Intended for healthcare professionals


Shrinking budgets, improving care: Simplify processes and engage with patients

BMJ 2010; 340 doi: (Published 17 March 2010) Cite this as: BMJ 2010;340:c1251
  1. Graham Rich, project director
  1. 1University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU

    All countries are facing the question of how to maintain the quality of care in the face of static or shrinking health budgets. In the NHS it’s estimated that savings of over £20bn need to be made in the next few years. Graham Rich and Phil Leonard (doi:10.1136/bmj.c1258) argue that the NHS can save money while maintaining and improving the quality of care and set out their views on how to do this. But Yair Zalmanovitch and Dana Vashdi (doi:10.1136/bmj.c1259) think that something will have to suffer

    The National Health Service contains an immense amount of waste, and systematic ways to engage staff to review and simplify care are needed. Analysis of processes with the lean method of improvement shows that up to 40% of steps can be eradicated because they do not add anything to the end result.1 The lean method identifies overproduction (such as repeating the same questions to patients), unnecessary waiting, unnecessary transportation, too much processing, too much stock, unnecessary movement of staff and patients, and defective work as types of waste. Improvements in processes result in a more efficient service with higher quality built in.

    Stop creating dependent patients

    Despite decades of concern, the …

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