How to design Lean interventions to enable impact, sustainability and effectiveness. A mixed-method study

Abstract

Objective: This study’s aim was to assess how various organisational designs affect Lean interventions’ success. Refinement of design and analytics contributes to the knowledge of organisational change management, and promote sound investment in quality improvement.Methods: A panel of 11 experienced Lean consultants ranked the success of 17 Lean interventions implemented at a university hospital. This was done by assessing their impact on outcome, the sustainability of the improved work processes and the effectiveness regarding degree of goal achievement. The potential relationship between the interventions’ rank, organisation, targets for improvement, and use of time and resources, was analysed by a linear mixed model.Results: 30 percent of the interventions were assessed as successful, 60 percent as moderately successful, and 10 percent as unsuccessful. Employee and safety-staff representation (β 0.22 [CI 0.07–0.37]), top management attendance (β 0.14 [CI 0.10–0.18]), patient-related goals (β 0.13 [CI 0.06–0.20]) and hours in work-groups (β 0.01 [CI 0.00–0.01]) were related to impact on outcome. Interventions that ranged across divisions (β -0.45 [CI -0.75– -0.19]), employee and safety-staff representation (β 0.44 [CI 0.29–0.60]), comprehensive project organisation (β 0.22 [CI 0.08–0.36]) and patient-related goals (β 0.18 [CI 0.11–0.26]) were related to sustainability. Interventions that ranged across divisions (β -1.39 [CI -1.96– -0.81]), comprehensive project organisation (β 0.30 [CI 0.18–0.43]), employee and safety-staff representation (β 0.25 [CI 0.89–0.41]), limited top-management attendance (β -0.18 [CI -0.28– -0.08]), multi-disciplinary teams composed of several professions (β 0.16 [CI 0.08–0.24]) and patient-related goals (β 0.15 [CI 0.04–0.19]) were all related to a higher degree of effectiveness.Conclusions: To achieve quality improvement in hospitals, policymakers are advised to invest in time and a comprehensive project organisation. Furthermore, the interventions should engage multidisciplinary teams including employee and safety-staff representatives and pursue improvement for patients, across divisions. The methods applied constitute a framework for future research.

System-wide lean implementation in health care: A multiple case study

“…13,14 Nonetheless, most of the published lean studies have narrowed their focus to single technical applications or short-term improvements resulting in small pockets of best practices, with limited evidence on what drives effective system-wide lean implementation. 11,15,16 In order to understand the variation in how and when lean works in health care organizations, it is of a paramount importance to examine the organizational patterns that play a relevant role for the integration and the internalization of the change process. 10,16,17 A recent comprehensive review on the organizational factors that enable effective use of lean practices in health care has been conducted by the authors.…”

“…11,15,16 In order to understand the variation in how and when lean works in health care organizations, it is of a paramount importance to examine the organizational patterns that play a relevant role for the integration and the internalization of the change process. 10,16,17 A recent comprehensive review on the organizational factors that enable effective use of lean practices in health care has been conducted by the authors. 18 Findings showed that literature on lean in health care has mainly investigated single organizational factors (see Table 1), lacking insight on how these elements are influencing each other and how lean change management strategies can be developed across the organization as a whole.…”

Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement

“… 3 4 However, sustainability of results after the initial period of short-term gains has been proven difficult to achieve, 5 6 and there is only limited understanding of factors influencing variation in results across organisational settings. 5 7 Plausible explanations for some of the observed limitations can be found in the scope of the lean improvement efforts. The types of outcomes addressed have mainly focused on operational aspects of performance, while little attention has been paid to sociotechnical aspects, such as employees' health, well-being and creativity.…”

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement

“…lean has organizational and structural implications. When health care organizations manage to implement lean across organizational boundaries, the gains can be large and results can be sustained in the long term [ 35 ]. However, the shift towards a process-oriented organization in health care has proven difficult in Sweden and internationally [ 25 , 26 , 36 ].…”

“… The “model of improvement” which links the Plan-Do-Study-Act (PDSA) cycle of iterative learning with three questions related to goal, measurement, and what to change [ 11 ]. Results Factors related to lean success: comprehensive project organization, employee and safety-staff representation, and top management attendance [ 35 ]. Factors related to QI success: leadership from top management, QI experience, organizational culture, and data infrastructure/information systems [ 10 ].…”