Scaling Lean in Primary Care and Impacts on Organizational Performance

Hung, Dorothy; Harrison, Michael I.; Martinez, Meghan; Luft, Harold S.

doi:10.17294/2330-0698.1358

Cited by 10 publications

(15 citation statements)

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“…More broadly Lean aims to empower and engage the workforce in continuous quality improvement [ 16 – 18 ]. This type of approach has been shown to improve healthcare delivery [ 16 , 19 – 24 ] and a wide range of operational metrics such as efficiency, productivity, and satisfaction among patients, providers and staff, without detriments to clinical quality [ 25 ]. But less is known about Lean’s influence on teamwork, staff engagement, and participation in quality improvement, all of which are also targeted by Lean management principles.…”

Section: Introductionmentioning

confidence: 99%

Experiences of primary care physicians and staff following lean workflow redesign

Hung

Harrison

Truong

et al. 2018

BMC Health Serv Res

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BackgroundIn response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks to nonphysicians. One important question is how such innovations affect care team members, particularly in view of growing dissatisfaction and burnout among healthcare professionals. We examine the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. This included co-locating physician and medical assistant dyads, delegating significant responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members.MethodsThe redesigns were implemented and scaled in three phases across 46 primary care departments in a large ambulatory care delivery system. We fielded 1164 baseline and 1333 follow-up surveys to physicians and other nonphysician staff (average 73% response rate) to assess workforce engagement (e.g., job satisfaction, motivation), perceptions of the work environment, and job-related burnout. We conducted multivariate regressions to detect changes in experiences after the redesign, adjusting for respondent characteristics and clustering of within-clinic responses.ResultsWe found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, they also experienced higher levels of burnout and perceptions of the workplace as stressful. Trends were the same for both occupational groups, but the increased reports of stress were greater among physicians. Additionally, members of all clinics, except for the pilot site that developed the new workflows, reported higher burnout, while perceptions of workplace stress increased in all clinics after the redesign.ConclusionsOur findings partially align with expectations of work redesign as a route to improving physician and staff experiences in delivering care. Although teamwork and engagement increased, the redesigns in our study were not enough to moderate long-standing challenges facing primary care. Yet higher levels of empowerment and engagement, as observed in the pilot clinic, may be particularly effective in facilitating improvements while combating fatigue. To help practices cope with increasing burdens, interventions must directly benefit healthcare professionals without overtaxing an already overstretched workforce.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3062-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Experiences of primary care physicians and staff following lean workflow redesign

Hung

Harrison

Truong

et al. 2018

BMC Health Serv Res

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“…70 Intended improvements in practice processes sometimes inadvertently lead to more work for physicians. 16,20,[73][74][75][76] For instance, the adoption of electronic health records meant that tasks previously done by clerical staff were now being left to physicians: "Earlier I dictated referrals. Now I type them myself."…”

Section: Amplification Of Compensatory Labor By Suboptimal Task Distrmentioning

confidence: 99%

Impacts of Operational Failures on Primary Care Physicians’ Work: A Critical Interpretive Synthesis of the Literature

et al. 2020

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PURPOSE Operational failures are system-level errors in the supply of information, equipment, and materials to health care personnel. We aimed to review and synthesize the research literature to determine how operational failures in primary care affect the work of primary care physicians. METHODS We conducted a critical interpretive synthesis. We searched 7 databases for papers published in English from database inception until October 2017 for primary research of any design that addressed problems interfering with primary care physicians' work. All potentially eligible titles/abstracts were screened by 1 reviewer; 30% were subject to second screening. We conducted an iterative critique, analysis, and synthesis of included studies. RESULTS Our search retrieved 8,544 unique citations. Though no paper explicitly referred to "operational failures," we identified 95 papers that conformed to our general definition. The included studies show a gap between what physicians perceived they should be doing and what they were doing, which was strongly linked to operational failures-including those relating to technology, information, and coordination-over which physicians often had limited control. Operational failures actively configured physicians' work by requiring significant compensatory labor to deliver the goals of care. This labor was typically unaccounted for in scheduling or reward systems and had adverse consequences for physician and patient experience. CONCLUSIONS Primary care physicians' efforts to compensate for suboptimal work systems are often concealed, risking an incomplete picture of the work they do and problems they routinely face. Future research must identify which operational failures are highest impact and tractable to improvement.

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“…Along with improvement in productivity and efficiency with delivery of care, Lean principles also have the potential to increase patient and staff satisfaction. 8 Using these principles within EBP requires a basic understanding of what they are and how they can affect the design and implementation of the EBP project. To better explain the relationship of Lean to EBP, we will provide examples and brief definitions.…”

Section: Introductionmentioning

confidence: 99%

Using Lean Principles as an Implementation Strategy within the EBP Process

Fowler¹,

Steffen²,

Mentz³

2022

Journal of PeriAnesthesia Nursing

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Evidence-based practice (EBP) is the cornerstone of nursing practice. While allowing the evidence to guide the design of an EBP protocol, it is important to consider the potential impact on the cognitive workload of busy clinicians. The Iowa Model includes developing a localized protocol as a part of the Design & Pilot step of EBP. 1 This step in the EBP process is the ideal time to address potential workflow concerns related to the localized protocol, by including clinician and patient feedback into the design process and midstream corrections that are anticipated. 2 Clinicians at the point-of-care are best equipped to inform how the localized protocol will be used and identify any potential roadblocks that would lead to workarounds or resistance to adoption.

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Scaling Lean in Primary Care and Impacts on Organizational Performance

Cited by 10 publications

References 0 publications

Experiences of primary care physicians and staff following lean workflow redesign

Experiences of primary care physicians and staff following lean workflow redesign

Impacts of Operational Failures on Primary Care Physicians’ Work: A Critical Interpretive Synthesis of the Literature

Using Lean Principles as an Implementation Strategy within the EBP Process

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