Abstract
BackgroundThe goal of Lean Enterprise Transformation (LET) is to go beyond simply using Lean tools and instead embed Lean principles and practices in the system so that it becomes a fundamental, collective mindset of the entire enterprise. The Veterans Engineering Resource Center (VERC) launched the Veterans Affairs (VA) LET pilot program to improve quality, safety, and the Veteran’s experience. A national evaluation will examine the pilot program sites’ implementation processes, outcomes and impacts, and abilities to improve LET adoption and sustainment. This paper describes the evaluation design for the VA LET national evaluation and describes development of a conceptual framework to evaluate LET specifically in healthcare settings.MethodsA targeted literature review of Lean evaluation frameworks was performed to inform the development of the conceptual framework. Key domains were identified by a multidisciplinary expert group and then validated with key stakeholders. The national evaluation design will examine LET implementation using qualitative, survey, and quantitative methods at ten VA facilities. Qualitative data include site visits, interviews, and field observation notes. Survey data include an employee engagement survey to be administered to front-line staff at all pilot sites. Quantitative data include site-level quality improvement metrics collected by the Veterans Services Support Center. Qualitative, quantitative, and mixed-methods analyses will be conducted to examine implementation of LET strategic initiatives and variations in implementation success across sites.DiscussionThis national evaluation of a large-scale LET implementation effort will provide insights helpful to other systems interested in embarking on a Lean journey. Additionally, we created a multi-faceted conceptual framework to capture the specific features of a Lean healthcare organization. This framework will guide this evaluation and may be useful as an assessment tool for other organizations interested in implementing Lean principles at an enterprise level.
Highlights
The goal of Lean Enterprise Transformation (LET) is to go beyond using Lean tools and instead embed Lean principles and practices in the system so that it becomes a fundamental, collective mindset of the entire enterprise
The third component includes an analysis of relevant quality improvement metrics created and collected by the Veterans Health Administration (VHA) to assess changes in clinical and non-clinical processes and outcomes at each Veterans Affairs (VA) facility
Recruitment and sampling Qualitative Site Visit/Interviews The pilot sites will be invited to participate in the evaluation per an introductory email from the Veterans Engineering Resource Center (VERC) leadership and the Quality Enhancement Research Initiative (QUERI) director
Summary
The goal of Lean Enterprise Transformation (LET) is to go beyond using Lean tools and instead embed Lean principles and practices in the system so that it becomes a fundamental, collective mindset of the entire enterprise. Initial deployment of Lean management at individual VA medical centers began in 2011, in 2015, the VHA National Leadership Council formally adopted Lean management as a national quality improvement strategy [20]. This VA LET program consists of a centralized deployment strategy that includes sensei (coaching) services for each pilot site along with programmatic and implementation support and guidance. To our knowledge, this innovative program is the largest, multi-site Lean enterprise transformation effort to date
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