The clearest indication that the 'tool heads' don't understand the problem is their assertion that the lean tools will help the NHS meet its targets
Beware 'tool heads' bearing targets - they won't make things any better for the patient, argues John Seddon
The NHS is experiencing a wave of euphoria over 'lean'. In the form this is taking - lean 'tools' developed in manufacturing - this initiative will fail and that is a tragedy, for lean has much to offer.
'Lean' is the label applied to the Toyota production system, an economic legend in its own lifetime. On any measure - efficiency, quality, growth, market capitalisation - Toyota leads. The secret behind the company's success is a completely different way of thinking about the design and management of work.
Taiichi Ohno, the man who developed the Toyota system, insisted we should never 'codify method' (write down the 'tools') for it is thinking that is the key; how you conceptualise your problems. The importance of his assertion becomes obvious when you see 'tool heads' (as I call them) applying ideas or tools from manufacturing in service organisations. These tools represented ways of solving problems in manufacturing; the problems to be solved in service organisations are quite different.
For example, in manufacturing it is essential to standardise the work as a prelude to improving it, for without standardisation you cannot learn. In service organisations, by contrast, standardising the work usually drives up costs.
The reason is very simple: service organisations experience much more variety in the nature of demand and if high variety demand hits a standardised organisation design, the system will not absorb that variety. That means costs can only rise as service worsens.
In patient terms this means 'take it the way it is designed, not the way you need it'. Patients are treated as though they are 'products' and illnesses as though they are 'product families'.
The recent closing of NHS Direct facilities is, I imagine, an acknowledgement that the service does not solve patient problems, but rather that it passes many problems on to other agencies: pharmacies, GPs and accident and emergency.
Increasing the number of patient transactions can only drive up costs and frustrate the patient. Similarly my experience of spending time on an ambulance taught me that many of the people taken to A&E don't get their problems solved there.
A&E gets clogged with people who won't get their problem solved but who nevertheless have to be seen in target times. An obsession with meeting target times has little to do with solving patient problems.
Perhaps the clearest indication that the 'tool heads' don't understand the problem is their assertion that the lean tools will help the NHS meet its targets. Targets, like all arbitrary measures, distort systems. Instead of using targets, NHS people should be using real measures, derived from the work, that aid the understanding and improvement of that work. The key measure missing from the 'tool box' is demand; understanding the type and frequency of patient demand on the system. Only by understanding demand can we begin to design a system that responds to demand; that gives people what they need.
The tragedy is that the NHS, like all command and control systems, is replete with waste and application of the 'tools' will produce some results. But these results are of little value compared with the results that could be achieved by changing the system.
My fear is that NHS managers applying these tools will think they have 'done lean' when they have not even started. Taiichi Ohno will be turning in his grave.
Professor John Seddon is honorary visiting professor at the Lean Enterprise Research Centre, Cardiff University. He is the author ofFreedom from Command and Control: the Toyota system for service organisations.