Believe it or not, before writing my rabid rantings, I often engage in a little research on the subject in hand, and during this process one of the phrases I keep coming across is “lean thinking” or “lean healthcare”.
Lean thinking is a managerial approach, first devised by Toyota, and defined here. I can see how these objectives might suit manufacturing industry but is it really suitable for healthcare delivery. To start with the phraseology, I have previously had a go at management jargon and I am afraid the phrase “improving flow and eliminating waste” sounds to me distinctly urological. And the phrase“ the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination” leaves me feeling distinctly uneasy.
The concept of lean thinking as applied to manufacturing industry, and some of the potential pitfalls are fully described here, but there is one phrase that for me stands out in this article. Waste (earmarked for elimination) is defined as “any (human) activity that absorbs resources but creates no value”. Now healthcare consumes vast amounts of resources, but creates absolutely nothing of value, as manufacturers understand the word. Value, in the context of healthcare is a nebulous and ill defined concept and may mean different things to different people.
This NHS web site is very positive about lean healthcare but the jargon runs thick. Just read points 1 to 5. What a load of shite, written by the NHS Institute for Innovation and Improvement. This quango is a prime example of an activity that absorbs resources but creates no value.
So lets have a look at one or two places where NHS Trusts have applied this philosophy. Bolton is one such. Just read this page, written by Ms Heather Edwards, head of communications in Bolton, extolling the virtues of lean healthcare. She seems not to have noticed that since they introduced lean healthcare Bolton has become one of the most lethal places for patients in Britain, with a 22% excess mortality. How do these people get away with such brazen mendacity.
Similarly deluded are these grinning fools trumpeting the success of lean healthcare at that shining example of success Airedale. Compare this with a more impartial view.
It seems to me that applying lean thinking to Healthcare is a recipe for disaster. Management do not seem to understand that that they are not running a factory for profit. The concept of lean healthcare is simply used as an excuse to slash staffing numbers to levels where patients can not properly be cared for. Because after all caring for patients creates nothing of value and is therefore a wasteful activity.