Waste – is the UK Government getting it?

The new UK Government has announced plans to attack the “Waste of Rework” in the NHS, provider of the public UK hospital system.  BBC News – Hospital Face Fines

The Waste of Rework is the waste of resources (time, people, materials, equipment etc) when a process isn’t completed to the required standard. Consequently more of the resources have to be spent putting the work right – which also has a knock on effect on the subsequent work planned.

It doesn’t matter whether we are talking about metal forming, handling insurance forms, answering customer calls, or attending to patients, doing a job right first time, will use up less resources, than having to re-visit the job.  So this waste, from a Lean point of view, is pretty universal.

The change proposed is that if a customer (okay they do still call them patients, they haven’t admitted these people are customers who have paid for the service, through taxes!) is re-admitted within 30 days of being discharged then the hospital will not be paid for the second stay, if it is related.

Hence I’ve viewed this as the hospitals will no longer be paid for the Waste of Rework, so the incentive is to get treatment right first time!

Within many of the reports on this new ideal came the complaint that this change will lead to longer times in hospital and increase the length of waiting lists. The people making these claims have never seen any lean thinking or queuing demonstrations on the effect re-work has on the capacity of a system. Re-work lowers the capacity of any system and often by more than the measured rework figure.

So a 10.5% rework rate will reduce capacity by more than 10.5% because of the effects it has on planning, we use a calculation known as OEE (Overall Equipment Efficiency) to demonstrate this, don’t be put off by the manufacturing bias to the name of this, you can use it for any process.

Now I don’t have all the figures to understand this but the % of re-admissions as proportion of all discharges, in the NHS, went up from 8.8% in 1998/9 to 10.5% in 2007/8.  There is no indication whether this 

  • is a statistically significant rise,
  • is a consistent rise from 1998/9, or just 2007/8 was a high year
  • is a function of re-admissions within the new 30 day limit,
  • is due to a focus on treatment at home, which might carry more risks
  • or just a function of an ageing population.

Whether it will actually work or drive the correct behaviours we don’t know because is the problem of rework being caused by people being sent home to early, or by something else….

Now if the Government used the 5Whys to determine this waste, then we’d have a better idea…..



P.S.   Do you know what the rework level is in your organisation?


4 responses to “Waste – is the UK Government getting it?

  1. Pingback: Tweets that mention Waste – is the UK Government getting it? « the lean manager -- Topsy.com

  2. Mark,

    I agree with that but I think that the NHS needs to do its own work to solve this problem with some freedom in what the solution is. More patches from central government in the form of incentives and fines just confuses focus even further. The NHS need method not more constraints.

    I will disagree a little in that I don’t want to be a customer. In a shop I am a customer. In a hospital I am a patient. On a train or plane I am a passenger. They are different things and I think we should stick to those things instead of making everyone a customer all the time.



  3. Rob, I agree that thinking changing one variable/target from top down is the way forward shows, that as yet, we still have the same thinking. So maybe the Government haven’t got it, which helps to answer the question posed.

    I note from your blog (http://worthsolutions.com/blog/) that only 25% of re-admissions are due to related issues, so it looks like the problem relates to an overall of 2.5% of re-admissions and I don’t have any figures as to how this stacks up in the wider medical world.

    What I am aware of, personally, are people who have been discharged because they could be treated at home but later developed complications and had to be brought back in. So
    despite everyone agreeing that the home treatment plan was the best way forward this route may not always be an option in the future.

    As for the customer comment; I believe that when I hand over my cash every month, in taxes and in every transaction I make that goes forward to fund such activities as the NHS then I am paying for a level of service and I’m not prepared to be patient. (*Having the quality of enduring; physically able to suffer or bear.)

    I’ve paid for the service & I expect the same from that transaction as I do from other organisations. My view is based on my personal experiences of the NHS over 34 years of continuous treatment, so I can appreciate that other people will retain other views. I could probably fill a book on mine.

    The main aim of the posting, though is to show to readers that wastes can be found in every type of organisation.

  4. I don’t think we disagree either. I just want central government to stop interfering.

    Hospitals should discharge people at the right time. Not too long, not too short. The judgement for that is up to doctors, nurses and the patient. Having government set fines or central policy won’t help medical staff make better decisions for the patient it is just another distraction from that.

    With the customers thing. To me customers are sold to, marketed to, offered deals and choice. That is not what I want from public services. I want good local service that is worth the money we all pay, but I don’t want choice or to be told how good it is. I just want it to be effective and efficient.

    “wastes can be found in every type of organisation” – I’m in total agreement there!!



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