Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals.

GOAL: This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals. METHODS: We performed multivariable regressions using data from the 2017 National Survey of Lean/Transformational Performance Improvement. The data were linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. We examined 11 outcomes measuring financial performance, quality of care, and patient experience and their associations with Lean adoption. We also explored potential drivers of positive outcomes by examining Lean implementation in each hospital, measured as the number of units using Lean tools and practices; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers. PRINCIPAL FINDINGS: Lean adoption and implementation were associated with improved performance in U.S. public hospitals. Compared with hospitals that did not adopt Lean, those that did had significantly lower adjusted inpatient expenses per discharge and higher-than-average national scores on the appropriate use of medical imaging and timeliness of care. The study results also showed marginally significant improvements in patient experience and hospital earnings before interest, taxes, depreciation, and amortization margins. Focusing on these select outcomes, we found that drivers of such improvements involved the extent of Lean implementation, as reflected by leadership commitment, daily management, and training/education while controlling for the number of years using Lean. PRACTICAL APPLICATIONS: Lean is a method of continuous improvement centered around a culture of providing high-value care for patients. Our findings provide insight into the potential benefits of Lean in U.S. public hospitals. Notably, they suggest that leader buy-in is key to success. When executives and managers support Lean initiatives and provide proper training for the workforce, improved financial and operational performance can result. This commitment, starting with upper management, may also play a broader role in the effort to reform healthcare while having a positive impact on patient care in U.S. public hospitals.

Seizing the opportunity: the emergence of shared leadership during the deployment of an integrated performance management system.

BACKGROUND: Performance management systems have been introduced in health and social services institutions to improve organizational performance, supporting the emergence of new management behaviors that are more rooted in collaborative management practices. This study aims to understand how different leadership styles emerge through the implementation of a performance management system and its related tools, and how these can foster distributed leadership. METHODS: Over two years, the implementation of an integrated performance management system supporting the integration of social services for children, youth, and families was studied at a recently merged Canadian healthcare organization. Qualitative analysis of data collected from 15 interviews, 3 focus groups, and over 350 h of non-participant observation was conducted. RESULTS: The results show that leadership evolved to adapt to the context of organizational integration and was no longer confined to a single manager. Transformational leadership was needed to encourage the emergence of a new integrated performance management system and new behaviors among middle managers and team members. Transactional leadership was legitimized through the use of a status sheet when the integration project did not deliver the expected results. Both transformational and transactional leadership paved the way to distributed leadership, which in turn promoted collaborative practices associated with activities in control rooms and dialogue stemming from the status sheets. Distributed leadership among team members made a difference in the outcome of the integration project, which became a driver of collaboration. CONCLUSIONS: The integrated performance management system and the use of its tools can help renew leadership in health and social service organizations. The results lend credence to the importance of distributed leadership in promoting collaborative practices to improve services for children, youth, and families. The results also highlight how various leadership styles can contribute to the emergence of distributed leadership over time.

The determinants of burnout and professional turnover intentions among Canadian physicians: application of the job demands-resources model.

BACKGROUND: Burnout among physicians is growing at an exponential rate and many are leaving the profession. Nevertheless, the specific antecedents and intermediary stages involved in predicting their professional turnover intentions are not fully clear. PURPOSE: We apply the Job Demands-Resources model and investigate an innovative model which predicts physician burnout and its ultimate consequences on professional turnover intentions. METHODOLOGY/APPROACH: Structural equation modeling was used on cross-sectional survey data from a sample of 407 Canadian physicians. RESULTS/CONCLUSIONS: Job demands (work stress, work overload, and work-family conflict) and job resources (patient recognition and meaning at work) influence intention to leave the profession through a two stage health-impairment and motivational process related to health problems and professional commitment, respectively. PRACTICAL IMPLICATIONS: This study identifies key job resources and job demands which predict physician burnout and professional turnover intentions thereby pinpointing which levers managers can use improve their health and retain them in the profession.

Associations Between Lean IT Management and Financial Performance in US Hospitals.

BACKGROUND AND OBJECTIVES: To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes. METHODS: Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance. RESULTS: Controlling for other factors, adoption of Lean IT management was associated with lower length of stay ( b = -0.098, P = .018) and inpatient expense per discharge ( b = -0.112, P = .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge ( b = -0.176, P = .034) and higher earnings before interest, taxes, depreciation, and amortization margin ( b = 0.124, P = .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P = .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis ( b = 0.188, P = .031). CONCLUSIONS: Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes.

The Integrated Performance Management System: A Key to Service Trajectory Integration.

INTRODUCTION: This article presents an experience of deploying an integrated performance management system as a catalyst for the integration of a service trajectory for children in vulnerable situations. Called ''Jimmy'', the project identifies how the integrated performance management system makes it possible to improve accessibility, continuity of services and well-being at work among stakeholders. METHODS: An action research was conducted in a large healthcare organization in Canada, between August 2016 and October 2018. Data was systematically collected throughout the various cycles of research using field notes, more than 350 hours of observations, 15 interviews and 3 focus groups. RESULTS: This research supports using an integrated performance management system as a model for collaborative management that supports both horizontal and vertical integration in the service trajectory. The use of visual boards and status sheet meetings were determining factors for service integration and the functioning of integrated teams. This also led to improvements in accessibility and continuity of services, as well as in employee well-being. DISCUSSION AND CONCLUSION: Supported by the various tools of the integrated performance management system, Project ''Jimmy'' reinforces the implementation of linkage and coordination models, which in turn helps create strong connections among teams. The status sheet meetings and visual boards are tools that vertically integrate different hierarchical levels and horizontally integrate various front-line stakeholders through the user-oriented trajectory.

Medical commitment to Lean: an inductive model development.

Purpose The purpose of this paper is to study the factors influencing doctors' involvement in Lean change initiatives in public healthcare organizations in Canada. Design/methodology/approach An inductive research was conducted over a three-year span studying Lean implementation across three healthcare organizations in Canada. Various interviews were conducted with healthcare actors. Through analytical induction, analysis of the data allowed for multiple factors to be triangulated from which a conceptual model was developed. Findings Fifty-four interviews with 18 Lean healthcare actors allowed for the identification of ten factors possibly influencing the commitment of doctors towards Lean change. These factors are categorized into pre-change antecedents and change antecedents. Also, the level of transformational leadership demonstrated by a project manager was shown to potentially moderate the effect of medical behavioral support for change on change outcomes. These findings allowed us to develop a conceptual model of medical commitment and its impact of Lean change outcomes. Originality/value The paper investigates the role doctors play in Lean implementation, currently an important issue discussed among healthcare actors and researchers. Yet, very little academic research has been published on this subject.