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Lean maturity and quality in primary care
University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.ORCID iD: 0000-0003-2211-620x
University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.ORCID iD: 0000-0003-1443-6211
University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production.ORCID iD: 0000-0001-8238-034x
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.ORCID iD: 0000-0002-9912-5350
2019 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 2, p. 141-154Article in journal (Refereed) Published
Abstract [en]

Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.

Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality. 

Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019. Vol. 32, no 2, p. 141-154
Keywords [en]
healthcare, Lean principles, Liker, observations, qualitative
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:hig:diva-26374DOI: 10.1108/JHOM-04-2018-0118ISI: 000463633800002PubMedID: 30950305Scopus ID: 2-s2.0-85060950444OAI: oai:DiVA.org:hig-26374DiVA, id: diva2:1192901
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2020-01-29Bibliographically approved
In thesis
1. A staff perspective on Lean maturity, well-being, and quality in primary care
Open this publication in new window or tab >>A staff perspective on Lean maturity, well-being, and quality in primary care
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Lean is commonly implemented in healthcare but it is unclear how much of Lean is adopted and whether Lean is associated with staff’s well-being and quality of care.

Aim: To describe staff perception of Lean maturity in primary care, and to determine to what extent staff-rated Lean maturity is associated with staff rated thriving, exhaustion, and musculoskeletal complaints, as well as staff rated quality of care.

Method: Survey data were collected in 2015 (n=481 staff) and 2016 (n=351 staff) at 48 primary care units; they were analyzed using confirmatory factor analysis (Paper I), and multiple regression analysis, taking nesting within units into account when possible (Paper II-IV). Interviews (n=12 staff) and observations (n=28 staff) were analyzed deductively.

Results: The developed Lean in Healthcare Questionnaire, based on Liker’sdescription of Lean, generally showed acceptable psychometric properties (Paper I). Lean maturity varied within and between units. The highest maturity concerned staff adherence to routines, and the lowest concerned having a change agent at the unit (Paper II). Lean maturity was positively associated with staff satisfaction with care, both cross-sectionally (Paper II) and, mediated by increased resources, in a longitudinal analysis (Paper IV). The 12-month prevalence of musculoskeletal complaints in the shoulders, neck, and low back was 50-58%, and the 7-day prevalence 25-37% (PaperIII). Lean maturity was not associated with musculoskeletal complaints (PaperIII). Increased Lean maturity was, however, associated with increased thriving, mediated by increased job resources, as well as with decreased exhaustion, mediated by decreased job demands (Paper IV).

Conclusion: Lean maturity varied in primary care. It was positively associated with staff-rated quality of care and thriving, and negatively associated with exhaustion. Musculoskeletal complaints were common, but not associatedwith Lean maturity.

Abstract [sv]

Bakgrund: Lean i hälso-och sjukvården är vanligt. Det är dock oklart i vilken utsträckning Lean har implementerats och om det finns samband mellan Lean och välbefinnande.

Syfte: Att beskriva hur personal uppfattar mognaden av Lean inom primärvården, samt att påvisa i vilken utsträckning det finns ett samband mellan medarbetarnas skattning av mognad av Lean och deras skattning av thriving, utmattning och muskuloskeletala besvär, samt deras skattning av vårdkvalitet i primärvården.

Metod: Enkätdata samlades in 2015 (n=481 medarbetare) och 2016 (n=351 medarbetare) vid 48 primärvårdsenheter, som analyserades med konfirmatorisk faktoranalys (delstudie I) och multipel regressionsanalys (delstudie II-IV). Intervjuer (n=12 medarbetare) och observationer (n=28 medarbetare) analyserade deduktivt.

Resultat: Lean in Healthcare Questionnaire utvecklades, baserat på Liker’s beskrivning av Lean (delstudie I). Mognaden av Lean varierade, högst mognad rörde efterlevnad av rutiner, lägst mognad rörde att ha en person på enheten som ansvarade för Lean implementeringen (delstudie II). Positiva samband sågs mellan mognad av Lean och medarbetares tillfredställelse med den vård de givit, i tvärsnitts- (delstudie II) samt longitudinell data (medierat av ökade resurser) (delstudie IV). Muskuloskeletala besvär från skuldror, nacke och ländrygg de senaste 12 månaderna uppgavs av 50-58%, besvär de senaste 7 dagarna uppgavs av 25-37% (delstudie III). Inget samband sågs mellan mognad av Lean och muskuloskeletala besvär (delstudie III). Samband sågs mellan ökad mognad av Lean och ökad thriving medierat av ökade resurser, samt minskad utmattning, medierat av minskade krav (delstudie IV).

Slutsats: Mognaden av Lean varierade inom primärvården. Positiva samband framkom mellan mognad av Lean och medarbetarnas skattning av vårdkvalitet och thriving. Sambandet till utmattning var negativt och inga samband framkom rörande muskuloskeletala besvär. Men att ha muskuloskeletala besvär var vanligt.

Place, publisher, year, edition, pages
Gävle: Gävle University Press, 2020. p. 58
Series
Doctoral thesis ; 12
Keywords
LiHcQ, CFA, GEE, musculoskeletal, MSD, thriving, exhaustion, quality, longitudinal, mixed-methods, LiHcQ, KFA, GEE, muskuloskeletal, MSB, thriving, utmattning, vårdkvalitet, longitudinell, mixad metod
National Category
Other Medical Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-31086 (URN)9789188145406 (ISBN)9789188145413 (ISBN)
Public defence
2020-02-27, Stora Jadwigasalen, Kungsbäcksvägen 47, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-02-04 Created: 2019-12-19 Last updated: 2020-04-02Bibliographically approved

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Kaltenbrunner, MonicaMathiassen, Svend ErikBengtsson, LarsEngström, Maria

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