Realising productivity and safety benefits

The House of Common’s Patient Safety Health Committee published a report stating that of the approximate 850,000 incidents reported annually through the National Reporting and Learning Service (NRLS) in England, over 65% are classified as “no harm” incidents, which include near misses and other prevented incidents. A further 25% are “low harm” incidents, while 5% of incidents involve moderate harm and around 1% cause serious harm to a patient. Finally, 0.5% – around 3,500 cases per year – cause death.1 However, the National Patient Safety Agency (NPSA) admits that there is significant under-reporting of patient safety incidents; therefore, these figures do not reliably show the amount of incidents that annually occur within the NHS. Creating processes that reduce the risk of patient safety incidents arising is therefore a high priority for healthcare organisations. Indeed, many organisations have patient safety related improvements that compete for resource and management “air time” with the productivity and cost improvement programmes. Even when joined together under banners such as a Quality & Efficiency Group (QEG) or Quality, Innovation, Productivity and Prevention (QIPP) programme, there will normally be separate strands of activity focused on safety to those focused on productivity. By separating productivity and safety improvements healthcare organisations run the risk of duplicating improvement efforts and missing out on the benefits that an integrated productivity and safety programme can bring. In this article we explore how a “Lean” based programme can be used to deliver improvements in both productivity and safety concurrently.

Diverging practices

Data collected by the National Patient Safety Agency (NPSA) suggests that one in ten patients is unintentionally harmed by their healthcare providers. These errors often occur because procedures are vague, leading to differences in the way they are applied and followed as practitioners develop their own methods in order to carry out tasks. This divergence in the way procedures occur and differences in working practices between teams has an impact on the overall performance of pathways, something that is most notable at the interfaces between departments and between organisations. The information loss that occurs at these boundaries contributes directly to delays (and increased costs) as well as increased risks. Tackling the divergence of processes and approaches to delivering healthcare is not easy. Current ways of working have typically evolved over many years. The scattered and isolated way departments work means that even if improvements occur at one point in a pathway, it can often just have the effect of moving problems upstream or downstream to other teams, with a corresponding increase in both costs and risks. Commenting on the need to find new ways to add value to NHS services, professor John Appleby, chief economist at The King’s Fund said: “If the productivity challenges can be met, then for patients it will mean better services and more of the things they value – fewer hospital infections, more operations, higher quality care. The task for the NHS is not to fixate on the cost side of the equation – saving money or making cuts – these are not improvements in productivity. Rather, it needs focus on the benefits side to find new ways of providing services that increase the value of care to patients.” The concepts of “Lean” have been used in healthcare improvement programmes for more than a decade. However, Lean has mostly helped healthcare organisations to deliver their productivity and cost improvement targets and in many ways this has contributed to the negative perception that many clinical staff have of it today. In reality, because safety and productivity improvements go hand in hand, the pure application of Lean to simply reduce costs may actually introduce additional sources of potential error. This should not be the case as many of the tools of Lean can simultaneously be applied to reducing risk and cost. In addition, Lean encourages people to work together to collectively solve problems. It is not a magic potion that will solve all ills within healthcare, but it does provide a framework for people working with day to day healthcare problems. It can help them understand what currently occurs and to redesign activity, helping to find the balance between clinicians making the right decision based on both previous knowledge and the application of a set process. Some of the most beneficial tools of Lean for improving productivity and safety are also some of the easiest to understand as is shown in the following examples of Lean tools and concepts: