Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals

Abstract

As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N=236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.

Continuous improvement, burnout and job engagement: a study in a Dutch nursing department

“…Not just the content of the changes matters, but also the context within which these take place. Every single implementation of CI has its own characteristics and takes place in a specific context (Andersen et al, 2014;Procter and Radnor, 2014;Wilson, 2014;Holden et al, 2015;Langstrand and Drotz, 2016), which bears on the effects. This considerable variety in content and context explains to a large extent why evaluation studies of applying lean in healthcare consistently find inconsistent results (Andersen and Røvik, 2015.;D'Andreamatteo et al, 2015).…”

Organization of change agents during care process redesign in Swedish health care

“…Other studies within the research program cover complementary aspects of contextual factors that impact on the implementation of LP. For example, one study covers details on health care professionals' perceptions of LP, [23] while another study covers the participating hospitals' motives for working according to LP. [24] The current study contributes with knowledge of how, and under what contextual conditions, formally appointed CAs may support lean-inspired care process redesign.…”

The impact of restricted decision‐making autonomy on health care managers’ health and work performance

“…The few studies that have been published show mixed results. Some studies indicate that health care workers have a relatively positive attitude towards Lean (Holden, Eriksson, Andreasson, Williamsson, & Dellve, 2015) and that Lean is associated with decreased work demands (Dellve, Williamsson, Strömgren, Holden, & Eriksson, 2015;Moraros, Lemstra, & Nwankwo, 2016). On the other hand, there are studies reporting that this kind of process-based governance leaves less room for autonomous decision-making in the health professionals' daily work and that it increases the workload (Conti, Angelis, Cooper, Faragher, & Gill, 2006).…”