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Lean on us – a clinical kitchen
  1. Simon Kelby
  1. Nightingale Hospice, Wrexham, Wales


Recognising the importance of food for patients is central to successfully delivering nutritional care. Our hospice sought to improve the patient experience by bringing kitchen staff into the clinical team. A project using Lean principles run by a volunteer industry expert and a Macmillan palliative dietician is underway to achieve this.


  • Improve the patient food experience.

  • Integrate kitchen staff into the clinical team

  • Develop team working without altering reporting structures

  • Use the new team to improve nutritional care.


  • Utilise Lean (a widely used tool in industry and the care sector) to affect the changes.

  • Ward and kitchen staff discuss problems, seek solutions, implement them and take responsibility for their success.

  • Launch a full review of nutritional care to find and resolve issues using Lean principles.

Results The project is still underway but already we have successfully brought together the kitchen and nursing staff increasing their mutual understanding. The team is developing better systems and have Lean tools to help them continuously improve. This has resulted in more consistent delivery of nutritional care to patients.

Conclusion We have not yet seen the full patient benefit but by bringing together the kitchen and nursing staff makes delivering nutritional care much simpler and more effective. Frustrations caused by lack of processes for communication between kitchen and ward staff led to inefficiencies and lower patient care. These are being overcome and the whole team is now more efficient and reactive to changing patient needs and is more efficient.


  • Bringing nutrition into clinical care ensures this critical area is more fully delivered.

  • Allowing the whole team to develop and implement ideas ensures full staff buy in.

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