The dissemination and implementation of strategic Lean thinking and decision making optimisation within the NHS
Lead Research Organisation:
University of Huddersfield
Department Name: Business School
Abstract
This project is aimed at disseminating the implementation of Lean thinking through the optimisation of decision making processes within the NHS. Since 2007, three Knowledge Transfer Partnerships (KTPs 1717, 7352, and 7698) have been undertaken between Bradford and Airedale Primary Care Trust (PCT) and Manchester Business School (MBS), which have enabled the organisation to achieve substantial cost savings. Implementing Lean thinking and optimising the decision making processes have been developed through these programmes - first to improve the effectiveness and efficiency of the utilisation of the PCT's logistical assets, second to design a framework supporting the development and deployment of the PCT strategy, and third to support the development of new healthcare infrastructure.
By further disseminating the knowledge accumulated from these three KTP projects it is believed that substantial cost saving and improvement can be realised by Primary Care Trusts (PCTs) and General Practitioner (GP) Clinical Commissioning Groups (CCGs). For example, by redesigning and optimising the trust's transport system and logistical assets management the PCT was able to save in excess of £280,000 per year. Moreover, the introduction of the Balanced Scorecard and other strategic tools significantly improved the strategy alignment between the different units as well as between the commissioning and provider arms. Finally, with the partial Lean implementation, the infrastructure development cycle time was reduced by up to 18% and the associated costs by 7.35% - these through the planning and design decision making processes. Knowing that between three and seven infrastructure developments are being undertaken by different Trusts at any one time, there is a substantial gross average cost saving between £1,500,000 and £3,500,000 per Trust that could be generated by focusing more resources and transforming the planning, design and management phases.
Hence, in the current restructuring environment where responsibilities are being transferred from the PCTs to the CCGs, we believe that disseminating best practice and the accumulated knowledge is an opportunity to challenge the status-quo and revise processes, working toward the rationalisation and optimisation of resources using Lean thinking.
Bradford and Airedale Primary Care Trust (PCT) will provide 50 per cent co-funding. Of which half (25 per cent of the total project) is a direct contribution (i.e. cash or secondment of staff. The remaining half (25 per cent of the total project) will be an indirect ('in kind') contribution - access to facilities/equipment or staff time.
In order to meet the aims and objectives stated in our proposal, the researchers have developed a coherent and robust dissemination strategy. We will take the collated experiences from the previous KTP programmes and, with the multiple stakeholders plan the active dissemination through, for example: Podcasts of improvement topics, tools and techniques; videos of practitioners; PowerPoint presentations with audio voiceover; ECCH Case Studies for education and training purposes (see www.ecch.com); guest lectures at multiple host universities; conference publications; research seminars; materials hosted on the University of Huddersfield, Business School web pages.
By challenging their current logistical assets management and transportation systems, their strategies deployment mechanisms and their infrastructure development processes, the NHS will gain efficiency and effectiveness through regulating decision making processes, increasing innovation and reducing costs. This project will make a difference to the NHS patients. Please see the supporting documents.
By further disseminating the knowledge accumulated from these three KTP projects it is believed that substantial cost saving and improvement can be realised by Primary Care Trusts (PCTs) and General Practitioner (GP) Clinical Commissioning Groups (CCGs). For example, by redesigning and optimising the trust's transport system and logistical assets management the PCT was able to save in excess of £280,000 per year. Moreover, the introduction of the Balanced Scorecard and other strategic tools significantly improved the strategy alignment between the different units as well as between the commissioning and provider arms. Finally, with the partial Lean implementation, the infrastructure development cycle time was reduced by up to 18% and the associated costs by 7.35% - these through the planning and design decision making processes. Knowing that between three and seven infrastructure developments are being undertaken by different Trusts at any one time, there is a substantial gross average cost saving between £1,500,000 and £3,500,000 per Trust that could be generated by focusing more resources and transforming the planning, design and management phases.
Hence, in the current restructuring environment where responsibilities are being transferred from the PCTs to the CCGs, we believe that disseminating best practice and the accumulated knowledge is an opportunity to challenge the status-quo and revise processes, working toward the rationalisation and optimisation of resources using Lean thinking.
Bradford and Airedale Primary Care Trust (PCT) will provide 50 per cent co-funding. Of which half (25 per cent of the total project) is a direct contribution (i.e. cash or secondment of staff. The remaining half (25 per cent of the total project) will be an indirect ('in kind') contribution - access to facilities/equipment or staff time.
In order to meet the aims and objectives stated in our proposal, the researchers have developed a coherent and robust dissemination strategy. We will take the collated experiences from the previous KTP programmes and, with the multiple stakeholders plan the active dissemination through, for example: Podcasts of improvement topics, tools and techniques; videos of practitioners; PowerPoint presentations with audio voiceover; ECCH Case Studies for education and training purposes (see www.ecch.com); guest lectures at multiple host universities; conference publications; research seminars; materials hosted on the University of Huddersfield, Business School web pages.
By challenging their current logistical assets management and transportation systems, their strategies deployment mechanisms and their infrastructure development processes, the NHS will gain efficiency and effectiveness through regulating decision making processes, increasing innovation and reducing costs. This project will make a difference to the NHS patients. Please see the supporting documents.
Planned Impact
Who will benefit from this research?
Direct beneficiaries and users of this project will include: NHS patients; NHS Bradford and Airedale which is responsible for commissioning, contracting and assuring the quality of primary care provision by the four independent contractor groups: GPs, dentists, optometrists and pharmacists (and for commissioning and assuring the provision of appropriate estates for general practice); Other public sector partners. E.g. Adult & children's services, education; A large number of policy maker stakeholders (healthcare service commissioning bodies, clinicians, Trust managers, patient representatives and groups, service providers, etc).
Other beneficiaries include: the six NHS Trusts mentioned in the Case for Support; General Practitioner (GP) Clinical Commissioning Groups (CCGs); the National Commissioning Board (NCB) to improve their strategic processes; the Department for Health and its Primary Care Development Unit - we will directly influence the policy makers; the University of Huddersfield.
How will they benefit from this research?
For the NHS: By further sharing the learning and methods developed from our three Knowledge Transfer Partnership projects we will make substantial cost savings for the NHS. For example, the current cost of services provided directly by NHS Bradford and Airedale is approximately £65million per year; the total for services purchased is over £700 million; the project value of just the premises developments to be undertaken by NHS Bradford and Airedale in the next 5 years is approximately £62 million and inflation in healthcare services costs runs at 4-5% pa. For NHS wide impact, knowing that between three and seven infrastructure developments are being undertaken by different Trusts at any one time, there is a substantial gross average cost saving of between £1,500,000 and £3,500,000 per NHS Trust that would be generated by focusing more resources and transforming the planning, design and management phases.
This project will sustain and disseminate among the network of NHS partners the methodologies to enable the implementation of Lean thinking within the areas outlined. The dissemination of these models and frameworks will enhance the transparency and the robustness of the decisions to streamline these processes (improve services to the patients) and generate cost reduction. This project will show that by implementing a Lean approach the complex decision making processes can be challenged and improved.
For the University of Huddersfield: engaging further with partners (e.g. NHS Bradford and Airedale, other NHS Trusts and external organisations) is a valuable activity. The engagement activities are part of the University strategy to make a larger impact. This proposed research will allow participation at conferences such as: the British Medical Journal (BMJ) conference, the EU based International Forum on Quality & Safety in Healthcare (see http://internationalforum.bmj.com/2012-forum); the US based Production and Operations Management Society (POMS, see http://www.poms.org/), the European Operations Management Association (EurOMA, see http://www.euroma-online.org) and the global International Group for Lean Construction (IGLC, see http://www.iglc.net/). Moreover, it will enable MSc students to work on real life projects during their dissertation. Moreover, case studies will be submitted to the ECCH for learning and teaching activities. The organisation of seminars and workshops across the Trusts and at the University of Huddersfield is also a relevant way to consolidate the link between the NHS and the University. Furthermore, to strengthen the legacy a special dissemination 'Road show' linked with the future state of the NHS Trusts and/or CCGs can be organised at the end of the project.
Direct beneficiaries and users of this project will include: NHS patients; NHS Bradford and Airedale which is responsible for commissioning, contracting and assuring the quality of primary care provision by the four independent contractor groups: GPs, dentists, optometrists and pharmacists (and for commissioning and assuring the provision of appropriate estates for general practice); Other public sector partners. E.g. Adult & children's services, education; A large number of policy maker stakeholders (healthcare service commissioning bodies, clinicians, Trust managers, patient representatives and groups, service providers, etc).
Other beneficiaries include: the six NHS Trusts mentioned in the Case for Support; General Practitioner (GP) Clinical Commissioning Groups (CCGs); the National Commissioning Board (NCB) to improve their strategic processes; the Department for Health and its Primary Care Development Unit - we will directly influence the policy makers; the University of Huddersfield.
How will they benefit from this research?
For the NHS: By further sharing the learning and methods developed from our three Knowledge Transfer Partnership projects we will make substantial cost savings for the NHS. For example, the current cost of services provided directly by NHS Bradford and Airedale is approximately £65million per year; the total for services purchased is over £700 million; the project value of just the premises developments to be undertaken by NHS Bradford and Airedale in the next 5 years is approximately £62 million and inflation in healthcare services costs runs at 4-5% pa. For NHS wide impact, knowing that between three and seven infrastructure developments are being undertaken by different Trusts at any one time, there is a substantial gross average cost saving of between £1,500,000 and £3,500,000 per NHS Trust that would be generated by focusing more resources and transforming the planning, design and management phases.
This project will sustain and disseminate among the network of NHS partners the methodologies to enable the implementation of Lean thinking within the areas outlined. The dissemination of these models and frameworks will enhance the transparency and the robustness of the decisions to streamline these processes (improve services to the patients) and generate cost reduction. This project will show that by implementing a Lean approach the complex decision making processes can be challenged and improved.
For the University of Huddersfield: engaging further with partners (e.g. NHS Bradford and Airedale, other NHS Trusts and external organisations) is a valuable activity. The engagement activities are part of the University strategy to make a larger impact. This proposed research will allow participation at conferences such as: the British Medical Journal (BMJ) conference, the EU based International Forum on Quality & Safety in Healthcare (see http://internationalforum.bmj.com/2012-forum); the US based Production and Operations Management Society (POMS, see http://www.poms.org/), the European Operations Management Association (EurOMA, see http://www.euroma-online.org) and the global International Group for Lean Construction (IGLC, see http://www.iglc.net/). Moreover, it will enable MSc students to work on real life projects during their dissertation. Moreover, case studies will be submitted to the ECCH for learning and teaching activities. The organisation of seminars and workshops across the Trusts and at the University of Huddersfield is also a relevant way to consolidate the link between the NHS and the University. Furthermore, to strengthen the legacy a special dissemination 'Road show' linked with the future state of the NHS Trusts and/or CCGs can be organised at the end of the project.
People |
ORCID iD |
| David Bamford (Principal Investigator) |
Publications
Bamford D
(2014)
Lean thinking:theory, application and dissemination
Cheng S
(2015)
Improving access to health services - challenges in Lean application
in International Journal of Public Sector Management
| Description | ESRC project ES/K000667/1 was untaken jointly by the University of Huddersfield (UoH) and South West Yorkshire Partnership NHS Foundation Trust (SWYPFT). The project aimed to: i) disseminate strategic lean thinking; and ii) improve the service quality and rationalise the operational processes of the Single Point of Access (SPA) team across the Trust using Lean thinking. The project took place between January 2013 and January 2014. South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) are a specialist Foundation Trust that provides community, mental health and learning disability services to the people of Barnsley, Calderdale, Kirklees and Wakefield. The Trust also provides some medium secure (forensic) services to the whole of Yorkshire and the Humber. Over 1 million people live within SWYPFT's catchment area, across urban and rural communities from a range of diverse backgrounds. SWYPFT's services are delivered through four Business Development Units (BDUs) which operate independently and have developed in response to local commissioners', service user and community needs. Throughout the project, we produced a series of Podcasts, Prezis and papers around different aspects of the project which can be found in the Resources section of the dedicated website (please see URL listed below). The project took the form of a service review project which at its core followed Lean principles. Throughout the project, a number of Lean tools and techniques were carefully selected and adapted to facilitate the collection and analysis of data. The purpose of this was to allow the project team to: • Develop an understanding of current activities, resources and performance at each SPA • Evaluate performance of these teams • Identify waste and develop improvements approaches Whilst the project was able to meet the majority of these objectives, there were a number of issues that prevented a more comprehensive evaluation of the SPA teams to be conducted. These mostly stemmed from the availability of quality data. Eight facilitated 'service improvement' workshops were conducted across West Yorkshire. These included NHS personnel and key stakeholders, including Patient User Groups, and served to examine current service provision and potential future redesign ideas. These workshops directly informed the recommendations from the project. An improvement solution was developed which focussed on influencing the way referral information is provided to SPA. The preferred solution was: Greater use of telephone dialogue and increased electronic communications. When implemented, it is predicted that it will address the root cause of a number of process wastes - namely; removing duplication of inputting referral information, removing 'waits' and delays in the referral process caused by missing referral information. In doing so, it is expected it would lead to improved clinical decision making and signposting accuracy of the SPA clinician, and reduce the cycle time to processing a referral. The project also identified a number of system wide issues which must be simultaneously addressed in order to create and sustain any sort of long term change. These were: • Develop common and relevant Key Performance Indicators for SPA and provide the teams with access to data. • Creation of a formal 'feedback forum to improve relationship between SPA and Service Teams and to encourage learning from mistakes. • Clarify and develop standardised SPA operating policy and procedures which will improve clinical record keeping, as well as ensuring performance data is accurate and comparable. In November 2013 regional healthcare organisations were invited to attend a bespoke seminar, hosted at the University of Huddersfield, to share their service transformation experiences. Delegates from several NHS trusts, local Councils and third sector health service providers travelled from across Yorkshire and even as far as Greece to attend the event. |
| Exploitation Route | It is anticipated that the implementation of the recommended improvement solution will realise the following benefits to the organisation: • Consistent and more accurate clinical signposting through improved quality of referral information and reducing duplication in downstream services. • Increased staff productivity - less waiting for additional referral information and removal of duplication from inputting clinical information twice • Greater clarity in entry routes, rebuilding relationship with Referrers; especially primary care clinicians. • Standardisation of operational policy and procedures could potentially allow staff resources to be shared between localities and improve robustness of existing business continuity plans. • Reduction in use of paper to support NHS efforts to become paperless • Greater alignment between clinical information system and performance indicators • Greater embedment of Lean and cultivation of philosophy of continuous improvement Publications (to date): • Cheng.S, Bamford.D, Dehe.B (2013), Improving clinical access to mental health services in the NHS - the application of Lean thinking, in proceedings of British Academy of Management Conference, Liverpool, UK Potential use in non-academic contexts Through the use of Lean thinking and direct engagement with the NHS workforce, the project has exposed the extent of variations across the SPAs and revealed where wasteful processes and inconsistencies were occurring. These were not just at the operational level but also included wider system issues which will need to be addressed in order to support any meaningful long term improvements in the SPA teams. Identification and direct engagement with the dominant SPA customers facilitated the development of a solution that could not only eliminate the source of numerous process wastes, but improve user satisfaction by addressing an area of contention between primary and secondary care. A national SPA Forum was established and held their inaugural meeting on the 30.10.2013. Along with other representatives from SWYPFT, the project manager attended and actively participated in the SPA Forum which involved sharing the current state of SPA provisions in each organisation, i.e. staff resourcing, demand and capacity, operational challenges, etc. The findings from this external benchmarking exercise are as follows: • There are no common SPA models: o SPAs for physical health services were distinctly different from mental health SPAs, i.e. no clinical decision making took place and the role of the physical health SPAs was to pass on clinical records and book appointments. These SPAs were predominantly staffed by administrative staff in a call centre environment. • Lack of integration between physical and mental health and social care. • Use of a call centre/telephony approach appeared to be prevalent, and use of electronic record keeping was the norm, i.e. accepting referrals via email and document scanning and uploads. • Many SPAs felt that the lack of IT integration between primary and secondary care system was a major issues - this was particularly strong amongst mental health SPAs. • Common Key Performance Indicators did not exist but was identified as a priority item for development. • It was confirmed that no national guidance on SPA implementation existed to support organisations. |
| Sectors | Healthcare |
| URL | http://www.hud.ac.uk/research/researchcentres/boscat/leanhealthcare/ |
| Description | Through the use of Lean thinking and direct engagement with the NHS workforce, the project has exposed the extent of variations across the SPAs and revealed where wasteful processes and inconsistencies were occurring. These were not just at the operational level but also included wider system issues which will need to be addressed in order to support any meaningful long term improvements in the SPA teams. Identification and direct engagement with the dominant SPA customers facilitated the development of a solution that could not only eliminate the source of numerous process wastes, but improve user satisfaction by addressing an area of contention between primary and secondary care. A national SPA Forum was established and held their inaugural meeting on the 30.10.2013. Along with other representatives from SWYPFT, the project manager attended and actively participated in the SPA Forum which involved sharing the current state of SPA provisions in each organisation, i.e. staff resourcing, demand and capacity, operational challenges, etc. The findings from this external benchmarking exercise are as follows: • There are no common SPA models: o SPAs for physical health services were distinctly different from mental health SPAs, i.e. no clinical decision making took place and the role of the physical health SPAs was to pass on clinical records and book appointments. These SPAs were predominantly staffed by administrative staff in a call centre environment. • Lack of integration between physical and mental health and social care. • Use of a call centre/telephony approach appeared to be prevalent, and use of electronic record keeping was the norm, i.e. accepting referrals via email and document scanning and uploads. • Many SPAs felt that the lack of IT integration between primary and secondary care system was a major issues - this was particularly strong amongst mental health SPAs. • Common Key Performance Indicators did not exist but was identified as a priority item for development. • It was confirmed that no national guidance on SPA implementation existed to support organisations. |
| First Year Of Impact | 2013 |
| Sector | Healthcare |
| Impact Types | Economic |
| Description | Southwest Yorkshire Partnership NHS Foundation Trust (SWYPFT) in the Innovative Partnership |
| Organisation | South West Yorkshire Partnership NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | Since 2012 the Business School and SWYPFT have collaborated on three projects including an ESRC project, Innovation Compass (a project which formed part of the Improving Health and Wealth strategy in the NHS) and Magnificent Seven Management Development Programme (a non-accredited management development programme, provided by the Business School to key staff in the Trust). |
| Collaborator Contribution | Steven Michael, OBE Chief Executive of SWYPFT and a member of the Business School Advisory Board |
| Impact | Innovation Compass (a project which formed part of the Improving Health and Wealth strategy in the NHS) Magnificent Seven Management Development Programme (a non-accredited management development programme, provided by the Business School to key staff in the Trust). |
| Start Year | 2012 |
| Description | Challenges of Healthcare Transformation Seminar |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | On 12 November 2013 regional healthcare organisations were invited to attend a bespoke seminar, hosted at the University of Huddersfield, to share their service transformation experiences. Delegates from several NHS trusts, local Councils and third sector health service providers travelled from across Yorkshire and even as far as Greece to attend the event. N/A |
| Year(s) Of Engagement Activity | 2013,2014 |
| URL | http://www.hud.ac.uk/research/researchcentres/boscat/leanhealthcare/ |