Improving Care Delivery Through Lean: Implementation Case Studies
Contract Report
This report presents an introduction to the application of Lean principles in health care settings to improve quality of care, increase efficiency, lower costs, and provide better patient outcomes. Lean is an organizational redesign approach focused on elimination of waste, which is defined as any activity that consumes resources (e.g., staff, time, money, space) without adding value to those being served by the process. In addition to background information and the results of a literature review, the report presents six case studies from five organizations that implemented Lean principles in different types of health care settings. Recommendations are provided for similar organizations wishing to implement Lean in their facilities.
Prepared by:
American Institutes for Research
Urban Institute
Mayo Clinic
Project Background
Rationale and Purpose
Conceptual Framework
Purpose of Case Studies
Methods
Definition of the Sample
Data Collection Activities
Data Analysis
Limitations
References
Case 1. Lakeview Healthcare
Organizational Background
Description of the Health Care System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Lean Training
Lean Project Implementation
Lean Teams
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Cross-Cutting Project
Department-Specific Projects
Projects Started But Not Fully Implemented
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Business or Strategic Case
Factors that Influenced the Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Kaizen Initiative
Staff Engagement
Education and Training
Communication About Lean
Lean Team Composition and Size
Routinization of Lean Processes
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 2. Central Hospital
Organizational Background
Description of the Health System
Description of the Health Care Organization
Leadership
Staffing
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Improvement of "Door-to-Balloon" Process
Management of Surgical Procedure Cards
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 3. Grand Hospital Center
Organizational Background
Description of the Health Care System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Planning Implementation of Lean
Lean Project Selection Process
Lean Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Hip and Knee Replacement Costs
Cardiology Follow-up Appointment Scheduling
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 4. Suntown Hospital
Organizational Background
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Process for Implementing Lean
Planning for Implementation of Lean
Lean Project Selection Process
Lean Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Urinary Tract Infection Prevention and Reduction
Redesigning the Outpatient Medication Prescribing Process
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Moving Forward
Case 5. Heights Hospital
Organizational Background
Description of the Health System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Planning for Implementation of Lean
Lean Value Stream and Project Selection Process
Lean Training
Other Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Emergency Department Value Stream Projects (Retrospective)
Pediatric Continuity of Care Project (Prospective)
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 6. Horizon Hospital—Lakeview Healthcare
Organizational Background
Description of the Health System: Lakeview Healthcare
Description of Horizon Hospital
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Lean Training
Lean Project Implementation
Lean Teams
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Hospital Project
Horizon Hospital
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Using Principles to Design and Hospital
This report was prepared for the Agency for Healthcare Research and Quality by the American Institutes for Research (Contract HHSA290200600019). It is in the public domain and may be used and reprinted without permission. Citation as to source is appreciated.
Prepared by:
American Institutes for Research
Urban Institute
Mayo Clinic
Contents
IntroductionProject Background
Rationale and Purpose
Conceptual Framework
Purpose of Case Studies
Methods
Definition of the Sample
Data Collection Activities
Data Analysis
Limitations
References
Case 1. Lakeview Healthcare
Organizational Background
Description of the Health Care System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Lean Training
Lean Project Implementation
Lean Teams
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Cross-Cutting Project
Department-Specific Projects
Projects Started But Not Fully Implemented
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Business or Strategic Case
Factors that Influenced the Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Kaizen Initiative
Staff Engagement
Education and Training
Communication About Lean
Lean Team Composition and Size
Routinization of Lean Processes
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 2. Central Hospital
Organizational Background
Description of the Health System
Description of the Health Care Organization
Leadership
Staffing
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Improvement of "Door-to-Balloon" Process
Management of Surgical Procedure Cards
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 3. Grand Hospital Center
Organizational Background
Description of the Health Care System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Planning Implementation of Lean
Lean Project Selection Process
Lean Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Hip and Knee Replacement Costs
Cardiology Follow-up Appointment Scheduling
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 4. Suntown Hospital
Organizational Background
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Process for Implementing Lean
Planning for Implementation of Lean
Lean Project Selection Process
Lean Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Urinary Tract Infection Prevention and Reduction
Redesigning the Outpatient Medication Prescribing Process
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Moving Forward
Case 5. Heights Hospital
Organizational Background
Description of the Health System
Description of the Health Care Organization
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Planning for Implementation of Lean
Lean Value Stream and Project Selection Process
Lean Training
Other Training
Process for Lean Projects
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Projects Studied
Emergency Department Value Stream Projects (Retrospective)
Pediatric Continuity of Care Project (Prospective)
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Implementing Lean
Case 6. Horizon Hospital—Lakeview Healthcare
Organizational Background
Description of the Health System: Lakeview Healthcare
Description of Horizon Hospital
Other Environmental Context
Lean and Quality Improvement at the Organization
History of Quality and Efficiency Improvement Efforts at the Organization
Initiation of Lean at the Organization
Alignment of Lean and Quality Improvement Efforts
Process for Implementing Lean
Lean Project Selection Process
Planning Implementation of Lean
Lean Training
Lean Project Implementation
Lean Teams
Monitoring, Control, and Sustainment
Dissemination and Spread of Findings
Lean Hospital Project
Horizon Hospital
Outcomes of Lean
Intermediate Outcomes
Ultimate Outcomes
Factors that Influenced Success of Lean Implementation
Organizing the Lean Initiative
Implementing the Lean Initiative
Conclusions
Recommendations for Similar Organizations Using Principles to Design and Hospital
This report was prepared for the Agency for Healthcare Research and Quality by the American Institutes for Research (Contract HHSA290200600019). It is in the public domain and may be used and reprinted without permission. Citation as to source is appreciated.
The opinions presented here are those of the authors and do not necessarily reflect the position of the U.S. Department of Health and Human Services or the Agency for Healthcare Research and Quality.
Page last reviewed November 2014
Internet Citation: Improving Care Delivery Through Lean: Implementation Case Studies: Contract Report. November 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/system/systemdesign/leancasestudies/index.html
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