Improving Care Delivery Through Lean: Implementation Case Studies

Factor	Lessons Learned
Alignment	Staff viewed their roles at the hospital as misaligned with the goals of Lean. Difficult for some to transfer Lean principles to health care. Lack of a culture of setting goals and holding staff accountable for meeting expectations. Lack of department directors on the initial teams led to difficulty holding people accountable for changes made by the RCI team.
Scope, pace, and coordination	The pace of the Lean projects at the hospital was too fast, making it hard to monitor and follow up on projects.
Leadership	Lack of department directors on the RCI teams at the beginning led to the creation of solutions that were not feasible.. Team leaders from outside the department were not able to define changes that were sustainable for the department.
Resources	Lack of capital resources impeded the implementation of solutions. Lack of resources for data collection was a barrier to sustainability. Lean events were time consuming for staff.
Communication about Lean	There was not always effective communication about events and solutions to staff that did not participate in the event. Lack of Lean training was seen as a barrier to participation.
Staff engagement	Physician employment structure was a barrier to engagement, as there were no incentives for them to participate.
Lean team composition and size	"Fresh eyes" on the team suggested solutions that were not feasible and may have caused department staff to feel defensive.

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