退伍军人健康管理局精益企业转型项目的促进因素和障碍。
Facilitators and barriers to the Lean Enterprise Transformation program at the Veterans Health Administration.
出版信息
Health Care Manage Rev. 2021;46(4):308-318. doi: 10.1097/HMR.0000000000000270.
BACKGROUND
The Veterans Health Administration piloted a nationwide Lean Enterprise Transformation program to optimize delivery of services to patients for high value care.
PURPOSE
Barriers and facilitators to Lean implementation were evaluated.
METHODS
Guided by the Lean Enterprise Transformation evaluation model, 268 interviews were conducted, with stakeholders across 10 Veterans Health Administration medical centers. Interview transcripts were analyzed using thematic analysis techniques.
RESULTS
Supporting the utility of the model, facilitators and barriers to Lean implementation were found in each of the Lean Enterprise Transformation evaluation model domains: (a) impetus to transform, (b) leadership commitment to quality, (c) improvement initiatives, (d) alignment across the organization, (e) integration across internal boundaries, (f) communication, (g) capability development, (h) informed decision making, (i) patient engagement, and (j) organization culture. In addition, three emergent themes were identified: staff engagement, sufficient staffing, and use of Lean experts (senseis).
CONCLUSIONS
Effective implementation required staff engagement, strategic planning, proper scoping and pacing, deliberate coaching, and accountability structures. Visible, stable leadership drove Lean when leaders articulated a clear impetus to change, aligned goals within the facility, and supported middle management. Reliable data and metrics provided support for and evidence of successful change. Strategic early planning with continual reassessment translated into focused and sustained Lean implementation.
PRACTICE IMPLICATIONS
Prominent best practices identified include (a) reward participants by broadcasting Lean successes; (b) provide time and resources for participation in Lean activities; (c) avoid overscoping projects; (d) select metrics that closely align with improvement processes; and (e) invest in coaches, informal champions, process improvement staff, and senior leadership to promote staff engagement and minimize turnover.
背景
退伍军人健康管理局试行一项全国范围的精益企业转型计划，以优化向患者提供高价值护理的服务。
目的
评估精益实施的障碍和促进因素。
方法
在精益企业转型评估模型的指导下，对退伍军人健康管理局 10 个医疗中心的利益相关者进行了 268 次访谈。使用主题分析技术对访谈记录进行分析。
结果
支持模型的实用性，在每个精益企业转型评估模型领域都发现了精益实施的促进因素和障碍：（a）转型的动力，（b）领导层对质量的承诺，（c）改进举措，（d）组织内的协调，（e）内部边界的整合，（f）沟通，（g）能力发展，（h）明智的决策，（i）患者参与，（j）组织文化。此外，还确定了三个新出现的主题：员工参与、足够的人员配备和使用精益专家（大师）。
结论
有效的实施需要员工参与、战略规划、适当的范围和节奏、精心指导和问责制结构。当领导者明确表达变革的动力、在设施内协调目标并支持中层管理人员时，可见的、稳定的领导力推动了精益。可靠的数据和指标为成功的变革提供了支持和证据。战略的早期规划与持续的重新评估相结合，转化为集中和持续的精益实施。
实践意义
确定的突出最佳实践包括：（a）通过广播精益成功来奖励参与者；（b）为参与精益活动提供时间和资源；（c）避免过度规划项目；（d）选择与改进流程密切相关的指标；（e）投资于教练、非正式冠军、流程改进人员和高级领导层，以促进员工参与并最大限度地减少人员流动。
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