Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians

Purpose To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. Methods This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study. We conducted interrupted time series analysis to monitor changes in physician work patterns over 6 years. Key measures included total daily work time; time spent on “desktop medicine” outside the exam room; time spent with patients during office visits; time still working after clinic, i.e., after seeing the last patient each day; and remote work time. Results The amount of time that physicians spent on desktop EHR activities throughout the day, including after clinic hours, decreased by 10.9% (95% CI: −22.2, −2.03) and 8.3% (95% CI: −13.8, −2.12), respectively, during the first year of Lean implementation. Total daily work hours among physicians, which included both desktop activity and time in office visits, decreased by 20% (95% CI: −29.2, −9.60) by the third year of Lean implementation. Conclusions These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) —to determine the impact of Lean interventions on physician work experiences.

Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context

Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Methods The original HISI survey was sent over a secure organizational email system to the over 26,000 employees of the Hospital District of Helsinki and Uusimaa in March 2020. The data were randomly split with one part used to carry out an exploratory factor analysis (EFA), and the other for testing the resulting model using confirmatory factor analysis (CFA). Results A total of 6073 employees responded to the LHISI survey, for an overall response rate of 23%. The results indicated that the 43 items used in the original LHISI can be reduced to 25 items, and these items measure a five-dimensional model of the progress of Lean implementation: leadership, commitment, standard work, communication, and daily management system. In comparison with a single-factor model, the fit measures for the 5-factor model were better: smaller X2, larger comparative fit index (CFI), smaller root mean square error of approximation (RMSEA), and smaller standardized root mean square residual (SRMR). Conclusions The 25 item LHISI is valid and feasible to use in the context of Finnish healthcare. The LHISI allows the organization to self-monitor the progress of its Lean implementation and provides the leadership with actionable knowledge to guide the path towards Lean maturity across the organization. Our findings encourage further studies on the adoption and validation of the LHISI in healthcare organizations worldwide.

Externalities of Lean Implementation in Medical Laboratories. Process Optimization vs. Adaptation and Flexibility for the Future

Important in testing services in medical laboratories is the creation of a flexible balance between quality-response time and minimizing the cost of the service. Beyond the different Lean methods implemented so far in the medical sector, each company can adapt the model according to its needs, each company has its own specifics and organizational culture, and Lean implementation will have a unique approach. Therefore, this paper aims to identify the concerns of specialists and laboratory medical services sector initiatives in optimizing medical services by implementing the Lean Six Sigma method in its various variants: a comparative analysis of the implemented models, with emphasis on measuring externalities and delimiting trends in reforming/modernizing the method, a comprehensive approach to the impact of this method implementation, and an analysis of available databases in order to underline the deficit and information asymmetry. The results highlighted that in the case of clinical laboratories, the Lean Six Sigma method is conducive to a reduction of cases of diagnostic errors and saves time but also faces challenges and employees’ resistance in implementation.

Identifikasi Hambatan Penerapan Lean di Usaha Kecil dan Menengah (UKM)

Today's world competition has increased the pressure on Small and Medium Enterprises (SMEs) to adopt lean implementations. The purpose of this study is to make a small contribution by exploring the Lean Implementation Barrier (LIB) in SMEs through three case studies of SMEs in the city of Bandung. A case study approach is used and followed by the Interpretative Structural Model (ISM) in order to see the inter-LIB relationship. The results of this study indicate that lack of management commitment and leadership, lack of employee involvement and lack of resources are the main obstacles to lean implementation in SMEs in Indonesia. Moreover, poor communication among various levels within the company and inadequate dissemination of knowledge about the benefits of lean also create barriers to lean implementation. The implication of this research is to strengthen and expand information related to research on the application of lean in SMEs, especially the results of the identified barriers that can assist SMEs in implementing lean or future research in developing and identifying barriers to implementing lean in SMEs.

A conceptual framework for a systemic understanding of barriers during lean implementation

PurposeMultiple organisations which have attempted to implement lean production/manufacturing/thinking have failed to achieve significant benefits. Practitioners and researchers have identified the barriers that hinder successful implementation. This study first consolidates such lean implementation barriers that are common across all industry sectors. Further, a systemic understanding of lean barriers is attempted by determining causal relationships between barriers and their relative causal strength.Design/methodology/approachBarriers to lean implementation were first identified from extant literature and categorised into broad barrier groups. These barrier groups were classified into four categories as specified by Liker's 4P model of lean–philosophy, people and partnership, processes and problem-solving. Additionally, interrelations between barriers, both within and among these four categories were determined.FindingsThe barriers classified under philosophy were the most critical as it affects the barriers in other groups. Similarly, barriers such as lack of leadership and top management commitment, lack of resources, shortage of lean consultants and trainers, lack of systemic understanding of lean and the need for its implementation, lack of lean expertise and training were found to be the most critical causal barriers.Research limitations/implicationsHighly critical barriers in terms of causality should be addressed with high priority, as effective measures against them may eliminate or reduce the impact of other barriers.Originality/valueThis study addresses the confusion regarding the high number of lean barriers in extant literature by providing a systemic understanding of the same. By exploring the interrelations among barriers, the most important causal barriers and barrier types (4Ps) are identified, the knowledge of which could improve lean implementation success. This is a novel attempt in the domain of lean.

Applying Lean Healthcare to Improve the Discharge Process in a Mexican Academic Medical Center

Lean Thinking has been one of the preferred approaches to improve healthcare processes in developed countries; however, it has been barely used in Latin America. This study presents a Lean implementation in a Mexican public academic medical center. The goal was to reduce the time required to discharge patients from the Internal Medicine Department. This non-experimental intervention study measured, analyzed, and improved the process flow through a time study, value-added/non-value-added analysis, and the four-step quick changeover approach. Once changes were implemented, inferential statistics were used to compare results. Lean implementation allowed reducing the time to discharge patients from 6 to 3 h by eliminating 57% of non-value-added activities and 70% of errors found in discharge orders. This represents a 2% annual capacity increase and a 6.423 h bed made available without investment. Other findings include barriers regarding untrained staff about process improvement and departmental barriers and a successful quick changeover implementation. This is one of the handful of implementations of Lean Healthcare in Latin America. Furthermore, this is one of the very first studies that showcase the implementation of the quick changeover approach in healthcare. Further research should focus on the long-term impact and how the specific environment encourages/discourages future implementations.

Barriers for Lean implementation in the textile industry

Purpose The fundamentals of Lean are applicable and can be used in any industry, even non-profit and government organizations, however, there might be certain limitations due to the nature and the specifics of the industry. This study aims to explore what barriers of Lean implementation textile manufacturers might encounter. The authors consider the problem is worth to be explored for the potential to improve the effectiveness of Lean implementation in textile sector companies. Design/methodology/approach This research was conducted by using qualitative content analysis with open coding of the selected literature followed by empirical research in a Latvian textile manufacturing company. Findings The presented literature review shows Lean implementation barriers and critical success factors in various industries. The findings from the case study can be divided into two groups. The first confirmed the barriers already identified in the previous research. The second identified industry specific implementation barriers that were not recognized in the related literature. Research limitations/implications The original research was limited in scope to one Latvian textile manufacturer, therefore future studies on the subject to confirm the outcome of the research are required. Originality/value There is a limited number of studies on the application of Lean in the textile and apparel industry. The literature on Lean implementation in the Latvian manufacturing sector is also limited. The results of this research may have a practical application for textile manufactures considering implementing Lean in their processes.

Lean Implementation Barriers and the duality of lean in an Organisations

Lean strategy is all about elimination of waste and redundant process; competitive benchmarking, introducing continuous improvement programs, preventive maintenance optimization, cycle time reduction, just-in-time (JIT), new process improvement, quality management programs, value engineering, self-directed work team, total quality management. The study investigates how people and duality of lean impacts lean implementation in organizations, looking at the case of the food processing manufacturing firms in Nigeria. To achieve the objective, the study employed Structural Equation Modelling (PLS-SEM) using data collected from 340 questionnaire collected from food processing firms in Nigeria. It was discovered from the study that factors hindering implementation of lean could be in the form of poor communication strategy within organisation, organizational culture, organisational knowledge, management support, policies on human development. The paper concludes that lean implementation does not have a stand-alone methodology, but the existence or lack of the identified factors may make or hinder successful implementation of lean especially in the food processing manufacturing companies in Nigeria.