The outcomes of Lean management in a large academic hospital in Finland in 2018-2023: a qualitative study.

内容摘要

Lean management (LM) has been implemented in healthcare organisations, promising efficient operations, rapid patient access to care, improved staff satisfaction and lower costs. However, use of LM is questioned because there is no strong evidence of its outcomes, so proof of long-term and organisation-wide use is needed. The aim of the study is to increase understanding of the long-term effects of LM in healthcare. This is a case study done at the Helsinki University Hospital in Finland. A retrospective qualitative study was conducted in three sectors (A, B and C) of the hospital. Fourteen healthcare leaders from three sectors participated in interviews by answering structured and open-ended questions. The interviews were used to evaluate the outcomes that are experienced by the leaders in the hospital setting over a five-year period and evaluate indicators that they used to assess these outcomes. The interviews were analysed using qualitative and quantitative content analysis with ATLAS.ti analysis software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). The outcomes of LM can be grouped into three main categories (organisation, patient and staff) that are divided into six subcategories: experiential, care-related, work-related, economic, leadership and management, and image effects. The leaders experienced the greatest benefits on the organisation level, as it enhanced the effectiveness of the organisation's structure and operations, fostered continuous development, improved staff retention and attraction and promoted patient-centredness. According to the leaders, the most important benefits for patients included improved access to care, better care flow, enhanced safety of care and greater participation in improving operations. In addition, the leaders highlighted that the biggest benefits for staff, were increased work satisfaction, work competence, work commitment and ethical behaviour. We found that the use of LM also has disruptive and contradictory effects caused by the lack of organisation-wide Lean commitment and structure, and the media have bias towards negative portrayals of hospital efficiency. We found that six subcategories provide a comprehensive framework for qualitatively assessing organisation-wide experienced outcomes of LM in the hospital. Our findings emphasise that the organisation should be fully committed to the Lean method, and its structure should be clear so that the best benefits of LM can be achieved. We noticed that more qualitative LM research is needed to complement the Lean knowledge gained from quantitative research, develop more comprehensive and high-quality evaluation indicators and increase evidence for its use in healthcare.