Toggle Main Menu Toggle Search

Open Access padlockePrints

Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare

Lookup NU author(s): Dr Iain Smith, Professor Christian Hicks, Professor Tom McGovern



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Healthcare systems internationally face quality and productivity challenges and calls have been made for them to focus on delivering better value.1-3 However, in healthcare, value is a debated concept. Value is often viewed in terms of health outcomes per spend for a given population4 or in terms of clinical efficacy, focusing on interventions with a robust evidence base and reducing the use of interventions of low benefit.2 But it can also be considered at the level of the microsystem, and systematic quality improvement (QI) approaches can help provide better value through action on quality, safety, and productivity.1 Lean is one approach that is being increasingly used to enhance value in healthcare.5-7 In the UK, for example, NHS Improvement (which regulates NHS care providers) has embarked on a programme to embed Lean in English NHS trusts—some with support from the Virginia Mason Institute, a US based healthcare consultancy,8 and others with support from an NHS Improvement consulting team.9 Lean has drawn criticism for assuming that production efficiency techniques can apply directly to healthcare10 11 and for lacking methods to integrate clinical knowledge and expertise with patients’ preferences and needs in defining value.12 We examine how it can be used to engage stakeholders in both defining value and designing systems and processes to deliver value.

Publication metadata

Author(s): Smith I, Hicks C, McGovern T

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 2020

Volume: 368

Online publication date: 28/01/2020

Acceptance date: 28/01/2020

Date deposited: 29/01/2020

ISSN (print): 0959-535X

ISSN (electronic): 1756-1833

Publisher: BMJ Publishing Group


DOI: 10.1136/bmj.m35


Altmetrics provided by Altmetric


Funder referenceFunder name
Health Foundation