As hospitals around the world increasingly face pressure to improve efficiency, “Lean” process improvement has become a popular approach to improving patient flow. In this article, we examine nurses’ perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) “wasting time” to save time; and (d) the “real” work of providing clinical care versus the “Lean” work of process improvement. Our findings highlight the importance of soliciting hospital nurses’ perspectives when implementing Lean process improvements to improve efficiency and patient flow.
Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.
This study examined the implementation and hospitalwide scaling of a community-based transitional care program to reduce readmissions among adults 65 years or older. Our analysis was guided by the Care Transitions Framework and was based on semistructured interviews with program implementers to identify intervention successes, barriers, and outcomes beyond reducing readmissions. Such outcomes included the program's critical role in providing a safety net and transition to more advanced care, and redefining intervention success from more patient-centered perspectives.
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