One corporate executive noted that there were chiefs

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clinical leadership. One corporate executive noted that there were chiefs of service who were replaced because they did not apply Lean tools in their work. Two management engineers noted that it was virtually impossible to step down from a Lean project and that this had only happened when staff left the organization. Scope, Coordination, and Pace of Lean Activities Coordinating the timing of projects. As observed on two projects —Outpatient Electronic Health Records and Surgeons’ Preference Cards— competing priorities delayed Lean projects. Upcoming building renovations that would change the layout of the clinic and thus the flow of activities were cited by two management engineers for the delays on the Outpatient Electronic Health Records project. The Surgeons’ Preference Cards project was part of a larger value stream to change the IS for operating rooms. According to a management engineer, the project was delayed because of two competing priorities: a desire to focus on projects within the value stream yielding better financial returns and a need to address related issues first. One hospital executive stated that with limited resources, leaders must focus on the highest priority areas usually those that reap the greatest cost savings and other things must fall to the wayside. In practice, this means that the acute care setting receives the most attention and resources for process improvement before ambulatory care: but, the executive did not give any specifics related to the projects in this study. “It’s a very different organization to come in to. Because [if] you come in from the outside when you haven’t been exposed to the tools, it can be overwhelming. There’s many additional things that now they are required to know about and encouraged to use, and you have to be careful not to get sucked into the quagmire, saying, ‘I’m now gonna focus 90 percent of my time on these things,’ and lose sight of what my fundamental role is right for the customers and the patients we take care of. So, I think in our organization, it’s abo ut finding that balance. Coming in from the outside, that can be overwhelming.” Hospital Executive
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53 Although several leaders agreed on the importance of addressing process before implementing an IT solution, on the Outpatient EHR project, the EHR rollout plan and timeline were developed separately from the plans for Lean. Two m2anagement engineers stated that the EHR rollout was stalled, in part, because of a need for Lean. However, a hospital executive adamantly expressed that the rollout plan forged ahead at an accelerated rate without support from Lean. Getting buy-in from leadership and managers was also critical to the success of scheduling and implementing projects. One management engineer stated that there was not a manager or leader within the clinic to champion the Outpatient EHR project and, as a result, staff did not understand the need for a Lean project. However, another management engineer noted that senior leaders were more
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