Large System Transformation within Healthcare Organizations utilizing Lean Deployment Strategies

Hagg, Heather

Etd

Large System Transformation within Healthcare Organizations utilizing Lean Deployment Strategies

Public

Multiple U.S. healthcare organizations have been recognized as successful in enterprise-level transformation to create healthcare delivery systems that are safe, effective, patient-centered, timely, efficient and equitable. Many of these organizations have specifically cited the development, deployment and integration of enterprise-level deployment of Lean Management Systems as key to their transformational efforts. Given the intense national interest in improving quality, efficiency and efficacy of healthcare delivery systems, a greater understanding of the strategies utilized by these organizations was required in order to provide an understanding of the mechanisms that drive successful, sustained, enterprise-level transformation. We conducted a realist review of large system transformation utilizing enterprise-level Lean Deployment methods within healthcare organizations. Synthesis and analysis of the results from this review indicate that there are five primary strategies associated with successful healthcare-based Lean deployments: Respect for People; Strategic Alignment; Strategic Deployment; Large Scale System Improvement Efforts; and Small-Scale, Local Improvement Efforts. Additional findings from this review indicate that the applications of the specific mechanisms with these strategies are emergent within multiple transitional phases spanning 6-8 years. To supplement the findings from the realist review, a series of dynamic hypotheses and system dynamics model was created in order to explore how the mechanisms and context interact to drive phase transitions within healthcare-based enterprise-level Lean deployments. The results from this model indicate that no steady state initial conditions exist that support sustained enterprise-level transformation and that the emergent nature of these deployments is necessary to overcome constraints related to the organizational capacity and capability. Additionally, we investigate the design and deployment of enterprise-level Lean programs in order to increase rate of success and decrease deployment cycles.

Creator