Study Examines Five Hospital Systems’ Implementation of Lean

Organizational contexts have a profound effect on the successful implementation of Lean strategies and tools and may affect other types of process redesign and quality improvement, according to an AHRQ-funded study. Adopted from Toyota Production Systems, Lean is a continuous quality improvement strategy for standardizing and streamlining work flow. “Effects of Organizational Context on Lean Implementation in Five Hospital Systems” appeared online December 23 in the journal Health Care Management Review. Researchers, including AHRQ’s Michael I. Harrison, Ph.D., identified several ways intra-organizational context shapes Lean implementation and outcomes. These include CEO commitment and support, prior organizational capacity for performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts, training, appropriate project management and effective communication within and across teams. The findings underscore the importance of ensuring that the management system, information technology and other organizational conditions can support an improvement initiative.

2014 Dec 23. [Epub ahead of print]

Effects of organizational context on Lean implementation in five hospital systems.

Harrison MI1, Paez K, Carman KL, Stephens J, Smeeding L, Devers KJ, Garfinkel S.

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Abstract

BACKGROUND::

Despite broad agreement among researchers about the value of examining how context shapes implementation of improvement programs and projects, limited attention has been paid to contextual effects on implementation of Lean.

PURPOSE::

To help reduce gaps in knowledge of effects of intraorganizational context, we researched Lean implementation initiatives in fiveorganizations and examined 12 of their Lean rapid improvement projects. All projects aimed at improving clinical care delivery.

METHODOLOGY/APPROACH::

On the basis of the literature on Lean, innovation, and quality improvement, we developed a framework of factors likely to affect Lean implementation and outcomes. Drawing on the framework, we conducted semistructured interviews and applied qualitative codes to the transcribed interviews. Available documents, data, and observations supplemented the interviews. We constructed case studies of Leanimplementation in each organization, compared implementation across organizations, and compared the 12 projects.

FINDINGS::

Intraorganizational characteristics affecting organization-wide Lean initiatives and often also shaping project outcomes included CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts to Lean, staff training before and during projects, establishment of measurable and relevant project targets, planning of project sequences that enhance staff capabilities and commitment without overburdening them, and ensuring communication between project members and other affected staff. Dependence of projects on inputs of new information technology was a barrier to project success. Incremental implementation of Lean produced reported improvements in operational efficiency and occasionally in care quality. However, even under the relatively favorable circumstances prevailing in our study sites, incrementalimplementation did not readily change organizational culture.

PRACTICE IMPLICATIONS::

This study should alert researchers, managers, and teachers of management to ways that contexts shape Leanimplementation and may affect other types of process redesign and quality improvement.