Evidence‐based re‐engineering: re‐engineering the evidence

Elkhuizen, Sylvia; Limburg, M.; Bakker, Piet; Klazinga, Niek

doi:10.1108/09526860610686980

Cited by 32 publications

(10 citation statements)

References 88 publications

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“…While this design can provide useful insights, it has serious limitations regarding generalizability and inter-subjectivity. Along with the other methodological issues surrounding the evaluation of lean thinking, which we mentioned in the introduction [ 7 ], it is safe to say that not only more research, but also higher quality research is needed. At this time, to state that ‘the lean message is 100% positive’ [ 17 ] seems a bit of a stretch.…”

Section: Discussionmentioning

confidence: 99%

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Application of lean thinking to health care: issues and observations

Joosten

Bongers

Janssen

2009

International Journal for Quality in Health Care

319

273

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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.

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Section: Discussionmentioning

confidence: 99%

“…Despite this, a recent review identified only a few studies with a controlled before–after study design. To make matters worse, a wide range of often non-comparable measures was used, while some of the reported results were not even mentioned in the objective of the study and vice versa [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Application of lean thinking to health care: issues and observations

Joosten

Bongers

Janssen

2009

International Journal for Quality in Health Care

319

273

View full text Add to dashboard Cite

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“…Although research shows that transition to process orientation besides reducing cost also lead to a more patient-centred care and quality improvements, [20,21] in reality, according to a review of 86 studies on innovations related to re-engineering patient care, the dominant motivator for initiation of these changes was cost reduction and resource utilisation, while parameters related to patient experience and patient values were rarely used. [22] Therefore, the Latvian case while being a rather extreme example of the forced change, is however typical regarding the main motivator behind it. Respectively, by exploring the differences in adaptation in Latvian hospitals exposed to the same external environmental changes, the best practices used for process management implementation in clinical setting could be detected and further applied in other hospitals moving towards HPO.…”

Section: Introductionmentioning

confidence: 99%

Transition to hospital process orientation: The case of regional hospitals in Latvia

Barzdins

Konstante²,

Mitenbergs

et al. 2015

JHA

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Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital's performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital's managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.

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“…Some studies also report better patient outcomes after a redesign project. However, there are also various gaps in redesign literature [3,8,9]. One of these gaps is that very few research papers have investigated the effects of redesign on areas of performance outside the timely delivery of services or better patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…'Redesign' is the general term for a group of approaches that is being used to achieve some of these improvements [2]. In redesign, one implements multifaceted organizational interventions that lead towards more customerfocused and cost-effective care, by removing unnecessary steps and potential for errors [3,4]. In a typical redesign project, operational improvements are accompanied by efforts to educate and activate the workforce, leadership support and other types of interunit coordination (sociotechnical improvements) [5].…”

Section: Introductionmentioning

confidence: 99%

Redesigning mental healthcare delivery: is there an effect on organizational climate?

Joosten

Bongers

Janssen

2013

International Journal for Quality in Health Care

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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.

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Evidence‐based re‐engineering: re‐engineering the evidence

Abstract: This appears to be the first time available evidence about redesign projects in hospitals has been systematically collected and assessed.

Cited by 32 publications

References 88 publications

Application of lean thinking to health care: issues and observations

Application of lean thinking to health care: issues and observations

Transition to hospital process orientation: The case of regional hospitals in Latvia

Redesigning mental healthcare delivery: is there an effect on organizational climate?

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