Lean thinking with John Seddon

"To improve performance, change thinking”.

Designing the system from the customer's point of view reduces variation and speeds flows, John Seddon told an audience of over 100 managers, clinicians and directors at this WYMIF event on 28th June at Elland Road.

John took the audience through his controversial and challenging translation of lean systems thinking from Toyota's highly succesful manufacturing methods to public sector services. Steps in redesigning systems… 1. What is the purpose, in customer terms? 2. Study the demand type and frequency wherever it hits the system what matters to the customer how does the customer understand type etc 3. Understand your capability to respond 4. Walk the flow of the work with the workers to identify value work and waste 5. Understand how the system conditions are creating failure demand 6. Think about how to redesign the system against value demand and to switch off failure demand John also described a Check process for introducing innovation very similar to the Plan Do Study Act circle.		More on John Seddon and lean thinking Don’t let the toolheads get you. http://www.lean-service.com  Start a discussion on lean thinking in the NHS Lean Thinking Network in the NHS Networks Register

How does all this apply to the NHS?

John certainly wasn’t claiming to have this all mapped out. Indeed a key part of his challenge for the day was to get us to do the work in thinking this through – changing our thinking, in fact. He did offer two case studies. Firstly he graphically described from his brief experience with Three Shires Ambulance Trust how he saw that artificial targets (response times) compromised the service’s ability to meet patient needs. In the afternoon his colleague Wilma Paxton gave a case study of redesign of a Symptomatic Breast Service from an unnamed Scottish Trust.

These examples were interesting but perhaps less exciting than the promise of the exposition of the ideas in the morning.Nevertheless they threw into relief some of the issues raised about how we translate these ideas into the NHS, not least…

• Who are our customers?

Simply the patient? Who is the customer for public health?

• What is the demand that hits our system?

The variety, volume and complexity of demand in the NHS all exceed those encountered in the manufacturing / private service sectors. This makes the task of understanding demands much harder.

• What does value mean for the NHS ?

This must be first and foremost health; the perception that in service industries the consumer is a co-producer of value is a helpful one. Conversely identifying failure demand in the context of human mortality and imperfect medical science is indeed challenging.

• These points also raise the issue of how we connect systems approaches at different levels: organisation, clinical microsystem; care pathway; locality; health economy; sub-regional or regional economy.