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Applying re-engineering principles to health care

Business process re-engineering has its roots in commercial manufacturing. Development work in the 1970s and 1980s in a range of commercial settings showed significant benefits from a systematic approach to the analysis and restructuring of manufacturing processes. It was widely adopted as a means of improving manufacturing output to produce significant improvements in quality, capacity and cost. The approach attracted the interest of managers in the NHS and two projects (at Leicester Royal Infirmary and at Kings Healthcare in London) were funded by the Department of Health to test its application in a health care setting.

The work started in Leicester in 1994. It involved a significant programme of 140 separate projects. A Framework for Defining Success was established to ensure that the impact of the work in its widest sense could be measured. Over the last five years significant gains have been made in the quality of services offered to patients, as well as in teaching and research. Indeed, few departments in the hospital were untouched by the initiative.

The key lesson from the work at Leicester has been that change is typically created bottom-up in contrast to the top-down approach championed by the academic supporters of re-engineering. Clinical and management leaders have to create the right conditions for improvement. Redesigning health care differs in significant ways from that which can be applied in industrial settings: it involves several distinct steps:

♦ Identifying specific patient groups - targets for service process redesign.
♦ Ensuring that those involved in service provision are involved in service redesign.
♦ Being clear about the tools and techniques available.
♦ Analysing the current process to identify strengths and weaknesses: what adds value and what doesn't?
♦ Creating a model for the redesigned service.
♦ Establishing performance measures.
♦ Testing the new process - being honest - does it or doesn't it work?

Leicester Royal Infirmary has created a tool-kit that describes the tools and techniques used for patient process redesign. The tool-kit provides the basis for a series of Re-engineering Masterclasses that have attracted clinical and managerial interest within the UK and internationally, with visitors from health services in New Zealand, Sweden and Denmark taking part. The Leicester Royal Infirmary's dissemination work has been recognised with the granting of specialist Learning Centre status, thus confirming their role as an integral part of the growing NHS Learning Network

To find out more contact

Ron Cullen
Centre for Best Practice
Leicester Royal Infirmary NHS Trust
Leicester LE1 5WW
Telephone 0116 254 1414
Fax 0116 258 5631


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