Cheng, Siu Yee, Bamford, David, Papalexi, Marina and Dehe, Benjamin (2015) Improving access to health services – Challenges in Lean application. International Journal of Public Sector Management, 28 (2). pp. 121-135. ISSN 0951-3558

Purpose: Healthcare organisations face significant productivity pressures and are undergoing major
service transformation. This paper serves to disseminate findings from a Lean healthcare project
using a NHS Single Point of Access environment as the case study. It demonstrates the relevance
and extent that Lean can be applied to this type of healthcare service setting.
Design/methodology/approach: Action research was applied and Lean tools used to establish
current state processes, identify wastes and develop service improvement opportunities based upon
defined customer values.
Findings: The quality of referral information was found to be the root cause of a number of process
wastes and causes of failure for the service. Understanding the relationship and the nature of
interaction between the service‟s customer/supplier led to more effective and sustainable service
improvement opportunities and the co-creation of value. It was also recognised that not all the Lean
principles could be applied to this type of healthcare setting.
Practical implications: The study is useful to organisations using Lean to undertake service
improvement activities. The paper outlines how extending the value stream beyond the organisation
to include suppliers can lead to improved co-production and generation of service value.
Originality/value: The study contributes to service productivity research by demonstrating the
relevance and limitations of Lean application in a new healthcare service setting. The case study
demonstrates the practical challenges of implementing Lean in reciprocal service design models and
adds validity to existing contextual models.

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