Abstract
A lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs’ person-centred practice. This realist inquiry asks ‘whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures’. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants’ LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.
Highlights
The CMO configuration (CMOc) relating to staff extracted from the realist review identified five potential contexts or contextual factors, seven mechanisms, and six outcomes (Figure 4)
The CMOc identified that staff who were Lean Six Sigma (LSS) practitioners often operated in contexts (C) where they met expressions of ‘we’ve always done it this way’ (C) [60,61] with improvement happening in silos and not across departments or organisations (C) [3,9,10]
They encountered perceptions of LSS as ‘the latest fad’ (C) [62,63,64] and feelings of ‘we tried that before and it didn’t work’ amongst colleagues(C) [65]. Another context they encountered was that healthcare staff often expressed that there was an overreliance on measurement and outcomes [18,26,29]
Summary
We undertake a realist inquiry to identify and to understand the contribution of Lean Six Sigma (LSS) to person-centred care and cultures, an under researched area. We detail the first study to use realist evaluation to explore the degree and nature of the coherence between LSS and person-centred methodologies in healthcare practice. In this first section, we introduce the process improvement methodology of LSS in relation to its component parts, Lean and Six Sigma. We outline the concepts of person-centred care and person-centred cultures. We set out the problem that the study seeks to address
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