Availability of resources numerous interviewees at

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owners were not able to “keep the momentum” on the project, contributing to its failures. Availability of Resources Numerous interviewees at Suntown, with the exception of the CEO, described staff availability as a barrier to participation in Lean projects. For projects involving clinical staff, such as the E-Prescribe event, providers were often unable to attend training sessions because of their schedules. One provider expressed frustration at the length of the Lean projects, noting that she would like to have more flexible participation in Lean events. In addition, one frontline staff person described how difficult it was for staff in full-time positions to devote extra time towards Lean improvement processes, with the implementation stage being the most difficult. Even the CEO indicated that there was some frustration among staff when there was no one to cover for them while they were away at workshops. In some ways, this barrier is a result of the organization’s small size and the fact that so many staff members fulfill multiple roles. Despite the challenges of finding the time to participate in Lean events, several interviewees mentioned that salaried employment at Suntown facilitated provider participation in Lean because staff can participate in training without worrying about losing money. Lack of capacity for data collection and reporting was also cited as a major barrier for Suntown in implementing Lean. As discussed in the previous section, Suntown does not routinely collect data after the RCE event, and actual improvements are not always measured. To overcome this barrier, the plan is to hire a full-time IT staff person who will also take on a data supervisory role. One senior executive indicated that hiring this individual would help improve and streamline data collection capabilities, allowing for a point person for organizational metrics. Several interviewees also noted that obtaining resources is a barrier to Lean implementation. Notwithstanding the support expressed by the CEO for allocating funds for Lean implementation, these interviewees reported that, because of budget constraints and existing organizational procedures for obtaining approval on purchases, purchasing new equipment to implement new processes designed in the RCE can be difficult. As the care coordinator said, “I have to go and find this paperwork. Once I find the right person who knows what the paperwork looks like then I have to get it signed by som e administrator.” This in turn adds to the time drain during the implementation stage. According to the quality assurance and clinical director, even when purchases are decided upon there is often a long lag time up to 2 months before the supplier ships the correct item. Staff Engagement Several staff, including senior executives and nurse managers, noted that participating in RCEs is important for facilitating staff buy-in to the Lean initiative. These individuals believed that after a staff person participated in a 3-day event and saw the potential reduction in waste, they would
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163 become believers in the Lean process. One frontline staff person whose first RCE was the UTI
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