Physician Engagement With Metrics in Lean Primary Care Transformation

Gray, Caroline; Yakir, Maayan; Hung, Dorothy

doi:10.1097/qmh.0000000000000182

Cited by 6 publications

(1 citation statement)

References 24 publications

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“…Zarbo et al11 describe a blending of top-down standardization of design components of the huddle board while permitting autonomy at the local level to choose meaningful metrics. In the 2020 data pull, Gray et al,31 reporting on implementation in an academic primary care setting, highlighted the importance of understanding how physicians make sense of data and provide recommendations that emphasize the need to engage physicians in metric selection to gain buy-in and motivation for engaging in improvement activities. Goodridge et al32 and Udod et al33 reported on nurses' perception of Lean implementation in Canada, highlighting the increased workload placed on nurse managers and a perceived lack of adequate training and support.…”

Section: Resultsmentioning

confidence: 99%

Lean Management Systems in Health Care: A Review of the Literature

Winner

Reinhardt

Benishek

et al. 2022

Quality Management in Health Care

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Background and Objectives: Many health care organizations now employ Lean tools to improve value in health care, yet reports of their effectiveness vary. This variation may be explained by the context in which Lean is implemented, whether as a tool or as a management system. This article reports on a structured literature review conducted to understand the evidence base for the impact of Lean Management System implementation in health care. Methods: A search of PubMed, Scopus, Emerald, EMBASE, CINAHL, and Business Source Complete databases was conducted in November 2017 and repeated in July 2020 to assess the evidence for the impact of Lean Management Systems in health care from 2000 to July 2020. Articles were included if they (1) reported on a Lean Management System or (2) reported on Lean Management System components as described by Mann1 (ie, leader standard work, visual controls, daily accountability process, and discipline). Results: A total of 52 articles met the inclusion criteria. Although all articles described some combination of leader standard work, visual management, and daily accountability as part of their Lean Management System, only a handful described use of all 3 components together. Only one explicitly mentioned the fourth component, discipline, required to consistently apply the first 3. The majority reported on single-unit or department implementations and most described daily huddles at the unit level that included review of key performance indicators, identification of improvement opportunities, and problem solving. The role of the leader in a Lean Management System was described a coach and a mentor. Barriers to adoption such as insufficient training and increased workload for nurses were noted along with the importance of relevance to the local context for unit teams to find value in huddle boards and huddles. As yet, evidence of Lean Management System effectiveness in driving health care improvement is absent due to weak study designs and lack of statistical rigor. Conclusion: Well-designed research on Lean Management Systems in health care is lacking. Despite increasing adoption of Lean Management Systems over the past 10 years and anecdotal reports of its effectiveness, very few articles provide quantitative data. Those that do report unit-level implementation only, little use of a comprehensive package of Lean Management Systems elements, and weaker study designs and statistical methods. More rigorous study designs and robust statistical analysis are needed to evaluate effectiveness of Lean Management Systems in health care. This represents a rich area for future health care management research.

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