From the perspective of some respondents however the

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gains beyond an increase in ROI. From the perspective of some respondents, however, the benefits of implementing Lean at the hospital reach beyond financial gains to increased employee morale, an increase in clinical knowledge, increases in efficiency, and in some cases a perceived increase in patient satisfaction and safety. In sum, the overall perception of success on the two projects was mixed, and staff were still uncertain about Lean. The CEO noted that some staff have embraced the concepts fully, some see Lean as a passing trend, and some are resistant to change and undermine the process. The D2B project was viewed as a partial success because the D2B time decreased, and staff communication between departments improved. Factors that Influenced Success of Lean Implementation During site visits and interviews, staff at all levels were asked to name the two or three greatest contributors to success as well as the problems or challenges they witnessed or faced in implementing Lean (see Exhibit 2.13). Findings regarding facilitators and barriers are based on responses to these questions. Barriers to implementation were identified approximately three times more often by staff than facilitators. Staff mentioned a great number of factors that helped or impeded Lean organization or implementation. All interviewees were also asked to share their insights, that is, their lessons learned based on their experience with Lean at the hospital. More specifically, they were asked whether and how they would change what they had done if they were to do it over again. As expected, these lessons learned were closely aligned with the facilitators and barriers. Here, we discuss the aspects or factors mentioned by interviewees, noting how they operated as facilitators and/or barriers in the context of organizing the Lean initiative and then implementing it. We also link lessons learned to these facilitators and barriers. In sum, facilitators related to staff engagement were the most frequently mentioned, with leadership and resources a distant second. Conversely, resource issues were by far the most frequently noted barriers. Issues surrounding communication about Lean and staff engagement were the second highest and were noted with less than half the references. There were far fewer data on lessons learned than barriers and facilitators; nevertheless, issues around scope, pace, and coordination of Lean activities were noted most often. Because the experiences at the hospital were so mixed, we have organized this section by first providing a summary table showing major factors that facilitated Lean success at Central Exhibit 2.13. Key Facilitators And Barriers to Lean At Central Hospital (from Conceptual Framework) Organizing Lean Applicability and locus of Lean activity Scope, pace, and coordination Implementing Lean Resources Staff engagement or resistance Communication about Lean Lean team composition and size
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90 Hospital (Exhibit 2.14), followed by a table that presents major factors that inhibited its success (Exhibit 2.15).
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