Competing tribes

Podium by sscreationsA post on Community Care offers an insight in to different constructions of Lean. Simeon Brody asks about the nature of lean and six sigma, and quotes some extracts from a Wikipedia entry. The nature of the replies provides good examples of competing constructions of Lean.

Some respondents see these approaches as inhumane, and entirely unsuited for health care in general, and mental health care in particular. It will make the NHS ‘more process oriented’ and will be a ‘dangerous interference in care’. One respondent comments, ‘I don’t know what this means exactly’, but goes on to conclude ‘  it’ll give whoever uses it an excuse to cut services in some way’. Two respondents link the approach to existing problems in services, and to a perceived move to a commercial environment, with confusion for staff, and a danger of staff moving away to escape new pressures. Another respondent wonders how long it will be until this is replaced by another management enthusiasm.

By the end of the exchange of responses, two posts from lean enthusiasts were posted. These were generally sympathetic to the comments, but argued for the potential value of lean, although with no mention of six sigma approaches. The division between the generally supportive and the mainly oppositional posts was striking.

The conflation of Lean and Six Sigma approaches may prove to be an ongoing challenge for the use of Lean in mental health services. Leaving this aside, however, there are some narratives in these responses that I have seen echoed elsewhere:

  • Lean as a cost cutting measure
  • Bringing commercial process in to the NHS
  • Doing more for less
  • A management fad
  • A focus on process over outcome
  • Disruption for staff who have to put up with these management whims

These are recurring concerns about any changes to NHS services in the UK, and a posting from a former service user emphasises that person’s concern about the extension of industrial approaches to a service that is about care for people. Bridging this gap continues to be an important challenge for people working in Lean in any health and social care service, and certainly in mental health services. It can’t be bridged by shouting at people – information, practical demonstrations of change, and an approach that respects concerns will all be required. Proactive work with staff groups and user groups will be important, but for most staff and service users, evidence of positive change is most likely to produce an increase in trust.

Image courtesy of sscreations at

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