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Complexity complicates lean: lessons from seven emergency services

Pamela Mazzocato (Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)
Johan Thor (Jonkoping Academy for Improvement of Health and Welfare, Jonkoping University, Jonkoping, Sweden and Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)
Ulrika Bäckman (Medical Management Centre, Astrid Lindgren Children's Hospital/Karolinska University Hospital, Stockholm, Sweden)
Mats Brommels (Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)
Jan Carlsson (Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)
Fredrik Jonsson (Karolinska University Hospital, Stockholm, Sweden)
Magnus Hagmar (Department of Women's and Children's Health, Division of Obstetrics and Gynecology Karolinska Institutet, Stockholm, Sweden)
Carl Savage (Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 13 May 2014

Abstract

Purpose

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

Design/methodology/approach

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

Findings

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

Originality/value

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

Keywords

Citation

Mazzocato, P., Thor, J., Bäckman, U., Brommels, M., Carlsson, J., Jonsson, F., Hagmar, M. and Savage, C. (2014), "Complexity complicates lean: lessons from seven emergency services", Journal of Health Organization and Management, Vol. 28 No. 2, pp. 266-288. https://doi.org/10.1108/JHOM-03-2013-0060

Publisher

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Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited