Understanding before implementing: the context of Lean in public healthcare organizations

Fournier, Pierre‐Luc; Jobin, Marie‐Hélène

doi:10.1080/09540962.2018.1389505

Cited by 26 publications

(22 citation statements)

References 48 publications

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“…This may have a bearing on "project fatigue" in hospitals because so many problems within their facilities need attention 124 ; thus a short follow-up analysis might not be a proper indicator of achievement. Some other aspects that might compromise the sustainability of LH improvements include poor understanding of the organizational context, 125 less time for lean teams, and increased patient volume. 92 Conversely, the successful implementation of lean or any other improvement framework requires that the hospital and medical leadership are all strong supporters of the methodology, speak the same process improvement language, and are able to generate support and resources for an operation-wide forward movement.…”

Section: Discussionmentioning

confidence: 99%

Effects of Lean Healthcare on Patient Flow: A Systematic Review

et al. 2020

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Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

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Section: Discussionmentioning

confidence: 99%

Effects of Lean Healthcare on Patient Flow: A Systematic Review

et al. 2020

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“…Hereafter, a brief follow-up analysis might not be an appropriate indicator of improvement. Some other characteristics that might compromise the sustainability of LH achievements include increased patient volume [ 138 ], a poor understanding of the organizational context [ 169 ], insufficient space and time for coherent team co-operative improvement, the tension between promoting staff ownership and providing direction [ 88 ], the incomplete or slow adoption of the interventions [ 93 ], and a lack of standardization [ 48 ]. Naturally, to fully realize the potential benefits of LH, organizations need to minimize the impact of such barriers and capitalize on facilitating conditions that are specific to their local contexts [ 134 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

Zepeda-Lugo

Tlapa

Báez-López

et al. 2020

IJERPH

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Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

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“…During the last decades new administrative approaches (e.g., Lean [40] and Triple-Aim [41]), new treatment methodologies (e.g., a gene therapy) and new technologies are leveraged to both operational and leadership purposes [42,43]. At the same time, the outsourcing and subcontracting have increased [44] to even out the public-sector service demand and resource fluctuation.…”

Section: Discussionmentioning

confidence: 99%

Common controls driven conceptual leadership framework

Mussalo¹,

Hotti²,

Kirjanen³

et al. 2018

FinJeHeW

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The forthcoming social welfare and healthcare reform in Finland with its organizational, financing and steering changes challenges the leadership. All service systems levels of the social welfare and healthcare have to achieve performance objectives whilst at the same time also meeting conformance requirements. However, there are hundreds authority documents (e.g., best practices, guidelines, regulations and standards) the common controls of which are adapted partly manually and partly by leveraging automation in organizations. Leaders review and develop their practices around performance and conformity (i.e., conformance or compliance) within frameworks that are mainly the sets of principles. However, the common controls affect into the main tasks of the governance (i.e., direct, evaluate and monitor). Therefore, we construct a conceptual leadership framework to highlight the meaning of the common controls and the meaning of criteria for performance and conformity. The constructed framework contains the terms (e.g., a control objective, decision criteria, event, insight, and transaction) that are mainly defined in the glossaries of the authority documents. The terms are used to find out terms and definitions for the leadership framework to figure out cognitive meanings for the concepts of the common controls driven leadership.

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Understanding before implementing: the context of Lean in public healthcare organizations

Cited by 26 publications

References 48 publications

Effects of Lean Healthcare on Patient Flow: A Systematic Review

Effects of Lean Healthcare on Patient Flow: A Systematic Review

Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review

Common controls driven conceptual leadership framework

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