The maturity of lean management in a large academic medical center in Finland: a qualitative study.

Abstract

Background: Lean management (LM) provides hospitals with tools to respond to today's rapidly changing healthcare environment. However, evidence of its success is inconclusive. In some cases, well-executed LM supports effective, beneficial, and safe patient care; reduces costs; and increases patient and staff satisfaction. In other cases, however, the desired outcomes have not been achieved. Organizations must acknowledge the maturity level of LM to successfully implement it for continuous development. This study evaluates the maturity of Lean implementation using a structured interview with a framework based on the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) and utilizes findings about Lean adoption to evaluate factors that support and hinder its implementation, with the aim of assisting leaders in maintaining and developing Lean in health care.

Methods: The article describes a case study done at Helsinki University Hospital. A qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fifteen healthcare leaders from the three sectors participated in a semistructured interview based on the dimensions of the LHISI. Qualitative content analyses were based on grounded theory.

Results: We concluded that the five dimensions (leadership, commitment, standard work, communication, and daily management system) of LHISI provide a comprehensive framework for qualitatively evaluating Lean in the hospital. We found that the five dimensions are influenced by other explanatory factors. These explanatory factors, knowledge about Lean, available data, and environmental, psychological, and organizational factors all support and hinder leadership, communication, daily management, and commitment to Lean in the hospital. The results highlight differences in the Lean maturity levels in the hospital. We noticed that 9 of 15 leaders had a misunderstanding of Lean, and all 3 sectors showed a lack of staff commitment to Lean in their units.

Conclusion: To strengthen the organization-wide implementation of Lean, it is necessary to understand that LM is a comprehensive sociotechnical management system, for which it is not enough to mechanically implement Lean with tools and techniques alone. By focusing on and developing the five dimensions and explanatory factors, organizations can achieve a high maturity of Lean and reach their full potential. A good level of competency and commitment to Lean by the leaders and the staff alike are important for achieving goals, engaging the staff, and increasing the quality of patient care in the hospital. The long-term Lean development of a hospital organization can be followed and continuously maintained via easy-to-use maturity tools.