Acceptance of lean redesigns in primary care

Hung, Dorothy; Gray, Caroline; Martinez, Meghan; Schmittdiel, Julie A.; Harrison, Michael I.

doi:10.1097/hmr.0000000000000106

Cited by 44 publications

(45 citation statements)

References 15 publications

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“…One interview study in both primary care and hospitals in Sweden addressed the use of VSM, continuous improvements, standardization, identifying waste, teamwork, daily short meetings, supporting and coaching leadership style, visual control and 5S (Drotz and Poksinska, 2014). An interview study with staff in primary care in the UK described adoption of VSM and stakeholder mapping (Grove et al, 2010), while a study of primary care in the USA described standardization, work flow, redesigning rooms and holding daily morning meetings (Hung et al, 2016). The above studies have provided only a partial insight into Lean maturity, in that they have failed to address Lean maturity using Liker's entire 4P model and to collect information on Lean from all staff members, both of which, according to Liker, are paramount to successful implementation and maintenance of Lean.…”

Section: Lean In Healthcarementioning

confidence: 99%

Lean maturity and quality in primary care

Mathiassen

Bengtsson

Engström

2019

JHOM

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Purpose -The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker's description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff. Design/methodology/approach -Data were collected using a survey based on Liker's four principles, divided into 16 items (n ¼ 298 staff in 45 units). Complementary observations (n ¼ 28 staff ) were carried out at four units. Findings -Lean maturity varied both between and within units. The highest Lean maturity was found for "adhering to routines" and the lowest for "having a change agent at the unit." Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality. Practical implications -Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker's principles and using the results as guidance for further development. Originality/value -This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker's principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

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Section: Lean In Healthcarementioning

confidence: 99%

Lean maturity and quality in primary care

Mathiassen

Bengtsson

Engström

2019

JHOM

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“…The lower human resource (clinical personnel) level could have contributed to the lower fidelity in the implementation of the ICDM model in the DKK health district compared to the WR. Other contextual factors that have been described as facilitators for successful implementation and sustainability of chronic care models and were not assessed in this study, include the commitment and support of the leadership, training of personnel, participants responsiveness, sufficient funding, acceptability of the intervention and collaboration with other sectors [43,48,[51][52][53]. The observed variability in fidelity level across ICDM model components and health districts could indicate adaptations to the model to fit different contexts.…”

Section: Discussionmentioning

confidence: 96%

Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in Two Districts, South Africa

Lebina¹,

Alaba

Ringane

et al. 2019

Preprint

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Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model.Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test.Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685-2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00-9.33) vs 2.0 (IQR: 1.67-2.92)], and fewer medical officers per clinic [median 1 (IQR: 1-1) vs 3.5 (IQR:2-4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27-31)]; 77% [30/39 (IQR: 27-34)]; 77% [30/39 (IQR: 28-34)]; and 80% [35/44 (IQR: 30-37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2-5 hours) waiting times and one stream of care for acute and chronic services.Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

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“…5 This definition recognizes Lean as a management system that encompasses the social, behavioral, and contextual organizational factors that enable change and empower teams rather than just a technical methodology focused on process improvement tools. [6][7][8] Health system leadership developed guiding principles centered on organizational alignment, adoption of key leadership behaviors, and evidence-based problem solving that correspond to the broader Lean principles of align, enable, and improve. 9 While we opted to use Lean to guide our efforts, it is important to recognize that other quality improvement and transformation approaches share similar guiding principles.…”

Section: Guiding Principlesmentioning

confidence: 99%

Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future

et al. 2020

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This Perspective presents a case study of multidimensional clinical transformation in an academic general internal medicine practice. In the face of increasing internal and external pressures, health systems and individual medical practices have pursued multiple strategies to improve quality, patient experience, and efficiency, while reducing staff and provider stress and burnout. We describe a Lean-informed approach that emphasizes the importance of organizational alignment in goals, evidence-based problem solving, and leadership behaviors to support a culture of continuous improvement. Our aim in this Perspective is to provide a real-world example of a feasible process for the planning, preparation, and execution of effective transformation, and to present lessons that may be useful to other academic health center practices seeking to develop innovative models to achieve the quadruple aim.

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Acceptance of lean redesigns in primary care

Cited by 44 publications

References 15 publications

Lean maturity and quality in primary care

Lean maturity and quality in primary care

Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in Two Districts, South Africa

Utilizing Lean Leadership Principles to Build an Academic Primary Care Practice of the Future

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