Lean implementation in healthcare: offsetting Physicians’ resistance to change

Fournier, Pierre‐Luc; Jobin, Marie‐Hélène; Lapointe, Liette; Bahl, Lionel

doi:10.1080/09537287.2021.1938730

Cited by 21 publications

(18 citation statements)

References 52 publications

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“…Such reorganization is needed to adapt the technology to social needs, including the beliefs and barriers of patients and caretakers [ 168 ], as well as cultural barriers, lack of awareness, and resource limitations [ 160 ]. Moreover, physicians’ resistance to change has been commonly reported when implementing lean interventions [ 169 , 170 , 171 ] due to the perception that lean interventions might target established medical practices [ 169 ]. However, in the present study, we did not identify any reported resistance to the dual intervention of LH and DTs.…”

Section: Discussionmentioning

confidence: 99%

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Tlapa

Tortorella

Fogliatto

et al. 2022

IJERPH

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Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean–Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.

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Section: Discussionmentioning

confidence: 99%

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Tlapa

Tortorella

Fogliatto

et al. 2022

IJERPH

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show abstract

“…The literature still often portrays physicians and many professional groups as reactive, inertial, and change-resistant in terms of assuming lead roles in navigating change, either for themselves or their organizations ( Fournier et al, 2021 ). The findings presented here paint an alternative picture of physicians.…”

Section: Discussionmentioning

confidence: 99%

Resiliency-based adaptations used by primary care physicians during the COVID-19 pandemic

Hoff

Neff

2023

Health Care Manage Rev

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Background: The COVID-19 pandemic is a profound change event for U.S. primary care physicians and their medical practices. Purpose: We examined how a group of U.S. primary care physicians and their medical practices used resiliency-based strategies, tactics, and mindsets to navigate pandemic-related change over the time period early 2020 through mid-2021. Methodology: A 15-month longitudinal qualitative study of the same 10 physicians interviewed a total of 42 times at four time intervals during the 2020-2021 COVID-19 pandemic. Data were analyzed using a systematic coding approach consisting of firstand second-order code categories feeding into an overall interpretive framework of resiliency-based adaptations. Results: Primary care physicians and their practices engaged in two main resiliency-based strategic adaptations during the pandemic. These adaptations were labeled "keeping the business afloat" and "keeping primary care relevant for patients." Each consisted of different strategies and tactics that shared common features including proactiveness, innovativeness, and pragmatism. Specific resiliency-based mindsets were identified that helped physicians both initially engage in needed strategies and tactics while continuing to engage in them over time. Conclusions:The results demonstrate how physicians use resiliency-based adaptation in response to profound change in their environments, defined by behavioral variety and motivated by self-interested and patient-centered imperatives. Practice Implications: Physicians are proactive and possess multiple adaptive capabilities. Seen in this more positive light, health care organizations should focus on greater engagement of their physician-employees in implementing innovation in care delivery and managing change, that is, as responsible partners rather than resistors to meeting organizational imperatives.

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“…Second, our research finds that resistance is both inevitable and necessary as logics of the past, present and future, carried by tools, institutions and people, confront each other through appropriating new performance management tools. Resistance serves as a meeting point (“un passage obligé”) and a place for reconciliation, where technological actors (tools), institutions and individuals connect with each other through conflicts (compatibility issues), shared reflexivity and local adaptive capacities (Fournier et al. , 2021b; Ropo and Salovaara, 2019; Sergi, 2016).…”

Section: Discussionmentioning

confidence: 99%

Appropriating integrated performance management tools in healthcare: a sociomaterial work story

Côté-Boileau

Bréton

Rouleau

et al. 2021

JHOM

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PurposeThe purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work.Design/methodology/approachMulti-site organizational ethnographic case studies in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 h), individual semi-structured interviews (N = 34), and document review (N = 143).FindingsThree types of legitimate sociomaterial work are accomplished when actors appropriate control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional work-paths: tools consistently engage in disruptive work; institutions consistently engage in maintaining work, and people consistently engage in creation work. The study reveals the potential of performance management tools as “effective integrators” of the technological, managerial, policy and delivery levels of data-driven health system performance and improvement.Practical implicationsThis paper draws on theoretically informed empirical insights to develop actionable knowledge around how to better design, implement and adapt tool-driven health system change: 1) Packaging the three agents of data-driven system change in health care: tools, institutions, people; 2) Redefining the search for performance in health care in the context of value creation, and; 3) Strengthening clinical and managerial relevance in health performance management practice.Originality/valueThe authors aim to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging theoretical, ontological and practical conceptions of work in healthcare organizations and beyond.

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Lean implementation in healthcare: offsetting Physicians’ resistance to change

Cited by 21 publications

References 52 publications

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Resiliency-based adaptations used by primary care physicians during the COVID-19 pandemic

Appropriating integrated performance management tools in healthcare: a sociomaterial work story

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