Work air conducted five case studies of individual

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work, AIR conducted five case studies of individual health care organizations that implemented Lean. Prior to the case studies, the AIR research team conducted a review of the literature to determine whether an evidence base exists for using Lean in health care. We found that the majority of studies about Lean lack data on key areas and domains important for understanding quality improvement, organizational behavior, and organizational change. In addition, the literature is largely anecdotal and devoid of theoretical frameworks, not comparative, authored by the individuals who have implemented the projects rather than independent investigators, and limited to those projects that were successful. a Four major findings stemmed from the literature review: Information about Lean implementation in health care is unreliable and anecdotal. Peer-reviewed articles are relatively scarce, although there is a large volume of grey literature. Reports from peer-reviewed and grey literature were single case studies of limited validity. In addition, nearly all of the documents focused on one organization, department, and project, making it very difficult to determine what factors or features of organizations and the external environments in which they operate are important for successful a An executive summary of the literature review is available separately at .
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2 implementation and maintenance of Lean. Finally, studies generally failed to use more rigorous quasiexperimental designs or comparative and longitudinal case study designs. Data are inconsistent or absent in many domains that research in other fields (e.g., quality improvement) suggests are important. There is little rigorous reporting about external impetus or context for Lean (e.g., market factors and conditions), key organizational factors (e.g., how culture affects who implements Lean), impact (e.g., economic, quality of care, outcomes of care), and sustainability. The outcomes measured were primarily efficiency and quality and, less frequently, safety and patient satisfaction. Lean studies are atheoretical. Few papers provided clear theoretical backgrounds or frameworks for reported findings. There is a positive publication bias in Lean literature. Nearly all documents included in our review reported positive outcomes and results from implementing Lean, and many were authored by consultants or individuals in the organizations implementing Lean. In short, considerable gaps remain in the existing literature about Lean. These gaps make it very difficult, if not impossible, to discern which organizational characteristics and/or environmental conditions are critical for successful implementation and sustainability of Lean and its impacts on efficiency, quality/safety, and other important outcomes (e.g., patient satisfaction). This lack of research warrants additional investigation of the implementation of and outcomes related to Lean.
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  • Fall '17
  • Shankar Purbey

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