Unlocking the Power of Change Management in Lean Healthcare: A Guide for NHS Managers

As an NHS manager tasked with improving operational performance, you might feel skeptical about process improvement methodologies. Terms like “Lean” or “Kaizen” can sound like buzzwords that promise efficiency but risk disrupting your already overstretched teams. You’re not alone in thinking, “Is this really worth the effort?”

The truth is, Lean healthcare isn’t about upending workflows or adding more work. At its core, it’s about streamlining what already exists to reduce waste, empower staff, and deliver better care – without chaos. Here’s how to approach using change management with Lean, in a way that aligns with NHS priorities, respects your teams, and drives lasting results.

1. Start with Personal Leadership – Not Top-Down Mandates

The Challenge: Staff often view process improvement as a “management fad” that only adds to high levels of bureaucracy. This immediately puts your improvement efforts on the backfoot. Your project will be viewed as a temporary thing that will eventually go away.

I’ve personally seen many projects fail almost right from the beginning as managers fail to appreciate the importance of making the improvement effort ‘theirs’ in an authentic manner. You have to make the project a personal endeavour and own it from day one.

Why it matters: Change starts at the top. As a manager, your visible support and commitment is crucial. When leaders champion improvement efforts, it sends a clear message that this isn’t just another passing fad – it’s a priority. Your role is to consistently set the vision, provide resources, and keep the momentum going.

The Lean Approach:

• Lead by example: Instead of dictating changes, visibly support improvement efforts. Attend team huddles, ask frontline staff for input, and allocate time/resources for pilots.
• Why It Works: When leaders prioritize improvement as part of daily work (not an “extra”), teams see it as legitimate. This builds trust and reduces perceptions of disruption.

Tip: Even if you’re not a “change management expert,” showing genuine interest and asking your teams for their ideas can make a huge difference. Make them feel that they are at the core of the change process.

2. Engage Frontline Teams – They Know Best

The Concern: “We don’t have time for workshops or brainstorming sessions.” This is a good way to fail fast. Your operational teams are the ones that are closest to the actual processes. They use them every day. They will know what’s working and what’s not. More importantly they’ll know why and have ideas on what to fix. There are two vitally important things you can do here? 1 – ask your teams for their ideas, 2 – provide training to give them the skills to be able to articulate the problem e.g. Lean essentials training.

Why it matters: Lean healthcare isn’t about imposing change from above – it’s about empowering your staff to improve the way they work. When teams are involved in shaping new processes, they’re more likely to embrace change and less likely to resist it.

The Lean Solution:

• Small, incremental changes: Empower your staff to identify “quick wins” e.g., reorganising supply closets to save nurses’ time.
• Why It Works: Frontline staff know where the inefficiencies are. By involving them, changes feel less like imposed “disruption” and more like solving daily frustrations.

Tip: Start small. Invite your teams to identify “quick wins” or simple changes that could make their day easier. Celebrate these successes to build confidence.

3. Communicate, Communicate and Communicate some more – No Surprises

The Fear: “Change will confuse people and create resistance.” In all of my years implementing Lean and change management, one consistent truth I’ve seen time and time again is that in the absence of good communication the void is filled with misinformation. The net affect is that the change effort becomes that much harder to deliver success and takes longer.

Why it matters: Uncertainty breeds resistance. By communicating early and often – explaining the “why” behind changes and how they’ll benefit both your staff and patients – you can reduce anxiety and build trust.

The Lean Fix:

• Explain the why: Connect improvements to patient outcomes (e.g., “Reducing medication errors” vs. “implementing a new checklist”).
• Share progress regularly: Use simple visuals (e.g., whiteboards in staff rooms) to show how small changes add up.
• Why It Works: Transparency reduces anxiety. When teams see how their effort ties to better care, they’re more likely to buy in.

Tip: Use real stories and examples, if possible from your own projects. Alternatively, show how process improvements have helped other NHS teams reduce stress, save time, and improve patient care.

4. Focus on Patients – Not Just Processes

The Doubt: “Will this actually improve care, or just look good on paper?”. This is an important point. Change projects can all too easily focus more on what is done than on to whom it is done. The first Lean principle asks you to specify value from you patients’/end users’ perspective. Engaging with patients will reveal vital clues to what you need to do and importantly not do. If patients find one aspect of the process as value adding and important, it’s prudent to keep that particular process.

The Lean Priority:

• Start by mapping patient journeys: Identify bottlenecks (e.g., delays in discharge) that harm both staff morale and patient experience.
• Measure what matters: Track metrics like wait times, not just cost savings.
• Why It Works: Linking changes to patient value keeps teams motivated and ensures improvements have real-world impact.

5. Build Skills Gradually – No Overwhelm

The Hesitation: “We don’t have Lean experts here.” Starting any improvement project can be a daunting task. Getting it wrong can have big consequences. The personal impact of failure can also be daunting. One way to mitigate this risk is to start small. Don’t try to boil the ocean. Know that one of the most important requirements for successfu delivery will be having the right skillsets to do what is required.

Why it matters: The first likely step you will take before starting your improvement project will be to gather robust data. Data collection and analysis is an important skill to have. Once you are aware that you need this you can start to plan the ‘how’ to achieve it. This is where change management comes in. Speak with your teams and identify colleagues who might find this a welcome challenge and take on relevant training. Once you’ve created the ‘pull’ there’s a greater likelihood of strong engagement and success with any training.

The Lean Answer:

• Start with one tool: Train teams on a single method e.g., 5S for organizing workspaces and scale slowly.
• Pair staff with “Lean champions”: Identify early adopters who can mentor others.
• Why It Works: Bite-sized learning prevents burnout and builds confidence organically.

6. Celebrate Small Wins – Fast Momentum

The Worry: “Improvement projects take too long to show results.” Usually there is lots of pressure to improve operational performance that is trending downwards. This means that you are typically under the proverbial spotlight and need to turn around things quickly. I’ve already said that process improvement is not a ‘quick fix’. To do it right, and make improvements sustainable, takes effort and time. Fortunately, change management principles can help to maximise your efforts. A key factor to getting momentum is celebrating wins. I’m not talking about large scale wins (they’re nice) but take time. I’m referring to small wins e.g. achieving a small milestone like a colleague completing Lean training, getting sign off to commence a small project or even getting your first positive feedback from colleagues and patients. The size is unimportant, it’s the impact that your’re celebrating.

Why it matters: As people we want to know that what we spend our time and energies on is important. A key validator is recognisition and kudos for a job done well. This principle is incredibly important for effective team engagement and culture change.

The Lean Strategy:

• Have a simple strategy in place of monitoring progress and capturing successes.
• Publicly recognise teams: Acknowledge contributions in staff meetings or newsletters.
• Why It Works: Quick wins prove the value of Lean without waiting months for ROI. Momentum builds morale.

7. Make It Sustainable – Avoid Backsliding

The Risk: “We’ll do all this work, then go back to old habits.” A real risk is that new ways of working quickly return to old ways of working. This usually happens over period of time. It’s a sign that something has either got lost or overlooked during the redesign process. In my experience this is a consequence of poor communication and team engagement. It’s vitally important that you regularly speak with your teams and listen to what they say.

Why it matters: Usually, team members will raise a ‘red flag’ if they have an issue. It’s your job as a leader to take the time to listen and mitigate any issues that are raised. Yes, this will take even more of your precious time, which you don’t have in abundance. The fact is, it will save you lots of time and headache in the longer term.

The Lean Safeguard:

• Standardize successes: Turn proven changes into simple protocols (e.g., a new handover checklist).
• Audit gently: Use peer reviews, not punitive checks, to sustain progress.
• Why It Works: Embedding changes into daily routines makes them stick—no extra effort required.

8. Why Bother? The Real Benefits

You might still be wondering: Is all this effort worth it? Here’s what effective change management in lean healthcare can deliver:

• Less Firefighting, More Problem-Solving: Instead of constantly reacting to issues, you’ll have systems in place to prevent them.
• Happier, More Engaged Teams: Staff who are involved in improvement feel valued and are less likely to burn out.
• Better Patient Outcomes: Streamlined processes mean patients get the right care, at the right time, with fewer delays.
• Sustainable Results: Improvements stick because they’re built into the way your teams work—not just imposed from above.

Final Thoughts

Change doesn’t have to be disruptive or exhausting. With the right approach, you can lead your teams through lean healthcare improvements that make everyone’s lives easier—including yours. Start small, communicate clearly, involve your people, and celebrate every step forward. The results will speak for themselves.

Ready to give it a try? Your team—and your patients—will thank you.