Driving quality – clinical governance in the National Health Service

Implementing operations strategy through Lean processes within health care

Purpose

The purpose of this paper is to investigate how operations strategy and Lean concepts can be applied within a healthcare organisation and the degree to which both Lean and operations strategy are understood by senior-level National Health Service (NHS) personnel, based on the process of ongoing longitudinal cases studies. Further interviews and data analysis will examine actual performance of Lean capabilities within the NHS.

Design/methodology/approach

For this explanatory multiple-case study project the authors collected data through semi-structured interviews with executives in the NHS to understand how operations strategies are developed in the NHS and implemented in NHS hospitals. The unit of analysis is the hospital. Multiple (22) interviews took place over 12 months with senior-level personnel responsible for implementing change via operations strategy goals, and incorporating Lean initiatives. In addition, to triangulate data, the authors examined healthcare reports and strategy policy documents from each case hospital. This forms stage 1 of a longitudinal study which will examine the actual performance of Lean within the NHS hospitals across a range of operations parameters and explore links between such capabilities and the role and importance of operations strategy in more detail.

Findings

The findings lead to the conclusion that operations strategies were not fully developed within the hospitals. In addition, the ongoing data capture shows that “Best practice” was not being disseminated across the NHS, for either patient experience or organisational effectiveness and the role of operations strategy was not fully clear other than as a rather vague “umbrella” term. Despite Lean’s attraction for healthcare at a micro-level, significant operational and cultural hurdles must be overcome for the full strategic benefits of Lean to be realised. A much more holistic approach in providing a full service for the whole of the patient journey is needed.

Research limitations/implications

The sample provides an initial snapshot. A larger number of hospitals and/or further longitudinal research will be needed to deepen understanding of embedding strategic change to improve overall performance.

Practical implications

Tackling cultural performance and operational issues at a macro-level could help healthcare providers reconcile the perceived conflicting goals of improving patient care (i.e. service delivery) whilst simultaneously reducing costs. The role of explicit operations strategies could be pivotal in designing and implementing such change.

Originality/value

This research builds on and extends the work of Toussaint and Berry (2013), Seddon and O’Donovan (2010) and Carlborg and Kowalkowski (2013). The authors highlight how some of the apparent contradictions in the requirements of the various stakeholders create operational and strategic tensions. The authors highlight the multi-faceted nature of design and delivery of a multi-touchpoint service within the complexity of a large healthcare provider.