Large System Transformation within Healthcare Organizations Utilizing Lean Deployment Strategies

摘要

Given the intense national interest in improving the quality, efficiency and efficacy of healthcare delivery systems, a greater understanding of enterprise-level deployment of Lean Management Systems by U.S. healthcare organizations is required. We conducted a realist review of successful enterprise-level Lean Deployments within healthcare organizations. Synthesis and analysis of the results from this review indicated five primary strategies associated with successful healthcare-based Lean deployments. A dynamic cross-case analysis conducted within the review indicated that the specific mechanisms applied to implement these strategies are emergent within multiple transitional phases spanning 6-8 years. To supplement the findings from the realist review, a set of dynamic hypotheses and a system dynamics model were created to explore these phase transitions. The results from this work indicate that no steady state initial conditions exist that would support sustained enterprise-level transformation. The emergent nature of these deployments is necessary to overcome constraints related to organizational capacity and capability.