BackgroundIncidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.Development, theory and application of lean thinking to health careLean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles.DiscussionWe believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.

There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.

The need for improved quality in health care has forced health-care organizations worldwide to critically review and improve their current care delivery processes. While some of these projects succeed, there are also a number of projects that fail. One of the factors contributing to their success or failure is willingness to change. That is why a number of redesign methods, including care pathway development, emphasize frontline staff involvement to reduce resistance. One of the mechanisms used in care pathway development to involve staff is the sharing of influence or decision-making between superiors and their subordinates. This mechanism is also known as participatory decision-making (PDM). In this research paper, we have addressed this issue by investigating whether or not increasing PDM by developing care pathways and care programmes leads to increased organizational commitment, trust in management and willingness to change. Our research shows that PDM leads to increased trust in management and organizational commitment. Evidence indicating that PDM indirectly contributes to an increased willingness to change was also found. The outcome of our research suggests that increasing PDM when developing care programmes and care pathways can be an effective method of increasing the chances of success for care pathway development projects.

Objective. Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation.Design. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place.Setting. Two Dutch child-and adolescent-mental healthcare providers.Participants. Professionals that worked at one of the units at the start and/or the end of the intervention period. Intervention(s). The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series).Main outcome measures. Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate.Results. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited.Conclusions. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

No abstract