Blog - Smoothing the Flow - David Fillingham

In his latest blog, AQuA Chief Executive David Fillingham shares his thoughts on adapting Lean thinking within health and social care, and how this can be supported through improving Whole System Flow.

AQuA Chief Executive,
David Fillingham CBE

Having had six years seeking to introduce Toyota thinking (where the Lean methodology was created) into healthcare at Bolton Hospital, and another six seeking to apply it more widely through AQuA, I've come to believe that it is definitely a case of needing to adapt not just adopt.

Many attempts to use lean in healthcare have floundered because people have a mental model of hospitals as factories, and therefore of patients as the raw material on a production line. And we both know, this cannot be the case...healthcare is the ultimate service industry.

Most of this work has concentrated just on hospitals and has failed to engage adequately with staff working in primary and community areas, in mental health or in social care. Many of the problems currently being experienced in A&E departments are a reflection of challenges outside of hospitals

What's worse, lean initiatives have all too often been about management consultants being employed to foist lean onto a resentful workforce.

In The Challenge and Potential of Whole System Flow, our joint paper with The Health Foundation, we seek to address this in a number of ways:

Defining the Value

Firstly, value (the aim of creating flow) needs to be defined by the customer not the provider. In healthcare this implies a huge shift towards shared decision making with patients, co-production, and asset based approaches to community development. Techniques such as experience based co-design are a valuable way of addressing this in quality improvement work.

Focusing on the Whole System

Secondly, we have emphasised the need to use all of the resources in a community, not just those of the hospital. We have also taken flow to be not solely about the flow of patients through a system (which risks detracting from a patient focused, care giving ethos) but also about the flow of staff, information and resources.

With increasing numbers of frail older people needing support to live independently, we expect there to be increased flows of those components out of hospital and into community settings.

Addressing ‘Failure Demand’

Thirdly, this helps address the lean concept of 'failure demand' which is much more relevant in service sectors than in manufacturing. Many of the patients who 'flow' into hospitals should never need to. The biggest waste in healthcare is avoidable ill health.

Engaging the Frontline

Finally, all of this needs to be done with the deep and genuine engagement of frontline workers across disciplines and across care sectors. What we need are improvement approaches that give them full ownership of designing and delivering new care systems where staff, information, resources and, where necessary patients, flow smoothly without waste, delay, frustration or harm.

Throughout 2016/17, AQuA, supported by The Health Foundation, have held a series of events exploring Whole System Flow in health and social care. For the latest updates, follow @AQuA_NHS or #WholeSystemFlow on Twitter.