|
Project Goal: To determine ways of using simplified modelling and simulation software in Lean events to illustrate the principles and potential benefits of Lean to non-experts and thereby help to establish a more effective improvement methodology for Lean in the NHS.
Relevance of the Research: Lean thinking was developed in the automotive manufacturing industry but has become increasing prominent in other sectors including healthcare. However, it has become apparent that in healthcare organisations such as the UK National Health Service, there are some significant challenges being faced by those attempting to introduce Lean thinking including the high proportion of professional staff, large numbers of semi-autonomous clinicians, overriding safety issues, difficulties in identifying the “customer”, a language derived from manufacturing industries and the perceived complexity of the NHS system and interactions between the different parts.
Simulation and Lean are approaches that are both currently used in healthcare but are rarely discussed together. With the current focus on the efficiency of the NHS there has been growing interest in both simulation and lean and this was a motivation for creating this project.
The Approach: The research, focussed on hospitals, aimed to develop a handbook to support the implementation of Lean principles into an organisation using modelling and simulation as an enabling tool. The central research question was “How can improvement methodologies and modelling activities have an impact on lean improvement events and in turn on hospital performance, in particular, on patient flow?” To answer this, the team pursued the following objectives:
- To characterise the nature of complexities within healthcare in relation to Lean methodologies
- To identify the role of simulation and modelling to support Lean methodologies
- To explore the application of simulation and modelling alongside Lean
- To produce a handbook and website to support Lean practitioners implement Lean within Healthcare.
Partner Involvement: The project was supported by: University Hospital Coventry and Warwickshire Trust (UHCW); East Lancashire Hospital Trust; Royal Bolton Hospital Foundation Trusts; St Helens and Knowsley Teaching Hospitals; South Tees NHS Foundation Trust; Heart of England Trust; National University Hospital, Singapore; Simul8 Corporation.
Research Outputs:
Snapshot surveys of Lean in all 152 NHS acute hospital trusts in England were carried out for 2007/8 and 2009/10. From the resulting database the population was classified according to various measures of Lean performance as shown in Figure 1.
Over 60 staff, from five hospital trusts, were interviewed regarding the implementation of Lean together with the use of simulation and reports were prepared for each trust which were presented to and validated by senior management.
Three simulation interventions were carried out with Heart of England trust in an Acute Medical Unit, a Cystic Fibrosis Clinic and Outpatients - post-event reviews provided useful insight into the role of simulation in the implementation of Lean.
Involvement with The Royal Bolton Hospital Trust and UHCW in their Lean workshops in summer 2010 and with St Helens and South Tees Hospital Trusts in autumn/ winter 2010/11 led to the development of SimLean as an Educational and Engagement tool (a framework for using simulation alongside Lean).
SimLean consists of a ‘handbook’ supported by a web site (www.simlean.org) which can be used in a Lean event to demonstrate some Lean principles such as Flow and Value as well as guide a facilitator to turn a static (often paper based) process map into a dynamic map.
SimLean has three parts:
-
SimLean Educate - to be used as an introduction in a Lean event to demonstrate the principles of Lean in the context of healthcare and in a rapid manner
SimLean Facilitate - to allow traditional process maps to be transferred into a model which can then be run to allow ‘what-if’ scenarios to be generated
- SimLean Evaluate - which is the building of a detailed model after the Lean event
Publications: The project team has produced 3 journal papers, 16 conference papers, 3 practitioner articles, a book chapter and a webcast. In addition more than 15 seminars have been presented across the UK and internationally in Singapore and Australia.
Notable Impacts: Zoe Radnor and Nicola Burgess were invited to visit Singapore to give a presentation on Lean in Healthcare in the UK attended by over 40 members of Hospital Staff from the main 6 Hospitals across Singapore. The following day a seminar about SimLean was presented to the National Healthcare Research Group and the National University Hospital (NUH) and was well received with NUH subsequently presenting SimLean Facilitate at one of their Lean workshops In July 2011. In September 2011 the team received a British Academy of Management (BAM) Developmental Paper Award for their paper entitled “Developing SimLean: a fusion of simulation and lean for healthcare processes”.
What Difference has the Research Made?
- “The simulation was the turning point in the discussion.” (Lean Facilitator, St Helens and Knowsley)
- “Many thanks for your help at the medicine event just over a week ago. From our feedback about the day we had several comments that it would have been beneficial to have had more time to spend on the simulation and I am wondering how/if we can continue to use simulation to support the implementation of smooth flow along the non elective pathway…I am really keen to pursue this and possibly use it in other events.” (Head of Productivity and Improvement, UHCW)
-
- “What you’ve done in 2.5 days is fantastic, what could we do if we invested in this further, if you had more time…?” (Consultant Paediatric Doctor, Royal Bolton Hospitals NHS Foundation Trust)
-
- "I believe that simulation definitely helped during the 2 day event, I don‘t think the staff would have got as much as they did from the event without it and the solutions they are putting place are more meaningful.” (Improvement Facilitator, St Helens and Knowsley Teaching Hospitals)
Technology Transfer: There is great interest from Simu8 in developing the SimLean Educate and Facilitate features into a commercial product in which models would be supported and further developed.
Follow On Research: The project has been invited to become part of a Monash-Warwick Initiative project which has been funded to develop a research proposal on the Methodology and Evaluation of Lean in healthcare. This project includes researchers from Australia, Malaysia and the UK. The SLIM project will be used as a basis for an EPSRC grant application to develop the concept of dual use of operations management (lean) and operational research (simulation) further.
Interested? For further information and to discuss possible future collaboration please contact Dr Neil Davis, WMG, University of Warwick, CV4 7AL.
Email:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
|
