What do mental health services and the automotive industry have in common? You would be forgiven for thinking “not a lot” on the face of it, but they are moving ever closer together. We in mental health have been looking at business practices from outside our field that improve services for the benefit of patients, carers and staff alike. While car manufacturing may not appear an obvious starting point, it has arguably had the biggest impact so far, and its influence is set to grow.
From a UK perspective, the journey began in Japan and came via the US. Toyota developed their process of making cars that is now known as the lean manufacturing system. A system of efficient production that provides customer satisfaction, it has now been studied worldwide and the methods are being adopted in a range of other industries. It is founded on two underlying principles: jidoka (loosely translated as “automation with a human touch”) and Just-In-Time.
Jidoka is all about building quality into processes, having it as business as usual. Clear, measurable standards for quality are set and products are compared against these. Product quality is measured continuously, and when quality falls below any standard the process is stopped. This avoids making faulty products, and allows the process to be examined and rectified so production can start again. Just-In-Time is about making only what is needed, when it is needed. This is key to efficiency and ultimately requires stopping doing anything that does not add quality. Waste is eliminated and unnecessary activity is stopped. This frees up resources that can be used in other ways.
In 2002, Virginia Mason, a healthcare provider in the US, adopted these concepts and embedded them at all levels in the organisation, the first in the health sector to do so. Naming it the Virginia Mason Production System (VMPS), they saw patient care as the product. They report benefits including more time with clinicians as well as safer care (eg, through quicker times to seeing a doctor). Staff benefits described include less time having to revise work, and more time spent with patients.
By 2007, Tees, Esk and Wear Valleys (TEWV) NHS foundation trust, a mental health and learning disability trust, became the first mental health trust in the UK to adopt VPMS, and worked closely with Mason. Their Kaizen Promotion Office uses the system to develop services in the trust and engage staff. Kaizen is the Japanese term that refers to continuous improvement. Their work with VPMS led them to winning the Royal College of Psychiatrists award for Mental Health Service Provider of the Year in 2011.
East London foundation trust is another big player in mental health that has put quality improvement at the heart of what they do. Their work with the Institute for Healthcare Improvement Open School in Boston, US, has given them access to training for their staff to help improve the quality and safety of care. The breadth and depth of the engagement of staff in the organisation was recognised with a British Medical Journal award in 2016 for education.
Other mental health providers in the UK are now making progress, and finding their way to realising these benefits. In my own organisation, Hertfordshire Partnership University NHS foundation trust, we have developed early models for continuous improvement, and found staff have been keen to experiment with these in diverse aspects of our work. I’ve found this journey uplifting and inspiring. Quality improvement is something that is easy to get excited by. People come into healthcare to do their best for patients. These new concepts provide a language for people to talk about positive changes and give tools to help us get there. It becomes a cause to unite around and provides a common goal.
Now across the UK quality improvement is about to get serious in mental health care following the publication this year of two influential reports. The recent commission on acute mental health care led by Lord Crisp, former chief executive of the NHS and permanent secretary to the Department of Health, recommends that these should be used to drive up the quality of care in psychiatric wards. Furthermore, the health policy thinktank the King’s Fund sees quality improvement as a must-do by all health services to respond to growing demand in the future.
Our challenge as clinicians is to remember that while there is much we can learn from building cars efficiently, it is people’s lives at the centre of what we do. It is important for us to retain and develop our human touch. We must work together with patients to develop our approaches to quality improvement to give them the greatest chance of success.
If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.
Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.
