2021

Dorothy Y. Hung, Ph.D., Gabriela Mujal, M.H.A, Anqi Jin, Ph.D., and Su‐Ying Liang, Ph.D.

Purpose: To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day.

Elina Reponen MD, Ph.D., Ritva Jokela, Janet C. Blodgett M.S., Thomas G. Rundall Ph.D., Stephen M. Shortell Ph.D., Mikko Nuutinen Ph.D., Noora Skants M.D., Markku Mäkijärvi M.D., and Paulus Torkki Ph.D.

Background: Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare.

Elina Reponen M.D., Ph.D., Thomas G. Rundall Ph.D., Stephen M. Shortell MPH, MBA, Ph.D, Janet C. Blodgett M.S.c, Ritva Jokela Ph.D., Markku Mäkijärvi M.D., and Paulus Torkki Ph.D.

Background: Health-care organizations around the world are striving to achieve transformational performance improvement, often through adopting process improvement methodologies such as lean management. Indeed, lean management has been implemented in hospitals in many countries. But despite a shared methodology and the potential benefit of benchmarking lean implementation and its effects on hospital performance, cross-national lean benchmarking is rare. Health-care organizations in different countries operate in very different contexts, including different health-care system models, and these differences may be perceived as limiting the ability of improvers to benchmark lean implementation and related organizational performance. However, no empirical research is available on the international relevance and applicability of lean implementation and hospital performance measures. To begin understanding the opportunities and limitations related to cross-national benchmarking of lean in hospitals, we conducted a cross-national case study of the relevance and applicability of measures of lean implementation in hospitals and hospital performance

Dorothy Y. Hung, Ph. D , Quan A. Truong, M. P. H., and Su-Ying Liang, Ph. D

Background and Objectives: Many primary care practices have adopted Lean techniques to reduce the amount of time spent
completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency. Goal is to examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks.

Pierre-Luc Fournier, Ph.D., Denis Chênevert M.S.c, Marie-Hélène Jobin MBA, Ph.D.

Objective: The purpose of this paper is to study physicians’ reactions to Lean implementation in healthcare organizations. More precisely, we aim to answer the following question: what is the impact of pre-change and change antecedents on physicians’ behavioral reactions to Lean implementation? To do so, we used a quantitative research methodology anchored in two significant frameworks from change management theory, while considering the
unique characteristics of physicians as organizational actors. Using a survey of 176 physicians in healthcare organizations across the USA, the analysis revealed significant effects of pre-change and change antecedents on physicians’ behavioral support for Lean change, mediated by their commitment to organizational change. We concluded that process antecedents linked to change management practices were instrumental in engaging physicians toward Lean, whereas efficiency-driven Lean implementation and traditional managerial techniques of rewards and incentives were counterproductive. This paper contributes to the developing literature on Lean implementation and, more broadly, on service operations management in healthcare, notably by focusing on its most influential group of actors.

Pierre-Luc Fournier Ph.D., Marie-Hélène Jobin MBA, Ph.D., Liette Lapointe, Ph.D. M.S.c & Lionel Bahl, MBA

 Background and Objectives: Physicians’ resistance towards Lean is often viewed as an important barrier to its successful implementation in healthcare organizations. However, there exists a dearth of knowledge regarding what influences reactions from physicians towards Lean and what organizations can do about it. This study adopts a behavioral perspective and focuses on the triggers of physicians’ resistance towards Lean. Using longitudinal qualitative data from multiple case studies of Canadian hospitals, 15 behavioral triggers are identified. A cross-case analysis reveals that core-technical and efficiency-driven changes clash with medical professionalism and generate active resistance from physicians, while leadership and familiarity with Lean are linked to championing behaviors that mitigate it. This study provides a deeper understanding of physicians’ behaviors during Lean transformations and the factors that drive resistance. It also provides insight into how organizations can better engage their medical staff in the Lean efforts by focusing on the process of change to offset resistance.

John S. Toussaint M.D., John R. Griffith, MBA, FACHE, Stephen M. Shortell, Ph.D., MPH, MBA

Background: The U.S. healthcare system is hampered by the lack of a comprehensive continuous improvement management system that empowers providers with data to improve care. But a well-known management framework and a specific management approach fills this gap — the Baldrige Excellence Framework and the Shingo Model of organizational excellence. Hospitals successfully achieving the Baldrige Framework have documented high performance on critical measures of cost, quality, patient satisfaction, and worker satisfaction. We discuss the relationship between Baldrige and Shingo, review the evidence base for the achievements of the approaches to date, and suggest how government, accrediting agencies, and payers might best promote wider adoption of this integration.

Background: The Lean management system is being adopted and implemented by an increasing number of US hospitals. Yet few studies have considered the impact of Lean on hospital-wide performance.