Abstract
Background/Aims As approximately $750 billion is wasted in the U.S. health system each year, equivalent to roughly one-third of every medical dollar, “Lean” thinking and techniques offer promising solutions for maximizing value in health care. This study examines a large, multispecialty practice’s journey of implementing a Lean management system beginning in primary care. We sought to understand initial drivers and barriers to implementation, with lessons contributing to a learning system of improvement in health care.
Methods This case study was based on in-depth interviews with 16 physician and administrative leaders, and 4 focus groups of medical assistants and administrative staff. Transcripts were coded and analyzed using inductive, grounded methodology.
Results Respondents’ insights were clustered around three main themes: organizational leadership, professional values/culture, and availability of resources. Informants described organizational characteristics critical to implementing Lean and to which they attributed its success so far, including: strong leadership and the importance that leaders embody qualities they are espousing, willingness to engage all levels of staff in the change process, and willingness to adjust performance measures according to new job roles. However, many noted that values and norms surrounding clinical practice are often at odds with the Lean principle of standardizing work to eliminate waste, representing the biggest challenge for physicians who are socialized into a culture where independent thinking and autonomy is valued. The availability of resources was also cited as an important factor in executing changes, including time to do one’s regular work while implementing change, time to absorb new ideas and changes, and proper space configurations to support the change.
Conclusions Lean represents a non-traditional approach to managing the delivery of medical care. In a Lean operating system, value is seen first from the patient perspective and while this is a point of easy agreement, how that principle is operationalized can be fraught with challenges that must be negotiated. These challenges may be addressed in part by strong leadership and adequate resources. Further study is currently underway as the effort is extended to additional sites in the organization, with additional findings to be presented on how Lean can be successfully implemented in health care.
