Abstract
Healthcare is under intense pressure to reduce waste, provide better value at lower cost and eliminate preventable harm. Lean is a term used to describe operational improvement methods to eliminate waste and do more with less(1). Early application of Lean in healthcare focused on implementing Lean tools to achieve reduction in lead-time and cost in specific units or departments. Lean in healthcare has evolved over the past 15 years beyond implementation of tools alone to include implementation of Lean Management Systems.
Methods
A structured literature review of peer reviewed articles on Lean Management in healthcare, published between 2000 and 2017, was conducted. The relationship between early stage Lean Management implementation and safety culture assessment at an acute care hospital was explored using difference in difference analysis of 2015 and 2017 scores. Face-to-face interviews with nurse managers involved in early stage implementation of Lean Management in an acute care hospital were conducted between July and September 2018.
Key results
Articles reporting on Lean Management implementation in healthcare suffer from weak pre-post designs lacking statistical analysis limiting understanding of the true impact of Lean Management implementation. In this study, analysis of the perceptions of local management, perceptions of senior management, and safety organizing scale questions of the safety culture assessment using the Difference in Difference approach showed no statistical difference for units exposed to early stage Lean Management compared to those not exposed.
Interviews of nurse managers revealed that introduction of the Lean management system, particularly the True North room, provided clarity on what was important to the organization. All nurse managers interviewed were well acquainted with True North noting alignment of unit metrics to organizational goals. Interviews also revealed tension between the executive level need for standardization of huddle boards and staff engagement. Nurse managers emphasized that, while unit huddle board metrics must align with organizational goals, they must also be meaningful to front line staff to achieve desired improvement.
Conclusions
Longer exposure times to Lean Management systems, stronger study designs, and rigorous statistical analysis are needed to evaluate the effectiveness of Lean Management implementation in healthcare
