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A few weeks ago I came to work at 10am on a Monday, to an A/E department busy with the normal hubbub of minor injuries and walk-in problems. The number of new arrivals was nothing unsual and there were plenty of staff, but there was nonetheless a queue of ambulance patients waiting outside majors. This was not a queue to be seen by a doctor, but a queue for a cubicle. And why were there no cubicles? Because all of them were full of patients, bedded down for the night, waiting for a space in a ward. The hospital is full and, to give it a medical term, sclerotic.
Sadly, it is a situation which is repeated – especially during the winter months – day after day, in many hospitals across the UK.
In an HSJ article last week, we were asked to look to the car industry for guidance on how to fix these problems of our sclerotic hospitals and sloppy quality.
Which reminds me of a similar problem – but on a much vaster scale – that I witnessed a few years back. The Vaxhaull plant in Luton was trying to make the Frontera – a Japanese designed SUV doing well in many markets across the world. Problems in the UK with “quality” – which is to say parts, manufacture, labour relations and everything else that makes up a car plant - had caused the reject rate for finished cars to escalate. Rejection was so common that the entire plant was surrounded by abandoned cars each condemned as being unsafe. Every available nook and cranny on the vast site was taken up with abandoned, poorly manufactured cars, each bearing a quality control sticker on its windscreen itemising the reasons for its failure.
The reasons for problems of quality and patient-flow in our hospitals are many, and interrelated: they are systemic – which makes fixing them all the more difficult. Poor quality drives away high performers, leaving the most needy hospitals with the least capable staff. Poor quality leads to financial penalties, which leaves fewer resources with which to fix the issues; lack of alignment betwen clinical and administrative leaders causes stagnation of initiatives … the list is endless.
The HSJ article asked us to consider what we can learn from Unipart - the winner of the battle to become supreme in the car-parts market. Does Unipart have anything to teach healthcare about how to run a hospital? Clearly they know a lot about processes – and how to make them ‘lean’. I am the first to extol the importance of processes – especially given their impact on me as a clinican. But healthcare is not just about processes. It is also about service and empathy and clinical judgement. It is about dealing with the distressed and dying. It is ultimately about people looking after - caring - for other people.
The misunderstanding, when we look at Unipart or any other successful company (such as John Lewis or BP or any other great examples) is to mistake the “content” of their success with their “method”.
The “Unipart Way” says John Neill in the HSJ article is “the company’s own approach to ‘lean’ production – the elimination of process waste and inefficiency” It is, he says, “like performing a symphony, says Neill, and requires total commitment throughout the organisation”
It is the second of these statements that is crucial – but we are distracted by the first. ”Aha!”, we think, “If only we got our processes right, everything would be OK”. After all, that’s how Unipart got it right.
But that is the mistake. That is why we are wrong to concentrate on lean. Lean is not HOW Unipart got it right and won-out against its competitors. Lean processes is WHAT unipart got right, in order to win-out against its competitors
HOW Unipart got it right was by gaining “total commitment throughout the organisation”. Only with that could they get their processes right – which allowed them to become more successful and competitive.
Translating that into the world of heatlhcare, we need to put People Before Processes: create positivity, recognise great care, ensure every healthcare organisation is ‘first or best’ for the people working in it, train our leaders properly … the list is pretty long. Only then can we hope to have the necessary commitment to fix the processes.
You may be wondering how Vauxhall solved the problem of the Frontera’s terrible production quality? Answer: they never did. In 2002 they gave up and closed the car plant altogether.
Problem solved.
A few weeks ago I came to work at 10am on a Monday, to an A/E department busy with the normal hubbub of minor injuries and walk-in problems. The number of new arrivals was nothing unsual and there were plenty of staff, but there was nonetheless a queue of ambulance patients waiting outside majors. This was not a queue to be seen by a doctor, but a queue for a cubicle. And why were there no cubicles? Because all of them were full of patients, bedded down for the night, waiting for a space in a ward. The hospital is full and, to give it a medical term, sclerotic.
Sadly, it is a situation which is repeated – especially during the winter months – day after day, in many hospitals across the UK.
In an HSJ article last week, we were asked to look to the car industry for guidance on how to fix these problems of our sclerotic hospitals and sloppy quality.
Which reminds me of a similar problem – but on a much vaster scale – that I witnessed a few years back. The Vaxhaull plant in Luton was trying to make the Frontera – a Japanese designed SUV doing well in many markets across the world. Problems in the UK with “quality” – which is to say parts, manufacture, labour relations and everything else that makes up a car plant - had caused the reject rate for finished cars to escalate. Rejection was so common that the entire plant was surrounded by abandoned cars each condemned as being unsafe. Every available nook and cranny on the vast site was taken up with abandoned, poorly manufactured cars, each bearing a quality control sticker on its windscreen itemising the reasons for its failure.
The reasons for problems of quality and patient-flow in our hospitals are many, and interrelated: they are systemic – which makes fixing them all the more difficult. Poor quality drives away high performers, leaving the most needy hospitals with the least capable staff. Poor quality leads to financial penalties, which leaves fewer resources with which to fix the issues; lack of alignment betwen clinical and administrative leaders causes stagnation of initiatives … the list is endless.
The HSJ article asked us to consider what we can learn from Unipart - the winner of the battle to become supreme in the car-parts market. Does Unipart have anything to teach healthcare about how to run a hospital? Clearly they know a lot about processes – and how to make them ‘lean’. I am the first to extol the importance of processes – especially given their impact on me as a clinican. But healthcare is not just about processes. It is also about service and empathy and clinical judgement. It is about dealing with the distressed and dying. It is ultimately about people looking after - caring - for other people.
The misunderstanding, when we look at Unipart or any other successful company (such as John Lewis or BP or any other great examples) is to mistake the “content” of their success with their “method”.
The “Unipart Way” says John Neill in the HSJ article is “the company’s own approach to ‘lean’ production – the elimination of process waste and inefficiency” It is, he says, “like performing a symphony, says Neill, and requires total commitment throughout the organisation”
It is the second of these statements that is crucial – but we are distracted by the first. ”Aha!”, we think, “If only we got our processes right, everything would be OK”. After all, that’s how Unipart got it right.
But that is the mistake. That is why we are wrong to concentrate on lean. Lean is not HOW Unipart got it right and won-out against its competitors. Lean processes is WHAT unipart got right, in order to win-out against its competitors
HOW Unipart got it right was by gaining “total commitment throughout the organisation”. Only with that could they get their processes right – which allowed them to become more successful and competitive.
Translating that into the world of heatlhcare, we need to put People Before Processes: create positivity, recognise great care, ensure every healthcare organisation is ‘first or best’ for the people working in it, train our leaders properly … the list is pretty long. Only then can we hope to have the necessary commitment to fix the processes.
You may be wondering how Vauxhall solved the problem of the Frontera’s terrible production quality? Answer: they never did. In 2002 they gave up and closed the car plant altogether.
Problem solved.
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