Abstract

In 2015 the Trust Development Authority launched a partnership between the NHS and The Virginia Mason Institute (USA) in an effort to improve quality and patient safety. Over the next five years, five Trusts will implement the ‘Virginia Mason Production System’; an adaptation of Toyota’s Lean manufacturing method. Whilst there is currently no literature describing the partnership, there is a wealth of literature on similar quality improvement initiatives that have used ‘Lean’ methods to enhance the efficiency and safety of healthcare. Radnor et al. highlighted the barriers faced whilst introducing the concept of Lean into the NHS. They found that ‘the conflict between managerial and the clinical roles’ limited the successful integration and long term benefits of Lean. The doctor-manager relationship has been poor historically; a recent publication by Davies and Powell suggests that this is still the case. Conflict results in lack of clinical engagement in quality improvement interventions, such as Lean. Quality improvement is reliant upon clinical engagement, therefore establishing clinical engagement in this partnership is vital. With this premise in mind, this study aimed to establish the extent of clinical engagement in the Virginia Mason Programme. The understanding, roles and priorities of doctors and managers were compared, and if they were found to be divergent, was this was a barrier to the successful implementation of the programme? Data collected during interviews with staff from 3 NHS Trusts found that the doctor-manager relationship was not perceived to be the major barrier to implementation. Other barriers that needed to be circumvented were; the reluctance to learn from an American healthcare system, lack of involvement of senior managers and a poor communication strategy. Promisingly, clinical engagement was prioritised by both managers and doctors, which if achieved, could secure the success of the Virginia Mason Programme within the NHS.