The maturity of lean management in a large academic medical center in Finland: a qualitative study

Abstract

Background Lean management provides hospitals with tools to respond to today´s rapidly changing health care environment. However, evidence of its success is inconclusive. In some cases, well-executed Lean management supports effective, beneficial and safe patient care, reduces costs and increases patient and staff satisfaction. In other cases, though, the desired outcomes have not been achieved. Organisations must acknowledge the maturity level of Lean management to successfully implement it for continuous development. This study evaluates the maturity of Lean implementation using a structured interview with a framework based on the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) and utilises findings about Lean adoption to evaluate factors that support and hinder its implementation, with the aim of assist leaders in maintaining and developing Lean in health care. Methods The article describes a case study done at the Helsinki University Hospital. A qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fifteen healthcare leaders from the three sectors participated in a semi-structured interview based on the dimensions of the LHISI. Qualitative content analyses were based on grounded theory. Results We concluded that the five dimensions (leadership, commitment, standard work, communication and daily management system) of LHISI provide a comprehensive framework for qualitatively evaluating Lean in the hospital. We found that the five dimensions are influenced by other explanatory factors. These explanatory factors, knowledge about Lean, available data and environmental, psychological and organisational factors, all support and hinder leadership, communication, daily management and commitment to Lean in the hospital. The results highlight differences in the Lean maturity levels in the hospital. We noticed that nine of 15 leaders had misunderstanding of Lean, and all three sectors showed a lack of staff commitment to Lean in their units. Conclusion To strengthen the organisation-wide implementation of Lean, it is necessary to understand that Lean management is a comprehensive socio-technical management system, for which it is not enough to mechanically implement Lean with tools and techniques alone. By focusing on and developing the five dimensions and explanatory factors, organizations can achieve a high maturity of Lean and reach their full potential. A good level of competency and commitment to Lean by the leaders and the staff alike are important for achieving goals, engaging the staff and increasing the quality of patient care in the hospital. The long-term Lean development of a hospital organisation can be followed and continuously maintained via easy-to-use maturity tools.