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In the absence of a safe and effective choice ambulance crews will often convey a vulnerable patient to hospital rather than leave them at risk at home. This leads to many unnecessary admissions and excessive cost. Working with an NHS Community Healthcare organisation to provide an out of hours rapid response service has given ambulance crews the options they need and reduced the overall costs associated with these patients by 45% whilst enabling more patients to remain in their own home.

Whilst there are many more case studies of the successful application of Lean in the public sector of all different sizes and scales it can be seen that Lean has mostly been applied on small to medium scale projects with easily standardised processes that experience relatively low levels of variability. Many of the examples of Lean in the public sector have also been ‘internal’ and have avoided cutting across organisational ‘borders’.

In the public sector many of the most important and highest cost processes are complex and have high levels of variability. These strategic and complex processes often also cut across the borders of departments and external organisations. The maximum value of Lean will only come when it is applied strategically to these more complex pathways. This can be a problem because public sector organisations are frequently structured like a multinational conglomerate with many separate ‘corporations’ engaged in different activities under a single management structure, making coordination much harder to achieve. This can be complicated further when multiple organisations are involved in the delivery of a single value stream as each organisation can be funded from a different ‘pot’ and has different corporate objectives.

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