Facilitating Lean Learning and Behaviors in Hospitals During the Early Stages of Lean Implementation

Abstract

there are still knowledge gaps in how management should facilitate effective lean learning processes and behaviors in hospitals. Evidence suggests that healthcare administrators and managers may be unprepared to provide their employees with the learning and experience necessary to develop a lean culture and mindset.The intent of this research is to examine the learning and behavioral changes of frontline professionals during a collaborative implementation of the Toyota Production System, or lean methodology, at three hospitals. More specifically, our research question is, "What learning and behavioral changes occur in hospitals in the early stages of implementing lean?" In order to shed light on this question, both qualitative and quantitative research methods were employed at the end of years one and two of the multi-year implementation effort. The collected data came from a survey instrument, direct observation, unstructured and semi-structured interviews, and focus groups. By studying three different hospitals, our results provide insights and guidelines for facilitating lean thinking and behaviors during the early stages of lean implementation.The article is structured as follows. A review is presented of the concepts of single-loop and double-loop learning, which are the underpinning of this research and critical to understanding lean learning. Following this discussion, we describe the design of the study and the types of data collected at the hospitals. The next section presents the steps taken to analyze the data as well as an interpretation of the statistical results. We conclude the article with a detailed discussion that includes recommendations for practitioners, limitations of our research, and suggestions for future work. Background InformationIn the context of lean, learning can be thought of as "the detection and correction of error" (Argyris and Schon, 1978), where error is anything that inhibits healthcare professionals from taking effective action on the job. The successful implementation of lean requires employees to be effective problem solvers and learners, thereby eliminating errors and making operating improvements. In addition, effective problem solvers must be motivated to improve. This in turn requires self-reflective and self-reactive capabilities that empower them to develop personal standards that motivate their process improvement behaviors (Bandura, 1990;Bandura, 2002). To study learning and behavioral changes we used the single-loop and double-loop learning models proposed by Argyris and Schon (1978). Both models and their organizational consequences are explored in detail.

Organizational learning in hospitals: A realist review

“…Individuals are more likely to be motivated to engage in innovative behaviours in organizations when they feel like they 'fit in' (Afsar, 2016) and are respected (Rangachari, 2008b). Then, as team members realize their ability to affect change in an organization, they feel empowered and motivated to contribute to positive change (Mazur, McCreery, & Rothenberg, 2012).…”

Knowledge driven lean in healthcare: a necessity

“…This paper asserts that the lean production system can be applied within a service industry like healthcare; in fact, this effort has already been undertaken to some success (Colling and Muthusame, 2007;Grunde, 2009;Joosten et al, 2009;Mazur et al, 2012;Myllärniemi and Seppänen, 2012;Salah et al, 2010;Sobeck and Lang, 2010). Implementing this type of knowledge-driven process will hopefully facilitate a revitalisation of the US healthcare sector and propel it above its dismal 37th place in the world.…”

The association between event learning and continuous quality improvement programs and culture of patient safety

“…Others who have successfully implemented A3-based programs to CQI have noted similar challenges. 16,17,[46][47][48][49] We need to continually address these real and understandable obstacles and evolve our strategies to foster participation because optimal improvement work requires broad participation.…”