lean in healthcare from using Six Sigma in the NHS, Public Money and Management, 28, 1, 27-34
- Radnor, Z. and Boaden, R. (2008), Lean in public services: panacea or paradox, Public Money and Management, 28, 1, 3-7Scorsone, 2008
- Womack, J.P. and Jones, D.T. (1996), Lean Thinking, New York, NY: Simon and Schuster
- Womack, JP, Jones DT and Roos D. (1990) The machine that changed the world, New York: Macmillan
Lean Healthcare Academy: A UK based collaboration which helps NHS and social care organisations generate time and cost savings and improve the patient experience through implementation of Lean principles: