Mairi Macintyre

UK health visiting: challenges faced during lean implementation

Purpose – The purpose of this paper is to present the challenges identified during a lean implementation in a health visiting service within a large primary care trust in NHS UK.Design/methodology/approach – Following a series of lean workshops a triangulated approach to data collection was adopted in order to determine the root cause of the challenges that were faced during this lean implementation. The three methods that were selected for qualitative analysis included semi‐structured interviews, document analysis and researcher participant observation.Findings – Six key challenges were identified from the data analysis. These were: high process variability; a lack of understanding of lean; poor communication and leadership; target focused; problems defining waste; and difficulty in determining who is the customer and what do they value?Practical implications – Although this particular lean implantation had limited success, the research has highlighted a number of challenges which would have to be addres...

Lean implementation in primary care health visiting services in National Health Service UK

Background This paper presents the findings of a 13-month lean implementation in National Health Service (NHS) primary care health visiting services from May 2008 to June 2009. Method Lean was chosen for this study because of its reported success in other healthcare organisations. Value-stream mapping was utilised to map out essential tasks for the participating health visiting service. Stakeholder mapping was conducted to determine the links between all relevant stakeholders. Waste processes were then identified through discussions with these stakeholders, and a redesigned future state process map was produced. Quantitative data were provided through a 10-day time-and-motion study of a selected number of staff within the service. This was analysed to provide an indication of waste activity that could be removed from the system following planned improvements. Results The value-stream map demonstrated that there were 67 processes in the original health visiting service studied. Analysis revealed that 65% of these processes were waste and could be removed in the redesigned process map. The baseline time-and-motion data demonstrate that clinical staff performed on average 15% waste activities, and the administrative support staff performed 46% waste activities. Conclusion Opportunities for significant waste reduction have been identified during the study using the lean tools of value-stream mapping and a time-and-motion study. These opportunities include simplification of standard tasks, reduction in paperwork and standardisation of processes. Successful implementation of these improvements will free up resources within the organisation which can be redirected towards providing better direct care to patients.

Service design and delivery

Service Design and Delivery provides a comprehensive overview of the increasingly important role played by the service industry. Focusing on the development of different processes employed by service organizations, the book emphasizes management of service in relation to products. It not only explores the complexity of this relationship, but also introduces strategies used in the design and management of service across various sectors, highlighting where tools, techniques and processes applicable to one sector may prove useful in another. The implementation methods introduced in the book also illustrate how and why companies can transform themselves into service organizations. While the book is primarily intended as a text for advanced-level courses in service design and delivery, it also contains theoretical and practical knowledge beneficial to both practitioners in the service sector and those in manufacturing contemplating moving towards service delivery. 26 contributing authors

Understanding Services and the Customer Response

So why have you picked up this book? Perhaps you are in a bookshop, browsing through titles and were attracted by its cover. Perhaps you bought it on-line and are now reading it in your bedroom. Maybe you’ve borrowed it from a friend and are browsing its pages during your coffee break. Whatever the circumstances, you, evidently, are the customer.

Are You Being Served

This book came about as the growing community of practitioners and academics were progressing the area of services to new levels of understanding. Servitization was first introduced as the trend in which corporations offer fuller market packages or bundles of customer-focused combinations of goods, services, support, self-service and knowledge. As production becomes increasingly commoditised in the eyes of the end user, companies have pursued value downstream through greater customer involvement and interaction. This change in business focus, and indeed strategy, has presented new challenges and opportunities to all involved with it.

Opportunities to Improve Health Visiting Services Through Lean Thinking

This paper presents the findings of applying tools and techniques emerging from the manufacturing sector, commonly referred to as lean, to a service sector setting of a health visiting service. In particular, value stream mapping was employed to demonstrate the current level of waste in common tasks for the participating health visiting service. Through participatory design work a re-designed future process map was created. Concurrently, stakeholder mapping was conducted to demonstrate the multiple links to other services that needed to be considered in the future state service design. Despite quantifiable evidence collected during the study demonstrating measurable improvements that would free up resource within the organisation, which could be redirected towards providing better direct care to patients, changes were not implemented. From follow-up interviews and analysis, poor leadership and cultural issues were identified as the main barriers to implementation of improvements. Leadership support and cultural disposition are critical in the transformation process; adopting an improvement culture is critical in both manufacturing and service sectors for successful implementation of lean, but their manifestation is necessarily different in a service dominant business model as opposed to a product-dominant business model. These differences occur because the value proposition is predominantly experience based in a service-dominant model.