Improving Care Delivery Through Lean: Implementation Case Studies

Contract Report

This report presents an introduction to the application of Lean principles in health care settings to improve quality of care, increase efficiency, lower costs, and provide better patient outcomes. Lean is an organizational redesign approach focused on elimination of waste, which is defined as any activity that consumes resources (e.g., staff, time, money, space) without adding value to those being served by the process. In addition to background information and the results of a literature review, the report presents six case studies from five organizations that implemented Lean principles in different types of health care settings. Recommendations are provided for similar organizations wishing to implement Lean in their facilities.


Prepared by:

American Institutes for Research
Kristin L. Carman, PhD
Kathy Paez, RN, PhD
Jennifer Stephens, MPH
Lauren Smeeding
Steven Garfinkel, PhD
Callan Blough

Urban Institute
Kelly Devers, PhD

Mayo Clinic
Michelle Hoover, Med
Tony Spaulding, MS
David Mapes

Contents

Introduction
   Project Background
      Rationale and Purpose
      Conceptual Framework
      Purpose of Case Studies
   Methods
      Definition of the Sample
      Data Collection Activities
      Data Analysis
      Limitations
   References

Case 1. Lakeview Healthcare
   Organizational Background
      Description of the Health Care System
      Description of the Health Care Organization
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
      Alignment of Lean and Quality Improvement Efforts
   Process for Implementing Lean
      Lean Project Selection Process
      Planning Implementation of Lean
      Lean Training
      Lean Project Implementation
      Lean Teams
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Projects Studied
      Cross-Cutting Project
      Department-Specific Projects
      Projects Started But Not Fully Implemented
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
      Business or Strategic Case
   Factors that Influenced the Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Kaizen Initiative
      Staff Engagement
      Education and Training
      Communication About Lean
      Lean Team Composition and Size
      Routinization of Lean Processes
   Conclusions
      Recommendations for Similar Organizations Implementing Lean

Case 2. Central Hospital
   Organizational Background
      Description of the Health System
      Description of the Health Care Organization
      Leadership
      Staffing
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
      Alignment of Lean and Quality Improvement Efforts
   Process for Implementing Lean
      Lean Project Selection Process
      Planning Implementation of Lean
      Process for Lean Projects
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Projects Studied
      Improvement of "Door-to-Balloon" Process
      Management of Surgical Procedure Cards
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
   Factors that Influenced Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Lean Initiative
   Conclusions
      Recommendations for Similar Organizations Implementing Lean

Case 3. Grand Hospital Center
   Organizational Background
      Description of the Health Care System
      Description of the Health Care Organization
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
      Alignment of Lean and Quality Improvement Efforts
   Process for Implementing Lean
      Planning Implementation of Lean
      Lean Project Selection Process
      Lean Training
      Process for Lean Projects
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Projects Studied
      Hip and Knee Replacement Costs
      Cardiology Follow-up Appointment Scheduling
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
   Factors that Influenced Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Lean Initiative
   Conclusions
      Recommendations for Similar Organizations Implementing Lean

Case 4. Suntown Hospital
   Organizational Background
      Description of the Health Care Organization
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
   Process for Implementing Lean
      Planning for Implementation of Lean
      Lean Project Selection Process
      Lean Training
      Process for Lean Projects
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Projects Studied
      Urinary Tract Infection Prevention and Reduction
      Redesigning the Outpatient Medication Prescribing Process
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
   Factors that Influenced Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Lean Initiative
   Conclusions
      Recommendations for Similar Organizations Moving Forward

Case 5. Heights Hospital
   Organizational Background
      Description of the Health System
      Description of the Health Care Organization
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
      Alignment of Lean and Quality Improvement Efforts
   Process for Implementing Lean
      Planning for Implementation of Lean
      Lean Value Stream and Project Selection Process
      Lean Training
      Other Training
      Process for Lean Projects
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Projects Studied
      Emergency Department Value Stream Projects (Retrospective)
      Pediatric Continuity of Care Project (Prospective)
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
   Factors that Influenced Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Lean Initiative
   Conclusions
      Recommendations for Similar Organizations Implementing Lean

Case 6. Horizon Hospital—Lakeview Healthcare
   Organizational Background
      Description of the Health System: Lakeview Healthcare
      Description of Horizon Hospital
      Other Environmental Context
   Lean and Quality Improvement at the Organization
      History of Quality and Efficiency Improvement Efforts at the Organization
      Initiation of Lean at the Organization
      Alignment of Lean and Quality Improvement Efforts
   Process for Implementing Lean
      Lean Project Selection Process
      Planning Implementation of Lean
      Lean Training
      Lean Project Implementation
      Lean Teams
      Monitoring, Control, and Sustainment
      Dissemination and Spread of Findings
   Lean Hospital Project
      Horizon Hospital
   Outcomes of Lean
      Intermediate Outcomes
      Ultimate Outcomes
   Factors that Influenced Success of Lean Implementation
      Organizing the Lean Initiative
      Implementing the Lean Initiative
   Conclusions
      Recommendations for Similar Organizations Using Principles to Design and Hospital
 

This report was prepared for the Agency for Healthcare Research and Quality by the American Institutes for Research (Contract No. HHSA290200600019). It is in the public domain and may be used and reprinted without permission. Citation as to source is appreciated.

The opinions presented here are those of the authors and do not necessarily reflect the position of the U.S. Department of Health and Human Services or the Agency for Healthcare Research and Quality.
Page last reviewed November 2014
Page originally created November 2014
Internet Citation: Improving Care Delivery Through Lean: Implementation Case Studies. Content last reviewed November 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/system/systemdesign/leancasestudies/index.html