Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study

Abstract

ObjectivesTo date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap.DesignSemistructured, indepth interviews.SettingOne of largest teaching hospitals in the Netherlands.Participants31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean.ResultsThe evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion.ConclusionsImplementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase.

Lean healthcare in developing countries: evidence from Brazilian hospitals

“…In the cases studied, the barriers faced were primarily associated with human factors, including employee distrust, medical interests, conflicts of interest, the frustration of previous attempts, adverse reactions due to lean healthcare's origins in the manufacturing sector and leadership with little training or involvement; other barriers included the lack of knowledge about new lean concepts and technological barriers such as employee computer use. These results corroborate the results found in several papers, such as Aij et al (), Bhat and Jnanesh (), Bhat et al () and Bhat and Jnanesh (), among others.…”

The Safer Delivery of Surgical Services Program (S3)

“…Reports of previous single-intervention studies have not found the need for extra support for clinical teams, 4,[16][17][18] suggesting that this may indeed be a consequence of the complication added by combined interventions, and participants' recognition of the need for extra support. Our more general findings on the challenge posed by the surgical context reflect those of other authors, who have highlighted how lack of senior support 14,19 and the complexity of clinical microsystems that are interdependent but not always well co-ordinated [19][20][21][22] can stymie improvement efforts. This indicates a need for care in the application of the S3 approach elsewhere, particularly outside formal research contexts where resources for support may be fewer, and where the expertise, legitimacy and neutral brokerage offered by an external team may not be available.…”

Connecting empowerment‐focused HRM and labour productivity to work engagement: the mediating role of job demands and resources

“…However, the existence of high labour productivity might not directly benefit a specific department in terms of higher budgets in the specific hospital context of our study. Budget constraints have urged health-care organisations to improve efficiency and reduce costs while maintaining quality (Aij et al, 2013). As a result, cost-containment strategies are highly relevant in the health-care industry and include tight budgets and a focus on keeping down labour costs (Schut and Van de Ven, 2005).…”