Lean Healthcare: Barriers and Enablers in the Colombian Context

Authors: Erika Ruiz, Nestor Ortiz

Abstract:

Lean philosophy has evolved over time and has been implemented both in manufacturing and services, more recently lean has been integrated in the companies of the health sector. Currently it is important to understand the successful way to implement this philosophy and try to identify barriers and enablers to the sustainability of lean healthcare. The main purpose of this research is to identify the barriers and enablers in the implementation of Lean Healthcare based on case studies of Colombian healthcare centers. In order to do so, we conducted semi-structured interviews based on a maturity model. The main results indicate that the success of Lean implementation depends on its adaptation to contextual factors. In addition, in the Colombian context were identified new factors such as organizational culture, management models, integration of the care and administrative departments and triple helix relationship.

Keywords: Barriers, enablers, implementation, lean healthcare, sustainability.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1124403

References:

[1] G. Kundu and B. Manohar. “Critical success factors for implementing lean practices in it support services.” International Journal for Quality Research, (Online). Vol 6. No. 4. pp 301–312. 2012
[2] A. Esain. S. Williams. And L. Massey. “Combining planned and emergent change in a healthcare lean transformation.” Public Money and Management: Integrating Theory and Practice in Public Management, Vol 28. No. 1, pp 21–26. 2008
[3] M. Diane. J. Womack. A.P. Byrne. O.J. Flume. G.S. Kaplan. And J. Toussaint. “Going lean in health care”. Innovation Series, pp 1–20. 2005
[4] N. Westwood. M.J. Moore and M. Cooke. Going lean in the NHS. Reino Unido: NHS Institute of Innovation and Improvement. p 154. 2007
[5] L. Cuatrecasas. “Design of a rapid response and high efficiency service by lean production principles: Methodology and evaluation of variability of performance.” International Journal of Production Economics, 80(2), 169–183. doi:10.1016/S0925-5273(02)00316-X, 2002.
[6] J.K. Liker and J.M. Morgan. “The Toyota Way in Services: The Case of Lean Product Development”. Academy of Management Perspectives, 20, pp 5–20. doi:10.5465/AMP.2006.20591002, 2006.
[7] T. Young. S. Brailsford. C. Connell. R. Davies. P. Harper and J.H. Klein. “Using industrial processes to improve patient care”. BMJ. Clinical Research Ed. vol. 328 (7432) pp. 162-164. 2004
[8] C.S. Kim. D.A. Spahlinger. J.M. Kin. R.J. Coffey and J.E. Billi, “Implementation of lean thinking: One health system’s journey.” Joint Commission Journal on Quality and Patient Safety, Vol. 35(8), pp 406–413. 2009.
[9] U. Apte, C. Goh, “Applying lean manufacturing principles to information intensive services,” International Journal of Services Technology and Management. Vol. 5, p 488, 2004.
[10] L. Cuatrecasas, “A lean management implementation method in service operations,” International Journal of Services Technology and Management. Vol. 5. p 532, 2004.
[11] B. Kollberg. J.J. Dahlgaard and P. Brehmer. “Measuring lean initiatives in health care services: issues and findings.” International Journal of Productivity and Performance Management, Vol. 56(1), pp 7–24. 2004
[12] A. Sanchez, M. Perez, “The use of lean indicators for operations management in services,” International Journal of Services Technology and Management. Vol. 5; p. 465, 2004.
[13] K. Aij, F. Simons, G. Widdershoven, M. Visse, “Experiences of leaders in the implementation of Lean in a teaching hospital--barriers and facilitators in clinical practices: a qualitative study,” BMJ Open. Vol. 3. No. 10. p 0365, 2013.
[14] Z. Radnor, P. Walley, A. Stephens, G. Bucci. “Evaluation of the lean approach to business management and its use in the public sector,” Scotland: Scottish Executive. 2006. 138 p
[15] A. Taylor, M. Taylor, A. Mcsweeney, “Towards greater understanding of success and survival of lean systems,” International Journal of Production Research. Vol. 51. No. 22; p 6607-6630, 2013.
[16] T.A Saurin, J. Rooke, L. Koskela, and S. Kremmer, “Guidelines for the management of complex socio-technical systems: an exploratory study of a refurbishment project”. IGLC 21, Fortaleza, 13-22.2013.
[17] A. Lewis, "Lean production and sustainable competitive advantage", International Journal of Operations & Production Management, Vol. 20 Iss: 8, pp.959 – 978, 2000.
[18] J. Moyano‐Fuentes, M. Sacristán‐Díaz, "Learning on lean: a review of thinking and research", International Journal of Operations & Production Management, Vol. 32 Iss: 5, pp.551 – 582, 2012.
[19] S. Jacobs and S. Pelfrey. “Applying just-in-time philosophy to healthcare.” The Journal of Nursing Administration, Vol. 25(1), pp 47–51. 199hi
[20] D. Whitson. “Applying just-in-time systems in health care.” IIE Solutions, Vol. 29(8), pp 32–77. 1997
[21] L.B. Souza. “Trends and approaches in lean healthcare.” Leadership in Health Services. Vol. 22(2), pp 121–139. 2009 doi:10.1108/17511870910953788
[22] P. Mazzocato. C. Savage. M. Brommels. H. Aronsson and J. Thor. “Lean thinking in healthcare: a realist review of the literature.” Quality & Safety in Health Care, Vol. 19(5), pp 376–82. 2010. doi:10.1136/qshc.2009.037986
[23] B. Poksinska. “The current state of Lean implementation in health care: literature review.” Quality Management in Health Care, Vol. 19(4), pp 319–29. 2010. doi:10.1097/QMH.0b013e3181fa07bb
[24] T.P. Young and S.I Mcclean. “A critical look at Lean Thinking in healthcare.” Quality & Safety in Health Care, Vol. 17(5), pp 382–6. 2008
[25] G. Loor. A. Vivacqua. J.F. Sabik. L. Li. E.D. Hixson. E.H. Blackstone and C.G. Koch. “Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.” The Journal of Thoracic and Cardiovascular Surgery, Vol. 146(5), pp 1028–32. 2013. doi:10.1016/j.jtcvs.2013.05.043
[26] S. A. Waits. B. N. Reames. R. W. Krell. B. Bryner. T. Shih. A.T. Obi. And S.L. Wong. “Development of Team Action Projects in Surgery (TAPS): a multilevel team-based approach to teaching quality improvement.” Journal of Surgical Education, Vol. 71(2), pp 166–8. 2014. doi:10.1016/j.jsurg.2014.01.015
[27] C. J. Warner. D.B. Walsh, B. A.J. Horvath. T.R. Walsh. D.P. Herrick. S.J. Prentiss. And R.J. Powell. “Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.” Journal of Vascular Surgery, Vol. 58(5), pp 1417–22. 2013. doi:10.1016/j.jvs.2013.05.007
[28] P. Hwang. D. Hwang and P. Hong. “Lean practices for quality results: a case illustration.” International Journal of Health Care Quality Assurance, Vol. 27(8), pp 729–741. 2014. doi:10.1108/IJHCQA-03-2014-0024
[29] P. Mcculloch. S. Kreckler. Y. Sheena. A. Handa AND k. Catchpole. “Effect of a “Lean” intervention to improve safety processes and outcomes on a surgical emergency unit.” BMJ. Clinical Research Ed. 2010. doi:http://dx.doi.org/10.1136/bmj.c5469
[30] R. Stuart and E. Sweet. “A systems approach to an institutional laboratory ventilation management plan.” Journal of Chemical Health and Safety, Vol. 20(4), pp 31–37. 2013. doi:10.1016/j.jchas.2013.03.491
[31] B. A. White. J. Baron. Y. Chang, Y. C.A.C. Jr and D.F.M. Brown. “Applying Lean Methodologies Reduces Emergency Department Laboratory Turnaround Times.” Annals of Emergency Medicine, Vol. 64(4), S9. 2014. doi:10.1016/j.annemergmed.2014.07.046
[32] L. Samuel, L and S. Novak-Weekley. “The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology.” Journal of Clinical Microbiology, Vol. 52(6), pp 18212–1817. 2014
[33] D.M. Berwick. A. Kabcenell and T. Nolan. “No Toyota yet, but a start.” Modern Healthcare, Vol. 35(5), pp 18–20. 2005.
[34] Z. Radnor. P. Walley. A. Stephens and G. Bucci. (2006). Evaluation of the lean approach to business management and its use in the public sector,Edinburgh: Social Research. pp 1–145 2006. doi:ISBN 0 7559 6056 4
[35] F. Badurdeen. K. Wijekoon and P. Marksberry. “An analytical hierarchy process-based tool to evaluate value systems for lean transformations.” Journal of Manufacturing Technology Management, Vol. 22(1), pp 46–65. 2011.
[36] Z. Radnor and P. Walley. “Learning to Walk Before We Try to Run: Adapting Lean for the Public Sector.” Public Money & Management, Vol. 28(1), pp 13–20. 2008. doi:10.1111/j.1467-9302.2008.00613.x
[37] K. Barnas. “ThedaCare’s business performance system: sustaining continuous daily improvement through hospital management in a lean environment.” Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources, Vol. 37(9), pp 387–99. 2011.
[38] D. Fillingham. “Can lean save lives?”. Leadership in Health Services Vol. 20, pp 231–241. 2007. doi:10.1108/17511870710829346
[39] D. Jones. “Design lean healthcare systems”. Lean Enteprise Academy website.Avaible at http://www.leanuk.org/article-pages/sector/healthcare.aspx
[40] D. Jones, A. Mitchell. “Lean thiking for the NHS”. NHS Confederation. 2006
[41] M. Cretikos. M. Parr. K. Hillman. G. Bishop. D. Brown. K. Daffurn and L. Young. “Guidelines for the uniform reporting of data for Medical Emergency Teams.” Resuscitation, Vol. 68(1), pp 11–25. 2006. doi:10.1016/j.resuscitation.2005.06.009
[42] J.R. Black and D. Miller. The Toyota way to healthcare excellence: increase efficiency and improve quality with Lean. New York: Health Administration Press. May 12, 2008
[43] R. Chalice. Improving Healthcare Using Toyota Lean Production Methods: 46 steps for improvement. USA: ASQ Quality Press. p. 62. 2007
[44] N. Burgess and Z. Radnor. “Evaluating Lean in healthcare.” International Journal of Health Care Quality Assurance, Vol. 26(3), pp 220–35. 2013 doi:10.1108/09526861311311418
[45] D.L. King, D. I. Ben-tovim and J. Bassham. “Redesigning emergency department patient flows: Application of Lean Thinking to health care”. EMA - Emergency Medicine Australasia, Vol. 18, pp 391–397. 2006. doi:10.1111/j.1742-6723.2006.00872.x
[46] E.W. Dickson. S, Singh. D.S. Cheung. C.C. Wyatt and A.S. Nugent. “Application of lean manufacturing techniques in the Emergency Department.” The Journal of Emergency Medicine, Vol. 37(2), pp 177–82. 2009. doi:10.1016/j.jemermed.2007.11.108
[47] C. Jimmerson. D. Weber and D.K. Sobek. “Reducing waste and errors: piloting lean principles at Intermountain Healthcare”. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources, Vol. 31(5), pp 249–57.2005.
[48] D. Folinas and T. Faruna. “Implementing lean thinking paradigm practices in medical set up.” Business Management Dynamics, Vol. 1(2), pp 61–78. 2011.
[49] M. Graban. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, (2 nd). USA: Taylor & Francis Group. 2011.
[50] H. Koning. J.P.S. Verver. J. Heuvel. S. Bisgaard, S and R.J.M.M Does. “Lean Six Sigma in Healthcare.” Journal for Healthcare Quality, Vol. 28(2), pp 4–11. 2006. doi:10.1111/j.1945-1474.2006.tb00596.x
[51] C.R. Nicolay. S. Purkayastha. A. Greenhalgh. J. Benn. S. Chaturvedi. N. Phillips and A. Darzi. “Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare.” British Journal of Surgery, Vol. 99(3), pp 324–335. 2012. doi:10.1002/bjs.7803
[52] T. Papadopoulos. “Continuous improvement and dynamic actor associations.” Leadership in Health Services, Vol. 24(3), pp 207–227. 2011. doi:10.1108/17511871111151117
[53] Z.J. Radnor. M. Holweg and J. Waring. “Lean in healthcare: the unfilled promise?.” Social Science & Medicine. Vol. 74(3), pp 364–71. 2012. doi:10.1016/j.socscimed.2011.02.011
[54] K.H. Aij. F.E. Simons. G.A.M. Widdershoven and M. Visse. “Experiences of leaders in the implementation of Lean in a teaching hospital--barriers and facilitators in clinical practices: a qualitative study.” BMJ Open, Vol. 3, pp e003605. 2013. doi:10.1136/bmjopen-2013-003605
[55] M. Ballé. A. Régnier. “Lean as a learning system in a hospital ward.” Leadership in Health Services, Vol. 20(1), pp 33–41. 2007. doi:10.1108/17511870710721471
[56] H.L. Farley. K.M. Baumlin. A.G. Hamedani. D.S. Cheung. M. R. Edwards. D.C. Fuller and J.M Pines. “Quality and safety implications of emergency department information systems.” Emergency Medicine, Vol. 62(4), pp 399–407. 2013. doi:10.1016/j.annemergmed.2013.05.019
[57] R. Sousa and C. Voss. “Contingency research in operations management practices.” Journal of Operations Management, Vol. 26(6), pp 697–713. 2008. doi:10.1016/j.jom.2008.06.001
[58] J.W. Creswell, “Qualitative inquiry and research de sign: Choosing among five traditions,” Thousand Oaks, CA, EEUU: Sage. 1998.
[59] R.K. Yin, “Case study research: Design and methods” (2nd ed.). Newbury Park, CA: Sage Publications. 1994
[60] K.M Eisenhardt, and M.E. Graebner, “Theory building from case studies: Opportunities and challenges,” Academy of Management Journal, 50(1), 25-32, 2007.
[61] M. Brod, L.E. Tesler, T.L Christiansen, “Qualitative research and content validity: Developing best practices based on science and experience,” Quality of Life Research, 18(9), 1263-1278. doi:10.1007/s11136-009-954, 2009.
[62] M. Malmbrandt and P. Åhlström. “An instrument for assessing lean service adoption.” International Journal of Operations & Production Management, Vol. 33(9), pp 1131–1165. 2013. doi:10.1108/IJOPM-05-2011-0175
[63] H.F. Wolcott, “Writing Up Qualitative Research”. (3 ed.) Sage, Thousand Oaks, CA, 2009.
[64] H. Bahaitham, A. Elshennawy, S. Furterer, “Assessment and Implementation of Lean Sustainability in Healthcare Organizations,” institute of Industrial Engineers. 2013; p 52.