Comment

NHSI Lean programme: Making common sense common practice

Common-sense changes – such as Vital Signs, an improvement practice for the NHS – have the potential to drive improvements across the health service, writes Alan Martyn, national director of lean transformation at NHS Improvement (NHSI).

What would the NHS look like if we implemented a daily improvement practice? More than 1.5 million staff who know what they and their team improved last month, who know what they and their team are working on to improve this month, and who are having fun doing it.

That was my response to the question during my interview for the role of director of lean transformation at NHSI. I added: “Because it’s helping patients and themselves by solving their problems.” 

Is this an impossible dream or could it really happen? And where would you start? 

Throughout my career, I’ve observed five truths about embedding improvement within healthcare organisations:

• Weak process is at the heart of workplace frustration and efficiency;
• There is enormous potential locked in the processes of every organisation;
• Staff and patients see this potential every day but don’t have a method to release it;
• It is possible to offer staff a method to allow them to release this potential;
• Safety, then quality, productivity, and finally, cost – improvement in that order.

However, if we are to have a unified method for improvement, we first need to get the language right. That allows the best possible conditions for improvement to flourish.

I love the word practice. It chimes in healthcare. It’s humble and works for our everyday lives (for example, we practice sport or music to get better).

When you get into formal improvement methods like Lean, systems thinking and quality improvement, they are full of habit-forming practices for improvement (e.g. Plan – Do – Check – Act)

So, Vital Signs is an improvement practice for the NHS. It has four main elements: enabling an improvement practice; supporting the practice with a method based on Lean principles and systems thinking; creating a learning network to support all those on the improvement journey no matter their starting point, current position, improvement method or coach; and offering direct consultancy support based on Lean principles.

Importantly, we see this as an improvement practice based on Lean principles rather than a Lean programme – mainly because we seek to integrate all improvers who are training in and using methods that bring rhythm to improvement practice and are habit-forming. 

Among the first wave of trusts participating in the programme are The Hillingdon Hospitals NHS FT, East Lancashire Hospitals NHS Trust, and Royal Surrey County Hospital NHS FT. 

These organisations and the other trusts in the programme’s first wave will have two broad goals: to improve performance against targeted performance areas, and to enable a practice of improvement. Achieving these goals will be bottom-up, by staff and patients. It will be focused on the problems they see and feel every day.

Before we started this programme, we put a lot of effort into developing the method and understanding why other efforts had succeeded or failed.

The first step was bringing together 17 organisations to look at how they deliver improvement today and the problems they had, and then to develop the improvement process at the heart of the practice, based on lessons. This process focuses on delivering improvement that staff and patients want – not top-down, goal-driven improvement.

These are early days for a programme with such a big dream, but just think of the power of 1.7 million people improving small things every month to make life better for patients and staff.

I think Aneurin Bevan and the NHS’s founders would have been proud of our goal in this 70th anniversary year. Perhaps Bevan saw the potential to engage staff to release the ‘possible’ when he said: “Discontent arises from a knowledge of the possible, as contrasted with the actual.”