Abstract
BackgroundThere is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.MethodsWe used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.ResultsImprovements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.ConclusionsDrawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).
Highlights
Accident and emergency departments (A&Es) all over the world are challenged with problems of overcrowding and excessive waiting times [1,2,3]
Health care delivery has traditionally been organized around specialties and professional groups that address patients’ problems one at a time, rather than around the entirety of each patient’s needs [7,8,9]
It consists of principles and practices that focus on minimizing the total time and resources needed to produce and supply goods or services to a customer, increasing efficiency
Summary
There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a leaninspired intervention in a Swedish pediatric Accident and Emergency department. Health care delivery has traditionally been organized around specialties and professional groups that address patients’ problems one at a time (function-based organization), rather than around the entirety of each patient’s needs [7,8,9]. Hoping to overcome the limitations of function-based organization, many healthcare organizations are adopting approaches such as lean thinking to better integrate health care delivery. Reductions in time and resource use are achieved by focusing on value-adding steps and eliminating non-value-adding steps in the production process [10,11]
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