Organisational readiness and Lean Thinking implementation: Findings from three emergency department case studies in New Zealand

Abstract

This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations.

New Zealand’s emergency department target – did it reduce ED length of stay, and if so, how and when?

“…Our analysis lends support to the view that process improvements in ED can make a significant contribution to improved timeliness [ 55 ], and that the target was valuable inasmuch as it stimulated these improvements in patient flow. However, our analysis also questions the value of ED targets as a long term approach.…”

Exploring “patient-centered” hospitals: a systematic review to understand change

“…Approaches such as ‘kaizen blitz’ or ‘rapid improvement events’ seem to have dominated the healthcare sector’s scenario, leaving sporadic experiences in terms of fully re-designing, in a holistic perspective, the whole set of processes that constitute pathways across organizations [70, 71]. In other words, “ while a project management implementation methodology may make many gains initially, sustaining the gains relies on the project’s integration and identifying what is needed for any changes to become routinized ” [72]. …”

“…In particular, organizational readiness, an adequate organizational culture, effective leadership (given the difficulty of effectively enrolling staff in the change agenda) and the availability of adequate resources and communication strategies appear to be fundamental for its success [57, 72, 73]. Moreover, lean must overcome important lines of resistance, which often see clinicians apprehensive about the motives and legitimacy of change as well as concerned about the validity of theories suggesting benefits for patients due to changed working practices [73].…”

exploration of the application of lean continuous improvement in higher education

“…Individual process improvements are easier to achieve than widespread integration, and the disparity is attributed to the culture of the organization (Bhasin, 2012b;Clark, Silvester, & Knowles, 2013;Fliedner & Mathieson, 2009;Rees, 2014). An organization's culture can affect performance and enhance or limit change (Atkinson, 2010;Bortolotti, Boscari, & Danese, 2015).…”

“…A lack of leadership, including a failure to create and communicate a strategic vision for the change, will hamper efforts (Atkinson, 2014;Gordon, 2002;Martinez-Jurado & Moyano-Fuentes, 2013). Sometimes the problem is with the inability of leadership to engage and motivate staff (Rees, 2014;Swartling & Poksinksa, 2013;Weiner, 2009). Without support from top managers, including the commitment of resources to hire consultants and provide effective training, LCI projects are likely to fail (Albliwi, Antony, Lim, & Weile, 2014;Turesky & Connell, 2010).…”