HOSPITALS and surgeries need to adopt the “lean” management techniques used by companies such as Tesco and Toyota to reduce the inefficiency and hold-ups experienced by patients in the NHS.

Health service leaders want hospitals to improve their service by better understanding how patient demand varies and identifying and removing the valueless activities that create bottlenecks in the system.

These include getting patients from accident and emergency to the operating theatre more quickly by removing unnecessary paperwork and reducing the number of different staff involved.

It also involves improving the layout of hospitals, so that waiting rooms and items such as diagnostic machines are where they are needed most, to save time and money and reduce patient and staff stress.

One hospital trying the “lean” approach, a production methodology first developed about 60 years ago by Toyota, found that processing a routine blood sample involved 309 separate steps, which it reduced to 57 with simple changes. They also found that under the current system more than 250 different interactions took place to discharge a patient with complex health problems.

A report commissioned by the NHS Confederation, Lean Thinking for the NHS, concludes that the lean system, which is also used by the Royal Navy and Royal Air Force, could revolutionise health care and dramatically improve quality and efficiency.

The key is to remove activities that do not add value to the customer, or patient, by redesigning how services work.

Early results of a study by Bolton Hospitals NHS Trust, with the assistance of the RAF, showed that the lean method helped to cut by a third death rates for patients having hip operations; reduced paperwork in the trauma unit by 42 per cent; and halved the amount of space needed by the pathology department.

Nigel Edwards, policy director of the NHS Confederation, which represents health service managers, said: “Many ideas about the organisation of work are deeply held and often wrong.”

Australian health chiefs at Flinders Medical Centre in Adelaide, who redesigned their care based on the lean model, found that it allowed them to do about 20 per cent more work and offer a safer service on the same budget and using the same infrastructure, staff and technology.

Gill Morgan, the NHS Confederation’s chief executive, said that more was needed to improve frontline services. “The NHS can learn from the latest thinking as adopted by the Royal Navy, RAF, Tesco and Toyota. NHS managers want to be at the vanguard of modern techniques to improve patient care.”

She said that the pioneering work done at Bolton and Wirral, which had also adopted the method, showed what could be done. David Fillingham, chief executive of Bolton Hospitals NHS Trust, added: “When we started out, some people were very sceptical. But I’ve never seen anything that energises staff in this way.”

Results of a survey of 203 NHS chief executives, released by the confederation at its annual conference yesterday, showed that 95 per cent accepted that the NHS must increase productivity and cut waste before they could justify more government funding.

Tony Blair has also called for trusts to improve efficiency. In an interview with Health Service Journal, published today, he says that the principles of quality healthcare provided equitably and free would remain abstract concepts without good NHS management.

The Royal Navy adopted the lean method after it felt pressure to reduce its aircraft support costs by 20 per cent.

It managed to reduce the number of aircraft repair bases and saved millions of pounds on its Sea King and Lynx helicopter operations.

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