As part of the Health Foundation’s GenerationQ leadership programme, Fellows spend time on the factory floor at Unipart, the car parts company that famously turned around its flagging fortunes by adopting organisational learning from Honda and Toyota. The resulting philosophy – ‘the Unipart Way’ – is a system of tools and techniques designed to promote efficiency and eliminate waste.
Brian Marshall, Unipart’s Director of Strategy, explains what the Unipart Way can teach healthcare practitioners wanting to deliver a higher-quality service.
At Unipart, improvement is part of our DNA. We have one simple focus: creating value for our customers. To deliver that value, we take a cross-functional and cross-organisational view, focusing on each stage of the process, end-to-end, with continuous improvement at every step. Our philosophy pervades the entire organisation. The most important thing that GenerationQ Fellows get out of their visit to Unipart is that they see that improvement is possible. It gives them hope and inspiration.
Our approach draws on practical tools such as control boards. This may be a complex computer-generated tool or simple grid drawn on a whiteboard, showing the detail of how each team member is progressing towards their goals, to help monitor performance. Another is the heijunka board (originated by Toyota), on which staff slot in details of schedules, inputs, outputs and metrics tracking performance over time, enabling us to plan better and level out the workload.
If you cross-skill people and have clear visuals showing you what’s happening hour-by-hour, you can move people around as the demand requires, to provide an agile, responsive service.
At Unipart, we know that improved flow leads to better-quality, lower-cost outputs. We dance to the beat of customer demand, and it’s that demand that dictates the pulse, pace and flow of everything we do. That helps prevent bottlenecks, delays and waste, enabling us to keep costs down and focus on delivering a better quality product.
We believe that the customer – or patient – needs to pull the process through. They shouldn’t have to fit around the organisation – the organisation needs to fit around them. But in healthcare, it’s often the other way round – for example, with operating times that suit the surgeon. We see that as waste.
The key principle that we share with Health Foundation Fellows is that in healthcare value is about the patient. Of course there are targets and financial constraints, but the wonderful simplicity is that healthcare professionals are in business for one thing: to treat patients. That’s a hugely challenging concept for managers who have to hit budgets. But referring back to this principle can often help them cut through the complexity.
Some people have said that industry and healthcare are an unusual choice of bedfellows when it comes to quality improvement. Clearly, industry is in the business of making things for consumers, and profit, while healthcare is about looking after people. However, our work at Unipart isn’t simply about chasing the dollar: it’s about developing our people in a way that delivers value in the most efficient way. And that’s directly translatable into healthcare. If industrial approaches can help improve patient wellbeing, safety and experience, then it has to be good practice for healthcare to adopt them.
How learning about the Unipart Way has influenced our GenerationQ Fellows
Clare Dieppe, A&E Consultant, Nottingham Children’s Hospital
I was particularly impressed by Unipart’s emphasis on visual representation. From finance to the factory floor, everyone can see who’s working today, what their targets are and if they’re meeting them. If they’re not, there’s no blame, but others can step in and help out. People seemed genuinely enthusiastic and committed to the way they work.
I’m now developing visual materials for our children’s emergency department, to inspire nursing staff to improve our service. A whiteboard will list the next observation needed for each of our seven cubicles, so that if one is missed, someone else can step in. I’m also developing simple visuals to illustrate our performance so staff can easily pinpoint areas for improvement.
James Rooney, Quality Improvement and Patient Safety Lead, Devon Partnership NHS Trust
Unipart was eye-opening in the simplicity of its approach. Healthcare has typically seen improvement as a ‘project’ but Unipart sees addressing demand and capacity issues as part of their day-to-day business.
In Devon we applied the learning to improving our adult referrals and assessment rates. Following our process mapping and observations, we created a single referral management centre coordinating slots across Devon. In the past year, just by focusing on this bottleneck in the clinical pathway, we’ve reduced waiting times by 48%.
Discussing the learning from GenerationQ and my experience at Unipart has contributed to a change in the nature of the dialogue we have within the trust. Now, clinicians talk about demand, capacity and streamlining all the time.