Facilitating and inhibiting factors in change processes based on the lean tool 'value stream mapping': an exploratory case study at hospital wards

Abstract

'Lean production' has become a prevalent rationalisation methodology in healthcare. Value stream mapping (VSM) is a commonly used lean tool to identify non-value-adding-work. VSM is a participatory tool. Thus, it may offer an opportunity to combine interventions for improved performance and ergonomics. The aim of the present exploratory study is to report observations that seem to play significant roles as inhibitors and facilitators for proper intervention processes when using VSM. Seven hospital wards have been investigated in Denmark, Iceland and Sweden. Information was obtained by screening key hospital documents and interviewing participants in and around the VSM processes. Nine tape-recorded interviews were performed. The results tentatively point to the facilitating effect on the VSM process by emphasising involvement and decision-making among the participants, first line manager support and engagement, allocation of sufficient resources, work environment issues as part of the VSM methodology and VSM routines that are well-established and broadly accepted.