Opportunities to Improve Health Visiting Services Through Lean Thinking

Abstract

This paper presents the findings of applying tools and techniques emerging from the manufacturing sector, commonly referred to as lean, to a service sector setting of a health visiting service. In particular, value stream mapping was employed to demonstrate the current level of waste in common tasks for the participating health visiting service. Through participatory design work a re-designed future process map was created. Concurrently, stakeholder mapping was conducted to demonstrate the multiple links to other services that needed to be considered in the future state service design. Despite quantifiable evidence collected during the study demonstrating measurable improvements that would free up resource within the organisation, which could be redirected towards providing better direct care to patients, changes were not implemented. From follow-up interviews and analysis, poor leadership and cultural issues were identified as the main barriers to implementation of improvements. Leadership support and cultural disposition are critical in the transformation process; adopting an improvement culture is critical in both manufacturing and service sectors for successful implementation of lean, but their manifestation is necessarily different in a service dominant business model as opposed to a product-dominant business model. These differences occur because the value proposition is predominantly experience based in a service-dominant model.