Training in lean techniques which have brought greater efficiency to secondary care settings is increasingly available to PCT staff.

Having enjoyed success in secondary care through initiatives such as the NHS Institute for Innovation and Improvement’s Productive Ward, lean techniques are now making their way into primary care. Lean is about eliminating waste by taking out the steps in a process that do not add value.

“You can use lean for any area,” says Tina Kenny, a GP in Milton Keynes and professional executive committee chair and medical director of Milton Keynes primary care trust, which ran a pilot of lean in five general practices.

The first step was for practices to decide what change they wanted to make.

An outside consultant was brought in, whose lean methodology skills were essential, says Dr Kenny, because that enabled staff to focus their efforts on cracking the problem rather than cracking the method.

The biggest successes were seen in a practice that used lean techniques to improve access to their appointments system.

The Lean Healthcare Academy offers open courses at its three regional centres in Stoke, Doncaster and Airedale.

The academy also offers e-learning modules, and can provide training to PCTs through a virtual classroom setting, which includes a half day video conference with a lean facilitator.

Full picture

Training staff is important, says academy regional manager/senior lean facilitator Abdul Ghani.

“By not training people you are not giving them the full picture of what you are trying to achieve.”

The academy is developing new projects with NHS Doncaster to look at using lean techniques in practice based commissioning and general practice.

And for field based community services - which involves district nurses, health visitors, physiotherapists and speech and language therapists - the NHS Institute is working with 13 PCTs across the country to develop a lean based product. It is set to be launched in October, with additional modules available in early 2010.

The tool will deal with scenarios relevant to these staff, such as scheduling a week, the perfect visit and agreeing a care plan with a patient.

Engaging frontline teams is crucial to the process, says Sean Manning, programme lead for productive community services at the NHS Institute. But he adds that it needs resourcing and leadership. “You have to have the organisational will and commitment behind this.”

Top tips for lean

  • Demonstrate improvements in one area before using lean on a second
  • Ask patients and professionals what they want from a service.
  • Measure and communicate improvements
  • Get training for staff on how to use lean
  • Use a consultant who is an expert on lean methodology
  • Avoid lean jargon and talk about quality improvement instead

Reducing waits using lean techniques - Bolton PCT case study

Bolton primary care trust provider services has used lean techniques to improve access.

“Our commissioners had set a six week referral to treatment target for all community based services by December 2007, because we were an early adopter site,” says Elizabeth Bradbury, associate director for quality improvement and clinical systems improvement consultant at the PCT.

In April 2007, 10 services were identified as the most likely to miss the target.

Before any improvement work was started, the NHS Institute’s sustainability tool (for more information see the weblink at the end of the main article) was used to assess the teams’ ability to implement change and sustain it.

Ms Bradbury says: “If there was an area that they were weak in, we would work on that, so that they were in a better sustainability position from the outset.”

Over eight months, each service followed a standard process of lean improvement work. A team leader was identified to co-ordinate and plan, and a clinical lead chosen.

Surveys and focus groups were used to find out what patients and professionals wanted. Data was collected on demand and capacity weekly, daily and sometimes hourly and process mapping was used to see which steps added value to patients and which did not.

A “dream state” was identified, as if teams had a blank sheet to redesign the service end to end. Realistic action plans were then devised, which included improvements a team could make on its own, plus things that might take longer and need support.

Facilitators introduced tools and techniques as required and helped teams measure improvement. Progress was reported daily to the team, weekly to management and monthly to the board.

The PCT met the December 2007 early adopter 18 week target. Waiting times were cut from 20 weeks maximum to six weeks or less, with an average of four weeks by May 2008.


For more on the Milton Keynes project, contact Tina Kenny at

Details of training available at the Lean Healthcare Academy

NHS Institute for Innovation and Improvement sustainability tool