Covid 19 and 'LEAN' Engineering
“We’ve got all the right Personal Protective Equipment, but not necessarily in the right places” (Morecambe, Wise, Preview, 1971)
Or;
why ‘LEAN’ might work for Toyota and Tesco but NOT for the NHS.
Or, as a dear military friend once advised me;
"If stores were for issuing they'd be called 'issues'. Stores is for storing not for issuing"
What unites Morecambe and Wise, Toyota, Tesco, Andre Previn and PPE? It's NOT a laughing matter.
Over an Easter Sunday Hot Cross Bun, the day after Priti Patel obfuscated the pitiful questioning of the UKs leading investigative journalists on the topic of PPE, I irritated Mrs 'H' by hypothesising that the real issue behind the lack of PPE and the overstretched NHS might be less about lack of kit but more likely about inefficiencies in ordering, storage, distribution, and an intuition that critical business decisions have been made for years by finance managers and procurers, NOT business practitioners.
I started to bore her about Toyota’s principles of ‘Lean’ engineering being applied to public services and unrealistic expectations of them that they, and the human beings providing the service, can run at 100%, 24hrs a day, 7 days a week. I pompously pronounced on the NHS and other public services naively assuming that you can automatically transfer private industry commercial leaders and thinking to the NHS and other pillars of public service with no knowledge of the businesses.
Imagine my surprise when she frustratingly interjected, not to tell me to 'wind my neck in' (surprisingly!), but to explain that after 45yrs of clinical nursing she knew all about ‘LEAN’ and how it applied to the NHS because she had been charged with applying its principles as a ward manager over a decade ago! On further examination it transpired that she and her fellow nursing sisters railed against many of the principles when budget controllers aggressively demanded to know why, for example, they had 2 boxes of rubber gloves in storage, or a reserve of catheters to enable patients to be discharged over a holiday period, such as Easter or Christmas. Her staff ended up running between wards to ‘borrow’ those essential supplies and she would be hauled before finance committees to justify purchase orders or reasonable reserves of stock, often for them to be declined.
Most ‘thoroughly modern matrons’ didn’t dare challenge senior management or support the practitioners for fear of sliding a few notches down the greasy pole of personal advancement, a sad symptom of so many public services.
Immediate open-source research revealed the existence of the ‘Going Lean in the NHS” paper from 2007 published by the NHS Institute for Innovation and Improvement in conjunction with Warwick University, authored by Neil Westwood, a ‘systems thinker’, Mike James-Moore, an industrial engineer, and Professor Matthew Cooke, an academic from Uni of Warwick.
The paper opens with by setting the scene as follows:
“Lean thinking, developed from the Toyota Production System, has been applied in many competitive sectors. Tesco, for example, is one of the biggest and most successful lean companies in the world”,
And continues;
“How lean thinking will enable the NHS to get more out of the same resources”
An introductory guide for healthcare organisations seeking to:
? improve quality and efficiency
? improve patient care and experience
? improve safety and reduce mortality
? reduce length of stay
? reduce waste
? lower costs
? eliminate delays
? improve staff morale
Any case study demands an (apolitical) outcome for it was was a labour leadership that launched “GOING LEAN IN THE NHS” and a Tory one that continued it.
In this case-study, 13 years of LEAN NHS application left a ward with just one pair of PPE goggles shared between ALL ward staff as they battled the impact of Covid 19, staff begging, stealing and borrowing vital equipment, and a family member manufacturing and delivering essential PPE to the ward.
Nothing short of scandalous on the day our PM is released from hospital, the RCN instructing members NOT to treat patients without the right PPE and a Secretary of State commending procurement!
So ‘LEAN’ might work for Tesco and Toyota but not automatically for the NHS. It doesn’t guarantee:
? improved quality and efficiency
? improved patient care and experience
? improved safety and reduce mortality
? reduced length of stay
? reduced waste
? lower costs
? eliminated delays
? improved staff morale
The link to the full document is available here:
Stay safe and well!
Leadership and Conflict Resolution Consultant. Risk Management and Reputation Protection.Creator of Change Without Tears programme. Enhanced ACAS accredited workplace mediation. Published Author
4 年Hello Ian Hynes Shocking to admit I’ve only just found out about your perspective on closed cultures. Sadly for staff and patients, the #NHS is like Bambi , belying criticism. This is understandable when we think of the ‘frontline ‘ saving lives. However the closed culture of the #NHS has promoted toxic #Leadership to the detriment of us all. Add into the mix the broken #speakup system, that lacks trust and confidence in dealing with #whistleblowing and Private Fraser of Dad’s Army fame,may say “ we are all doomed.” Organisations that enjoy a closed culture betray us all. Early intervention can make significant difference to the severity of outcomes and the wellbeing of staff and patients. #kaizen belief that it is the responsibility of everyone in an organisation to make suggestions to improve matters or raise concerns to mitigate Risks. A valuable article. Thank you .
Semi-retired management and HR consultant with employment law background
4 年It's not just the NHS it's every part of the "public" sector. I watched as the Falklands War erupted in part because we cut the support to the islands (showing my age there!). But I'll stop now before I go into a lengthy rant about the public sector and the imposition of untested dogmas, followed by an unwillingness to admit things when we get it wrong. I've got GP surgeries to support today as they have had Bank holiday Monday cancelled.