Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care

Poksińska, Bozena; Fialkowska-Filipek, Malgorzata; Engström, Jon

doi:10.1136/bmjqs-2015-004290

Cited by 74 publications

(63 citation statements)

References 30 publications

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“…However, long after implementation, some authors noted high variability in the applications and outcomes, requiring further research (Andersen & Røvik, ; Andersen, Røvik, & Ingebrigtsen, ; D'Andreamatteo, Ianni, Lega, & Sargiacomo, ). Others have indicated the necessity to evaluate not only the waiting times and economic performance but also the patients' and workers' experiential perspectives (Holden, Eriksson, Andreasson, Williamsson, & Dellve, ; Moraros, Lemstra, & Nwankwo, ; Poksinska, Fialkowska‐Filipek, & Engström, ; Waring & Bishop, ).…”

Section: Discussion Of Findingsmentioning

confidence: 99%

Construction of nursing knowledge in commodified contexts: A discussion paper

2020

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This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge. K E Y W O R D Sglobalization, health policy, nurse-patient relationships, nursing knowledge, nursing practice improve practice and global care, contributing to the common good, and working to achieve a fair and strong society. Thus, through organizational, sociopolitical, and emancipatory knowledge, nurses are enabled to use strategies to adapt to or resist commodified contexts while constructing basic patterns of knowing.

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Section: Discussion Of Findingsmentioning

confidence: 99%

Construction of nursing knowledge in commodified contexts: A discussion paper

2020

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“…Finally, it is a common critique of Lean-based approaches that, at least in implementation, they fail to take due account of the customer (the patient in the health-care context). 36 This was an issue that we took an interest in during our fieldwork.…”

Section: Framework For Understanding Local Approaches To Productive mentioning

confidence: 99%

“…October 2009 65 71 (48) 43 (24) 67 (48) 84 (38) November 2009 65 68 (49) 41 (23) 66 (38) 82 (30) December 2009 65 72 (42) 42 (24) 68 (40) 84 (26) January 2010 68 73 (51) 45 (10) 70 (23) 83 (33) February 2010 68 76 (49) 47 (4) 68 (37) 79 (29) March 2010 68 83 (53) 51 (4) 69 (33) 83 (35) April 2010 74 80 (61) 45 (13) 70 (37) 82 (41) May 2010 74 83 (61) 41 (10) 70 (32) 83 (35) June 2010 80 78 (67) 40 (16) 68 (42) 83 (36) July 2010 80 81 (63) 40 (18) 70 (28) 85 (29) August 2010 84 80 (64) 39 (21) 69 (37) 83 (27) September 2010 84 78 (62) 39 (16) 70 (50) 83 (33) October 2010 84 80 (55) 41 (10) 70 (39) 82 (4) November 2010 88 72 (53) 43 (11) 72 (42) 84 (26) December 2010 88 72 (49) 40 (9) 74 (42) 85 (27) January 2011 88 76...…”

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confidence: 99%

The 10-year impact of a ward-level quality improvement intervention in acute hospitals: a multiple methods study

Sarre

Maben

Griffiths

et al. 2019

Health Serv Deliv Res

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Background The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited. Objective To explore if PW had a sustained impact over the past decade. Design Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews. Data sources Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads. Results Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range < 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector. Limitations The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change. Conclusions Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18. Funding This National Institute for Health Research Health Services and Delivery Research programme.

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“…And, indeed, the evidence base for the use of Lean/TPS in healthcare is weak56–58 and increasingly negative 59 60…”

Section: Considering the Virtues Of ‘5 Whys’mentioning

confidence: 99%