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This research aims to contribute to the literature on Lean implementation in healthcare by studying the emotional experiences of the relevant actors related to a Rapid Process Improvement Workshop (RPIW) in a UK healthcare context. The purpose of this study was to go beyond what people think about Lean and towards an exploration of their subjective, emotional and “feeling” experience and whether that emotional experience influenced Lean implementation.

A phenomenological and symbolic interactionist qualitative case study was undertaken. Data related to participants' emotional experience were collected through non-participant observation and semi-structured interviews. Data were analysed using thematic network analysis.

This paper provides novel insights into the emotional experience of Lean as experienced through an RPIW. The findings reveal that participation in an RPIW is much more than a technical process. It influences how people feel about themselves, is based on relationships with others, and requires mental, physical and emotional effort. All of these factors influence engagement with, initiation of and sustainability of the RPIW.

A new conceptual framework for the planning and implementation of RPIWs has been developed. However, because of the chosen research approach, the results may lack generalisability. Therefore, researchers are encouraged to test the framework and proposed practice implications.

Despite emotions being an integral part of individual and social everyday life, emotional experience has not been studied in relation to Lean. This study is the first to explore emotions in relation to Lean, with implications for practice as to how RPIWs are managed with a new framework for implementation being proposed.

The purpose of this paper is to investigate whether intervention participants’ process appraisals relate to change in well-being and lean outcomes of entire teams. For this purpose, the study focussed on two main characteristics of a lean implementation process – workshop quality and outcome expectancy – and their interaction with the participation rate, and examined their association with leaner work processes and affective well-being in nursing teams.

Data were collected from a lean implementation project within 29 nursing wards of a university hospital. Employee surveys covering lean work processes and affective well-being at work were conducted before the implementation of four-day lean workshops in each nursing ward and six months after. The participating employee representatives evaluated the workshop quality and outcome expectancy of the workshops.

Multilevel analyses indicated that workshop quality did not relate to leaner work processes, but was associated with enhanced affective well-being after six months. By contrast, outcome expectancy was associated with leaner work processes, but did not relate to well-being. No moderation effects with participation rate were found.

The study shows the importance of monitoring process indicators in the early stages of implementation and optimising workshop contents and formats accordingly to ensure positive outcomes for entire teams.

The present study considers intervention participants’ process appraisals of workshop quality and outcome expectancy as good indicators of future change in lean work processes and the well-being of entire teams.

The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.

The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.

Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement.

The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application.

This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.

During years 2014-2016, Veterans Health Administration National Surgery Office conducted a surgical flow improvement initiative (SFII) to assist low-performing surgery programs to improve their operating room efficiency (ORE). The initiative was co-sponsored by VHA National Surgery Office and VHA Office of Systems Redesign and Improvement. The paper aims to discuss this issue.

An SFII algorithm, based on first-time-start (FTS), cancellation rate (CR), lag time (LT) and OR utilization, assigned an ORE performance Level (1-low to 4-high) to each VA Medical Center (VAMC). In total, 15 VAMCs with low-performance surgery programs participated in SFII to assess the current state of their surgical flow processes and used redesign methods to focus on improvement objectives.

At the end of the project, 14 VSAs, 40 RPIWs, 45 “90-day projects” and 73 Just-Do-It’s were completed with 65 percent (158/243) improvement actions and 86 percent sites improving/sustaining all four ORE metrics. There was a statistically significant difference in improvement across the three stages (baseline, improvement, sustain) for FTS (45.6-68.7 percent; F=44.74; p<0.000); CR (16.1-9.5 percent; F=34.46; p<0.000); LT (63.1-36.3 percent; F=92.00; p<0.000); OR utilization (43.4-57.7 percent; F=6.92; p<0.001) and VAMC level (1.7-3.65; F=80.11; p<0.000). The majority developed “fair to excellent” sustainment (91 percent) and spread (82 percent) plans. The projected annual estimated return-on-investment was $27,949,966.

The SFII successfully leveraged a small number of faculty, coaches, and industrial engineers to produce significant improvement in ORE across a large national integrated health care network. This strategy can serve healthcare leaders in managing complex healthcare issues in their facilities.

The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out.

The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED.

This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.

Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.

To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.

Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.

We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.

As the US health system moves to value-based care and aligns payment with quality, the role of the primary care provider (PCP) is becoming ever more important. The purpose of this paper is to outline a successful population health and care management strategy depending on accountable teams to standard workflow and agreed upon process and outcome measures in order to achieve the triple aim of improved health, patient experience, and value.

Two major areas of focus for primary care are ensuring that all patients receive appropriate evidence-based screening and prevention services and coordinating the care of patients with chronic conditions. The former initiative will promote the general health and well-being of patients, while the latter is a key strategy for achieving better outcomes and reducing costs for patients with chronic conditions.

To achieve these goals while managing a busy practice requires that the authors leverage the PCP by engaging clinical and non-clinical team members in the care of their patient population. It is essential that each team member’s role be clearly defined and ensures they are working at the top of their scope.

This initiative was successful because of the compelling objectives, the buy-in generated by using Lean methodology and engaging the team in the design process, use of multiple feedback mechanisms including stories, dashboards, and patient feedback, and the positive impact on providers, staff, and patients.

Introduction Consider a hi‐fi loudspeaker manufacturing company acquired on the brink of insolvency by an American multinational. The new owners discover with growing concern that the product range is obsolete, that manufacturing facilities are totally inadequate and that there is a complete absence of any real management substance or structure. They decide on the need to relocate urgently so as to provide continuity of supply at the very high — a market about to shrink at a rate unprecedented in its history.

Recent construction literature has been focusing more on integrative contracting approaches such as integrated project delivery (IPD). However, conceptual studies on integration in IPD literature are scattered and fragmented, that is, most of the studies only focused on the segmented dimension of integration. A systemic understanding of the concepts of integration in IPD project-based context is still lacking. To fill this gap, this paper analyzes two aspects of integration (dimensions and directions) in IPD literature and explores their extent in construction projects.

Grounded theory review and focus group discussion approaches were employed to perform a thorough conceptual review of the literature, frame the research into the theory and increase the fundamental understanding of the concept of integration in IPD literature.

In this study, IPD integrating techniques were identified and their integration dimensions and directions were discussed. Results show that integration in the project-based environment of IPD is a multidimensional construct. Based on organizational, contractual and operational characteristics of IPD projects, twenty-four integration mechanisms were identified and framed into seven clusters. The integration directions over project life-cycle were demonstrated in three contexts: (1) an on-site construction project, delivered traditionally, (2) an on-site construction project, delivered with IPD and (3) an off-site construction project, delivered with IPD.

This paper gathers the segments of integration into a comprehensive overview, which can help researchers and practitioners explore elements of IPD project success more precisely. A theoretical framework of integration clusters is developed, based on IPD literature. The impact of IPD on on-site versus off-site construction is illustrated from an integration direction perspective. Finally, future areas of studies for researchers and practitioners about the concept of integration in an IPD context are discussed. This paper provides a point of departure for future theoretical and empirical explorations.

The purpose is explore an approach to acquire, analyze and report data concerning an organizational change initiative that combines knowledge generation and knowledge use, and contrast that with a method where knowledge generation and use is separated. More specifically, the authors contrast a participatory group workshop with individual interviews analyzed with thematic analysis, focusing on information about the change process and its perceived practical relevance and usefulness.

Participants were managers responsible for implementing a broad organizational change aiming to improve service quality (e.g. access and equity) and reduce costs in a mental health service organization in Sweden. Individual interviews were conducted at two points, six months apart (i1: n = 15; i2: n = 18). Between the interviews, a 3.5-h participatory group workshop was conducted, during which participants (n = 15) both generated and analyzed data through a structured process that mixed individual-, small- and whole-group activities.

Both approaches elicited substantive information about the content, purpose and process of change. While the content and purpose findings were similar across the two data sources, the interviews described how to lead a change process, whereas the workshop yielded concrete information about what to do. Benefits of interviews included personal insights about leading change while the workshop provided an opportunity for collective sense-making.

When organizational stakeholders work through the change process through a participatory workshop, they may get on the same page, but require additional support to take action.