Writing in 1988, Avedis Donabedian suggested that the key markers of high-quality care are outcomes. The likelihood of achieving these outcomes is increased if organisations have the necessary structures and processes of care in place to meet quality standards. In other words, to deliver a high quality outwards-facing ‘product’ requires continually improving internal structures and processes. This was reinforced for me when a team from the Advancing Quality Alliance (AQuA, supporting over 70 member organisations in the North West to improve health and care) made the short trip to Ellesmere Port in Cheshire to visit Innospec, a specialist chemicals company, traditionally specialising in octane additives used in making motor fuel. With demand for lead in petrol decreasing, in 2006 the entire existence of the business was under threat. They were faced with two choices: innovate or disband.
Iain Smith Head of the North East Transformation System
Later in June the UK Improvement Alliance will meet in the North East of England with a focus on Lean thinking and learning about the journey of the North East Transformation System (NETS). As a quick reminder, Lean is a way of thinking about how to organize activities to deliver more benefits and value while eliminating waste. It is particularly associated with the Toyota Motor Company in Japan, and in health care with the Virginia Mason Medical Centre in Seattle – dubbed the US ‘hospital of the decade’ in 2010. Virginia Mason has come into the UK spotlight in recent years, with Jeremy Hunt paying them a visit in March 2014, and are now working with five trusts across the English NHS to help them improve.
At NETS we are now celebrating our tenth anniversary of working with Virginia Mason in thinking about Lean, prompting someone to ask me recently what I’ve learnt over that time.
I want to introduce you to three people. Stanley is a US Navy general. He’s 49, jogging in Iraq’s searing heat. Jean-François is a French industrialist. He’s just climbed out of his boss’s helicopter to be announced as the new Chief Executive of a brass foundry. Jos is a Dutch community nurse. He’s just quit his job. So has his wife. They have savings (small) and children (five).
Together, these three can help save our health services.
Let’s start in Iraq. It’s 2004. General Stanley McChrystal has just been appointed as Commanding General of the Joint Special Operations Command of the US Military. Unfortunately, it isn’t going well: the highly honed processes, and technological supremacy of the Task Force is being beaten by an insurgency of fighters with barely enough training to be called soldiers. McChrystal realised hierarchical decision making and information shared on a ‘need to know’ basis was holding them back. The Task Force was built to operate in a linear world, while Al Qaeda’s adaptability meant it was able to thrive in the wildly unpredictable nature of the post-Saddam Iraq.