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SeCtion tWo Change approaches & management tools
Use
Steps in LEAN
1. Specify value from a customer (client) perspective: this is a crucial first step in order to ensure that the organisation is designed to provide the correct service(s). Where services have a range of potential values and different perspectives in what value is most important it is recommended to design value streams around service users at each step of a process rather than around functional silos such as ‘day care’.
2. Identify the value stream for each process and identify ‘wasteful’ steps that do not add value: this requires mapping of all processes involved in providing a service. For example, all stages involved in provision of adaptations to assist home living to identify value-giving and wasteful steps in the pathway. Start and end points are agreed, for example diagnosis of a physical disability to provision of an aid. The mapping activity is undertaken by those who come in contact with the client throughout the process, initially looking at current practice on their own part of the pathway and subsequently coming together to identify wasteful steps.
3. Make the product/service flow continuously and standardise the process to ‘best practice’: this requires redesign of the process and elimination of the identified wasteful steps, such as waits for assessments to be undertaken.
4. Introduce ‘pull’ between all steps where continuous flow is impossible: where it is not possible to eliminate a wasteful step immediately bring in practices and capacity which ‘pull’ the client/customer to the next step in the process. For example, a reablement service which is aware of and able to respond to demand for people being discharged from hospital.
5. Manage toward perfection: systematically reducing waste within processes should become part of the organisational culture, so that non-value adding activity is constantly removed.
Implementation could be simplified as: focus on clients; design care around them; identify value from a client perspective and get rid of everything else (waste); minimise time waiting for care and throughout its course.
(Adapted from Burgess and Radnor, 2013, p. 222)
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