Do work that adds value, cut out the rest, and you will save time and money as well as providing a better service.

Do work that adds value, cut out the rest, and you will save time and money as well as providing a better service.

Sixteen years ago, as a doctor, I believed that the demand for healthcare outstripped our capacity to supply it. Swamped by a queue in the emergency department and a relentless waiting list, I also started to believe that the patients I trained to serve were being unreasonable.

That belief changed when I was subjected to the absurd process of justifying my illness to a receptionist so I could access care and return to work. Like many other patients and NHS staff, I voted for increased resources for the NHS and better pay for overworked staff.

In 2004, The Economistreported that NHS resources had doubled from£47bn a year to£98bn since 1997. This is a lot of money and services have improved. But as patients, have we experienced a doubling in quality of service and care? Despite relentless pressure on queues and waiting lists, The Economistreported only a 3 per cent increase in output. When it reprised the topic at the end of 2006, there was little progress.

Those who experienced the demise of British automotive manufacturers in the 1980s may feel a sense of déja vu. Despite huge government investment, customers were persistently asked to wait for the privilege of buying British. This changed when an affordable, high-quality car appeared, something no manager had believed possible without slave labour.

Instead of throwing money at the problem, the thrifty Japanese employees at Toyota learned to recognise how much of their daily
work adds value.

Only work that turns metal into a car that meets their customers' quality specifications is worth doing. Any work that does not, or results in errors, is waste. Any parts, or partially finished cars that have not been sold, represent hard work tied up in cold metal. So they only make a car when requested and then they make it quickly.

They eliminate any wasted non-value adding work, cutting costs, and have created a system that delivers an error-free product on time, in response to demand and at a total cost below the price their customer is prepared to pay.

As NHS staff, how much of our work adds value to patients? It is easy to enter a tortuous debate about indirect benefits, but let's be truthful.

Those of us serving on the front line spend most of our day finding patients, trawling corridors and searching cupboards for notes and equipment. Those of us in the back office spend all day answering each other's e-mail, in meetings, managing the waiting lists or answering GP and patient complaints because the e-mails and meetings have not resolved problems.

Good management is about getting on to the shop floor and tracking work as it is done. What is the series of events between a patient contacting their GP, getting treated and returning home?

Where and why do delays and errors occur? What proportion of work is wasting our time, patients' time and our hard-earned taxes?

Dr Kate Silvester is national coach for the Osprey programme, which offers clinicians an opportunity to learn and apply manufacturing systems and engineering techniques to improve timeliness, cost, efficiency and quality.