Clinical process and outcomes and patient safety

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Clinical process and outcomes, and patient safety Business or strategic case Exhibit 5.16. Key Facilitators and Barriers to Organizing and Implementing Lean at heights Hospital ( From Conceptual Framework ) Organizing Lean Scope, pace, and coordination Implementing Lean Staff engagement or resistance Resources Leadership qualities and support
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193 routinization of Lean. Interestingly, when we analyzed the findings by interviewee, we found some differences in perceived intermediate outcomes between leaders (executives and department managers) and frontline staff. Culture change, employee satisfaction, and increased Lean knowledge and skills were solely reported by those in leadership positions, while outcomes related to Lean routinization were reported by all. Organizational Culture Change Four executives and two managers indicated that Lean has produced positive cultural changes, with five of these six interviewees emphasizing that many areas still had not experienced an RIE. Participation in an RIE was key to this cultural shift, since Lean training took place within the RIEs, and RIE participants develop a strong sense of teamwork as the result of diverse staff nursing, medical, clerical and administrative coming together to work towards a common goal. One executive emphasized that this shift was only the beginning of a long journey of cultural transformation for the organization. Interviewees (four executives and one manger) saw a change in culture with respect to increased participation, teamwork, and more accountability at all levels. There was a sense that prior to Lean, some frontline staff were coming late to work and calling in sick, making other employees frustrated with the lack of commitment to the team. After participating in an RIE, absenteeism rates went down. Staff felt responsible to each other to arrive on time each morning so they could meet as a team. One executive noted the increased teamwork across departments where historically there had been little, and another commented on the enthusiasm of the clerical staff that was transmitted to the medical staff. The cultural shift also manifested itself in the approach to how work was done. One executive noted how staff not only came to him with problems but now offered solutions to those problems as well. A manger observed two frontline staff working together on the unit to get everyone on “one side,” creating a more inclusive, team -oriented environment. One physician executive noted that it is hard to say that cultural changes were due solely to Lean activities because the new executive director, a nurse who knows staff by their first name and readily shares her cell phone number, came to the organization in 2008 and began implementing MBWA. A couple of other executives concurred that the organizational culture had shifted since the arrival of the new executive director.
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