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UK health visiting: challenges faced during lean implementation

A.L. Grove (The University of Warwick, Coventry, UK)
J.O. Meredith (The University of Warwick, Coventry, UK)
M. MacIntyre (The University of Warwick, Coventry, UK)
J. Angelis (The University of Warwick, Coventry, UK)
K. Neailey (The University of Warwick, Coventry, UK)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 20 July 2010




The purpose of this paper is to present the challenges identified during a lean implementation in a health visiting service within a large primary care trust in NHS UK.


Following a series of lean workshops a triangulated approach to data collection was adopted in order to determine the root cause of the challenges that were faced during this lean implementation. The three methods that were selected for qualitative analysis included semi‐structured interviews, document analysis and researcher participant observation.


Six key challenges were identified from the data analysis. These were: high process variability; a lack of understanding of lean; poor communication and leadership; target focused; problems defining waste; and difficulty in determining who is the customer and what do they value?

Practical implications

Although this particular lean implantation had limited success, the research has highlighted a number of challenges which would have to be addressed prior to future lean exercises. This will assist other clinical and managerial staff to prepare for the challenges that may be faced during a lean implementation, and adapt their approach to future quality improvement.


The barriers to lean implementation could be overcome with upfront planning, transformational leadership, excellent communication, identification and sharing of best practice and, above all, a shared vision. There is no quick and easy solution to productivity improvement, community services, as in this paper, cannot expect to select lean tools and techniques and emulate the success seen elsewhere. If they wish to deliver world‐class healthcare in the face of constrained resources and greater demand, they need to adopt a long‐term vision.



Grove, A.L., Meredith, J.O., MacIntyre, M., Angelis, J. and Neailey, K. (2010), "UK health visiting: challenges faced during lean implementation", Leadership in Health Services, Vol. 23 No. 3, pp. 204-218.



Emerald Group Publishing Limited

Copyright © 2010, Emerald Group Publishing Limited

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