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Sustainment of Lean Redesigns for Primary Care Teams
- Source :
- Quality management in health care. 28(1)
- Publication Year :
- 2018
-
Abstract
- BACKGROUND Quality improvements are notoriously followed by "backsliding" or relapse to the status quo. This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. METHODS We conducted qualitative interviews of 57 leaders and frontline providers, and fielded post-Lean implementation surveys to 1164 physicians and staff in 17 primary care clinics across the system. We analyzed interviews and conducted independent sample t tests to identify key factors that facilitated the sustainment of new workflows among primary care teams. All analyses were conducted after Lean redesigns were implemented and scaled across the system in 3 consecutive phases. RESULTS Adherence to Lean redesigns was highest in the pilot clinic, despite having the longest postdesign measurement period. Members of the pilot clinic reported greatest participation in designing workflows, were most highly engaged in quality improvement efforts, and held most favorable beliefs about Lean changes. Adherence to redesigns was lowest among clinic members in the second phase of implementation; these members also reported highest levels of burnout. CONCLUSIONS Staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
- Subjects :
- Health (social science)
Quality management
Leadership and Management
Status quo
media_common.quotation_subject
Primary care
Burnout
Ambulatory Care Facilities
Workflow
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
Nursing
Ambulatory care
Surveys and Questionnaires
Humans
Quality (business)
030212 general & internal medicine
Care Planning
health care economics and organizations
Qualitative Research
media_common
Patient Care Team
Primary Health Care
030503 health policy & services
Health Policy
Qualitative interviews
Quality Improvement
0305 other medical science
Psychology
Total Quality Management
Subjects
Details
- ISSN :
- 15505154
- Volume :
- 28
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Quality management in health care
- Accession number :
- edsair.doi.dedup.....a47c75f59082a9b20fb01b18e3d22d0f