Are important for fit or match include the perceived

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are important for “fit” or “match” include: the perceived advantages relative to current practice (e.g., Lean results in superior efficiency and/or quality); compatibility with values, beliefs, and mission/vision; complexity (e.g., whether Lean is relatively easy to understand and use); trialability (i.e., the ability to experiment with Lean, on a limited basis, as opposed to an all-or-nothing approach); and observability (i.e., the extent to which the results are observable to key groups and stakeholders). 15 For example, alignment between Lean and the organizational culture is likely to be poor when there is limited experience with or trust of multidisciplinary teamwork. Similarly, in organizations where physicians are used to high levels of autonomy, there may be resistance to Lean’s stress on standardization of care processes. 4. Outcomes, both intermediate and ultimate. The next element of our conceptual framework is the outcomes associated with Lean implementation. The intermediate outcomes include employee satisfaction, culture change, increased knowledge of Lean, and routinization and diffusions of Lean methods and skills. For example, in the near or intermediate term, Lean can positively or negatively impact satisfaction among physicians and other clinicians and staff. The final outcomes include aspects of efficiency, quality, safety, and satisfaction. Further, in order for organizations to sustain Lean, there has to be a business and/or strategic case resulting from the initiative. 5. Integration of Lean into organizational routines. The final element of our conceptual framework is a feedback loop from the intermediate and ultimate outcomes to the internal context or organization. If organizations perceive and experience positive outcomes from their Lean efforts, they will be more willing and able to sustain their Lean efforts. In addition, as the organizations gain more experience with Lean, they will continue to learn about when and how to use it and how best to integrate it into their organizational structures and processes generally and, more specifically, with respect to quality improvement and Lean. Purpose of Case Studies The purpose of the individual case studies, as part of the larger project, was to examine the ways in which each organization has implemented Lean and identify the factors that influenced progress within individual Lean projects and on the ultimate outcomes. At a practical level, these individual case study reports are designed to provide potential Lean users with information that will enable them to make informed decisions about implementing Lean, based on experiences that are relevant to their own situation. The individual case studies contributed to goals of the project overall by providing evidence to answer study questions corresponding to each of the aims described here.
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