Nurses’ Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency

Nicosia, Francesca; Park, Linda G; Gray, Caroline; Yakir, Maayan; Hung, Dorothy

doi:10.1177/2333393618810658

Cited by 21 publications

(27 citation statements)

References 47 publications

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“…It is interesting that participants did perceive that Lean had value, but the context in which they were tasked with implementing Lean was overshadowed and dominated by more restraining forces (patient complexities, financial constraints) than driving forces (champions). We agree with previous research calling for organisations to invest adequate resources to engage in process improvement activities (Nicosia, Park, Gray, Yakir, & Hung, ).…”

Section: Discussionsupporting

confidence: 88%

“…When Lean becomes mandated as ‘non‐negotiable despite any dissatisfaction that it….may generate for staff, it is possible resistance may become even more fueled’ (D'Andreamatteo, Ianni, Lega, & Sargiacomo, , p. 14). Adding to this hurdle was the justification that Lean would result in massive savings for the health care system; however, this goal may not be tenable for professionals whose autonomy is constrained by perceived regimented processes and who object to less time spent on direct patient care (Nicosia et al, ). As such, Mann () argues that a focus on financial restraint may not result in the intended outcomes of patient quality.…”

Section: Discussionmentioning

confidence: 99%

“…For the most part, participants in this study understood that their work was shifting to a greater focus on managing people; they attempted to create conditions for a learning‐enriched work environment by being more visible on units and coaching staff to engage in continuous improvement, but the demands of their other responsibilities were not diminished or delegated, creating untenable workloads (Drotz & Poksinska, ). Swedish researchers have identified that to successfully translate Lean into health care settings, there are important differences between jobs in manufacturing and roles in health care that must be understood (Drotz & Poksinska, ; Nicosia et al, ). The intensive nature of improvement process work and the need to respond to complex dynamic patient needs can create significant additional work for nurses and add significant administrative responsibility for managers.…”

Section: Discussionmentioning

confidence: 99%

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Nurse managers implementing the lean management system: A qualitative study in Western Canada

Udod

Duchscher

Goodridge³

et al. 2020

J Nurs Manag

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Aim This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. Background The provincial government of Saskatchewan, Canada, implemented a multimillion‐dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. Methods This qualitative exploratory study employed semi‐structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. Results Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. Conclusion The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. Implications for Nursing Management Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Nurse managers implementing the lean management system: A qualitative study in Western Canada

Udod

Duchscher

Goodridge³

et al. 2020

J Nurs Manag

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“…1,2 Patient flow refers to the movement of patients through care settings. 3 It involves the medical care, physical resources, and internal systems needed to get patients from the point of admission to the point of discharge while maintaining quality and patient/provider satisfaction. 4 Medical services can involve either inpatient or outpatient care.…”

Section: Introductionmentioning

confidence: 99%

Effects of Lean Healthcare on Patient Flow: A Systematic Review

et al. 2020

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Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

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“…Combined with a continued focus on patients' clinical outcomes, this tends to favour Lean Six Sigma as an improvement methodology. However, increasingly there is now a focus on a better staff and patient experience (Nicosia et al, 2018;Moraros et al, 2016) that favours person-centred approaches. Powell et al (2009) recognise that improvement in healthcare quality is a challenge for healthcare staff; much quality improvement implementation places responsibility on those planning and delivering patient care to deliver process improvement.…”

Section: Introductionmentioning

confidence: 99%

A Discussion of the Synergy and Divergence between Lean Six Sigma and Person-Centred Improvement Sciences

Teeling

Dewing

Baldie

2020

International Journal of Research in Nursing

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Background: This paper discusses if and how the improvement sciences of Lean Six Sigma and person-centred approaches can be melded or blended in the health care context. The discussion highlights the relationship between each approach to improvement science in terms of their respective purposes, intentions and probable outcomes; positioning these as either synergies or divergences. Comparison of the key theoretical and methodological principles underpinning each approach to improvement is also considered and implications for future practice, policy and research are drawn out. The discussion is informed by part of the findings of a realist review of relevant literature. Conclusions: Lean Six Sigma as a process improvement methodology appeals to a wide range of stakeholders in healthcare internationally. Four key synergies and three key divergences between Lean Six Sigma and person-centred approaches were found. The discussion here highlights the need for further research into Lean Six Sigma implementation and its possible contribution to developing person-centred cultures. Impact: Adoption of Lean Six Sigma in health care by stakeholder groups, external to nursing, has been taking place. At the same time there has been a loss of Lean's original intention of respect for people in favour of a technical efficiency focus on reducing waste and variation. Our findings of four key synergies and three key divergences between both approaches indicate where synergies can be maximised and divergence narrowed to improve implementation and enhance methodological coherence. Researchers, policy makers and practitioners should be aware that use of Lean Six Sigma alone may have a limited impact on developing personcentred care and culture. Use of Lean combined with person-centred approaches may appeal to a wider range of stakeholders. Yet, their combined use and effectiveness has not as yet been evaluated.

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Nurses’ Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency

Cited by 21 publications

References 47 publications

Nurse managers implementing the lean management system: A qualitative study in Western Canada

Nurse managers implementing the lean management system: A qualitative study in Western Canada

Effects of Lean Healthcare on Patient Flow: A Systematic Review

A Discussion of the Synergy and Divergence between Lean Six Sigma and Person-Centred Improvement Sciences

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