In response
In this timely article Karen Dente highlights the consequences of failing to see the design and provision of health and social care as essentially a system.
It has long been understood that adverse incidents within health and social care are rarely to be laid at the feet of individuals alone.
Many of those involved in health and social care have considered their work fundamentally different from that of other industries - for far too long. Whilst this may be true in the detail of what they do, there are clear similarities across industries, be they focused on service or production. However, health and social care professionals have argued that dealing with human beings who are in distress, be it physical, psychological or social, is complex and difficult, and lessons from other industries are not helpful.
This, in our view - and supported by Karen Dente’s article - is to miss the point. One would not argue that to work in medicine is both complex and demanding, as is social care. However, as with the American realisation cited in her article, the conclusion of all the enquiries into adverse incidents in health and social care has focused on poor or inadequate systems.
The Toyota example demonstrates the simple premise that at one end of a system there is a need, which requires input, and at the other end there are outputs leading to outcomes. The key to success lies in being crystal clear about the need and the value and function of the steps in between need and outcome. Toyota is precise about its need - reliable, cost effective production of desirable motorcars - and their outcome: consistent high levels of sales and increased market share. Their use of Lean Principles ensures that they focused on each step of the production process to ensure that what they do wholly contributes to their desired outcome and that no step is redundant.
As raised in the article, there are many examples of where Lean Principles have been used in health and social care. Our experience has reinforced the value of applying Lean Principles and systemic thinking in these areas. One example relates to the integration of services for disabled children. Before applying Lean Principles to this service, children and their families were assessed separately by health, education, and social care. This often led to expensive, wasteful duplication, frustration on the part of parents and children and excessive waits for service. By seeing the process of assessment as a system and tracking each of the steps in the assessment process it was possible to identify where the ‘non value’ adding activity lay and eradicate it. It allowed each of the professional services to co-ordinate their input and make use of existing information, thus speeding up the process, enabling more assessments to be undertaken whilst at the same time reducing costs. This enabled the children to receive their assessed service quicker and reduced levels of anxiety and frustration on the part of parents.
The challenges in healthcare are not uniquely different. Service and process complexity can be managed. It does make sense and implementing sustainable change can be achieved much quicker and easier than you think.
01.07.2006