Lean Enterprise Transformation Research Articles

Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation

BackgroundThere is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program—Employee Whole Health (EWH)—focused on the holistic needs of all employees. This evaluation’s goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors—facilitators and barriers—affecting the implementation of VA EWH.MethodsThis cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation.ResultsEight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation.ConclusionsAs VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.

Engaging Patients in the Veterans Health Administration's Lean Enterprise Transformation: A Qualitative Study.

Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation. We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients. Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans. As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.

Facilitators and barriers to the Lean Enterprise Transformation program at the Veterans Health Administration.

The Veterans Health Administration piloted a nationwide Lean Enterprise Transformation program to optimize delivery of services to patients for high value care. Barriers and facilitators to Lean implementation were evaluated. Guided by the Lean Enterprise Transformation evaluation model, 268 interviews were conducted, with stakeholders across 10 Veterans Health Administration medical centers. Interview transcripts were analyzed using thematic analysis techniques. Supporting the utility of the model, facilitators and barriers to Lean implementation were found in each of the Lean Enterprise Transformation evaluation model domains: (a) impetus to transform, (b) leadership commitment to quality, (c) improvement initiatives, (d) alignment across the organization, (e) integration across internal boundaries, (f) communication, (g) capability development, (h) informed decision making, (i) patient engagement, and (j) organization culture. In addition, three emergent themes were identified: staff engagement, sufficient staffing, and use of Lean experts (senseis). Effective implementation required staff engagement, strategic planning, proper scoping and pacing, deliberate coaching, and accountability structures. Visible, stable leadership drove Lean when leaders articulated a clear impetus to change, aligned goals within the facility, and supported middle management. Reliable data and metrics provided support for and evidence of successful change. Strategic early planning with continual reassessment translated into focused and sustained Lean implementation. Prominent best practices identified include (a) reward participants by broadcasting Lean successes; (b) provide time and resources for participation in Lean activities; (c) avoid overscoping projects; (d) select metrics that closely align with improvement processes; and (e) invest in coaches, informal champions, process improvement staff, and senior leadership to promote staff engagement and minimize turnover.

Lean Enterprise Transformation in VA: a national evaluation framework and study protocol

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.

Back to Fundamentals for a Successful Lean Six Sigma Enterprise Transformation: An Introduction to Jet Special Issue on Case Studies of Lean Enterprise Transformation

Lean Six Sigma (LSS) has been implemented repeatedly in various industries and forms (Pepper and Spedding, 2010). Not all implementations are successful and sustainable, but a majority of them brin...

Company Self-Assessment of Lean Enterprise Maturity in the Aerospace Industry

This study investigates the use of Lean Enterprise self-assessment in the aerospace industry. Senior enterprise leaders from 31 enterprises in the U.S. and U.K. aerospace industries utilized the MIT Lean Enterprise Self-Assessment Tool (LESAT) as a means for measuring their current state of leanness in leadership/transformation processes, life-cycle processes, and enabling infrastructure as defined by the LESAT. The empirical results suggest that the companies sampled from the aerospace industry in this study exhibit the lowest maturity in practices related to establishing and deploying a lean enterprise vision, even in the presence of high maturity in lean production within the organizations. Based on the self-assessment, a clear opportunity related to lean enterprise transformation exists in raising the maturity of these enterprises in understanding their current value streams and defining their future value streams. A framework for incorporating LESAT results into formal information feedback mechanisms...

Kaizen Event Result Sustainability for Lean Enterprise Transformation

Lean enterprise transformation is achieved by the cumulative impact of both radical and incremental change. Kaizen events have been widely reported to produce significant incremental business improvements that can support enterprise-wide transformation efforts. However, sustaining or improving upon the results of a Kaizen event over time can be difficult for many organizations. Kaizen event result sustainability is critical for the achievement of transformation but has received limited empirical research attention to date. This article uses logistic regression to identify the factors that most strongly influence the sustainability of results after a Kaizen event based on a field study of 63 events that were part of larger lean transformation initiatives in 8 manufacturing organizations. The findings are also used to identify areas for future research and to develop preliminary guidelines for organizations using Kaizen events as a mechanism for lean enterprise transformation.

Potential of Standardization and Certification for Successful Lean Implementations

A successful lean implementation is the key for lean enterprise transformation. However, many companies are struggling to change the culture in their system and are having problems in adapting lean principles. In this article, we discuss whether lean standardization and professional lean certification (LS&C) has the potential to promote successful lean implementation leading to a lean enterprise transformation. For this purpose, we first analyzed the concepts of LS&C and reviewed the existing ones, including J4000 through literature review and personal communications with lean experts. We also conducted a survey among lean professionals to get feedback about their attitudes toward LS&C. The survey results suggest that there is significant support for LS&C, as around 60% of the survey attendants believe LS&C would eliminate problems in implementing lean principles. However, the awareness of existing standards among lean practitioners is very low, which indicates the need for development of new lean standar...

Lean Enterprise Transformation is a Business Necessity for Sustainable Growth: An Introduction to the Jet Special Issue

Lean Enterprise Transformation is a Business Necessity for Sustainable Growth: An Introduction to the Jet Special Issue

An ANP-based assessment model for lean enterprise transformation

There is a multitude of methodology on evaluation of lean transformation, but only few consider the relationships among the components of the lean enterprise transformation explicitly and focus on their prioritization and identification of the relative importance weights for every element of the lean transformation. For that reason, we try to quantify those relationships in this study. For a structured examination of the relationships among the elements, we suggest a model that provides a holistic view to the lean transformation process. This paper presents an analytic lean enterprise transformation modeling approach to the identification of weights of the organization’s lean transformation determinants. Thus, the highly qualitative relationships among the lean transformation components are operationalized. For determining of the relative importance weights for every element in the model, analytic network process modeling approach is used in the proposed framework. This approach has enabled us to apply the proposed lean enterprise transformation methodology at a global industrial manufacturing company in Turkey, and an illustrative case is presented.

CREATING A LEAN SYSTEM OF INNOVATION: THE CASE OF ROCKWELL COLLINS

Lean Transformation and Innovation have both been touted as strategies that are essential to the long-term survival of organizations. The question of whether the two approaches can be used simultaneously remains unanswered. This paper is the first step at deriving a theory of lean systems of innovation that combines the notions of lean enterprise transformation with that of innovation. The descriptive understanding of Rockwell Collins developed in this paper, draws on publicly available material to support the identifications of the key elements of a strategic system of innovation. Our analysis highlights the successful use of technology scanning, internal R&D, and open innovation within the innovation system at Rockwell Collins. Furthermore, the existence of a shared value proposition, a strong organizational culture that recognized and rewarded innovation, and the requisite organizational infrastructure serve as key enablers to architecting a strategic system of innovation that is reflective of lean enterprise thinking.