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Lean on us – industrial efficiency in hospice care
  1. Simon Kelby
  1. Nightingale House Hospice, Wrexham, Wales


With a tightening economy and increasingly complex patient needs our hospice sought novel ways to increase efficiency. Turning to industry for inspiration we appointed a volunteer expert in process management to help develop and run hospice efficiency projects.


  • Expert develops a clear methodology for hospices and leads the process

  • The expert trains staff in these principles

  • Improve patient safety and care

  • Increase staff and volunteer satisfaction

  • To be Staff led – Staff to identify problems, seek solutions, implement and take responsibility for them

  • Develop processes to continuously improve.

Methods A volunteer industry expert in process management first developed Lean for use in hospices and then ran the Lean projects. Lean is a widely used tool in industry and the care sector but not previously used in hospices. Staff identified problems; solutions were trialled, adjusted and implemented using Lean tools. The expert ensured projects were focused, delivering a tangible benefit in reasonable time.


  • £2500 reduction in purchasing of goods

  • Reduced handovers by over 5 h per week

  • Increased gift aid by £10 000 per year

  • Higher staff and volunteer satisfaction as fully involved.

  • Reduced wasted time increasing time spent with patients.


Conclusions Using an industry expert allowed the development of Lean for hospices and greatly speeded the implementations of solutions, helping us see processes in a fresh light. Staff trained in Lean now use their own initiative to solve problems using Lean principles.


  • Lean is successfully adaptable for hospices

  • Project solutions must be management encouraged but staff led

  • Use an expert to set up the process but staff must be trained to run the process long term

  • Significant efficiencies can be made while improving staff enthusiasm.

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