International Examples of Lean in Healthcare: Case Studies of Best Practices

Typically entrenched and systemic, healthcare problems require the sort of comprehensive solutions that can only be addressed by a change in culture and a shift in thinking. Organizations around the world are using Lean to redesign care and improve processes in a way that achieves and sustains meaningful results for patients, staff, physicians, and health systems. This book demonstrates how honest appraisal, intelligent planning, and vigilant follow-up have led to dramatic improvements in a variety of healthcare settings across the world. It teaches us how innovative organizations can find sustainable solutions to seemingly intractable problems by following a path guided by Lean Thinking. Lean methods may not solve every healthcare problem, but as these cases prove, changing a culture rather than personnel results in more effective sustainable change.

This multi-authored book provides expert descriptions of Lean methods and their application in healthcare, written by the people who developed and tested the methods in healthcare settings. Each chapter brings together a description of the technique or approach, with examples of application in practice from the author’s own practice. Authors use an engaging approach to their narrative, with examples from their personal experience or engagement being described to illustrate the practical application of theoretic approaches. In painting a picture of the environment in which these tools and techniques have been applied, readers will understand the transferability to their own workplace environment. This will be an opportunity to tell real stories of the application of Lean in healthcare and give readers the opportunity to learn from people from across the world, on subjects on which they are acknowledged topic experts, based on day-to-day Lean practice.

Dr Cameron Stark MB ChB, MPH, MSc, MRCPsych, FFPH. Consultant in Public Health Medicine Cameron graduated in medicine from the University of Glasgow in 1985. He trained in psychiatry on the South Glasgow Psychiatric Training Scheme, and then in Public Health with Argyll and Clyde Health Board. He was appointed to a NHS Consultant post with Ayrshire and Arran Health Board in 1994, and moved to NHS Highland in 1996. Within Public Health in NHS Highland, Cameron manages Health Intelligence, and Epidemiology and Health Science teams. He was the Clinical Lead for the Mental Health Collaborative improvement programme in Highland, and the Lead for the Knowledge Transfer Partnership with the University of Stirling’s Dementia Services Development Centre. Cameron was the Improvement Science lead for NHS Highland from 2014 - 2017, and line managed the NHS Highland KPO from 2015 - 2017. He is a Certified Lean Leader for RPIWs, and coaches new RPIW leaders. He co-developed the content for NHS Highlands’s Intermediate and Advanced Lean training courses and has delivered numerous Lean training courses. He now provides the Quality Improvement advice to NHS Highland’s ’Home’ Value Stream. Cameron co-developed the Lean Quality Improvement course which will be available on-line to all NHS Scotland staff. Cameron has published over 50 scientific papers and has edited three textbooks.

Professor Elaine Mead Elaine Mead is currently Executive Director of Improvement, Care and Compassion (IC&C), a small organization committed to supporting leaders on their improvement journey across the UK and Europe. Elaine has enjoyed over 32 years’ experience, working in both clinical and senior managerial roles within the National Health Service. Her original professional clinical background was as a diagnostic radiographer with experience in general, research and academic settings. Elaine now works as Faculty for the Institute of Healthcare Improvement (IHI) supporting quality improvement, safety and leadership within Trusts in the UK. As the first European Faculty member of Catalysis, she is currently coordinating the European Chief Executive forum supporting executive teams across Northern Europe. Elaine is also an Executive Sensei for NHS Improvement (NHSI) supporting the Vital Signs program by providing coaching support to senior teams. For the previous eight years Elaine held the position of Chief Executive of NHS Highland, originally moving to the Highlands of Scotland, UK, as their first Chief Operating Officer. She was responsible for the development of the first totally integrated health and care system in Scotland, which continues to support services across 41% of the most remote and rural land mass of Scotland, including 36 inhabited islands. Elaine is a passionate ambassador for quality and, working with the Virginia Mason Institute, led the development of the Highland Quality Approach, an improvement system supporting NHS Highland to improve quality of care based on increasing value. Through this work Elaine has built a worldwide network of contacts to share best practice and has hosted multiple study-tours to Highland, presented at key international conferences and has published on both quality improvement at scale and the integration of health and social care. As a committed practitioner of Quality Improvement, Elaine is a certified Lean Leader, was awarded a Fellowship by the International Society for Quality in Healthcare ISQua and is a member of QScotland. Elaine has also had opportunity to deliver health care and screening in the private sector, working for a number of organizations including the Harley Street Clinic, AMI and BUPA. Most recently Elaine took up position of visiting Professor at the University of the Highlands and Islands supporting the delivery of disperse multi-professional health and care training across the Highlands and Islands, is an active member of the Ireland East Hospitals Board in Dublin.

Clare Morrison is an experience Quality Improvement Lead with a track record of delivering projects successfully. Examples include developing patient safety initiatives which have been spread across Scotland and creating new models of pharmaceutical care that became part of the GP contract. She is driven to continually improve care and through taking an innovative approach has received multiple external funding awards to develop new services in rural areas. She understands the value of looking outside an organization to learn how to improve and it was inspiration from the US that led her to create NHS Near Me, a video consulting service for NHS appointments.

Clare is currently the Senior Clinical Quality Lead, NHS Highland where she leads transformation change through the application of quality improvement, initially by developing the NHS Near Me service. Previously she was the Leas Pharmacist (Quality Improvement), NHS Highland where she delivered Pharmacy Anywhere project to provide pharmacist input into dispensing practices by telehealth