Author Affiliations: Division of Health Policy and Management, School of Public Health, University of California, Berkeley (Mr Lee); Division of Biological Sciences, College of Letters and Sciences, University of California, Berkeley (Mr Lee); Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland (Dr Reponen); and Department of Information Systems and Quantitative Methods, Business School, Université de Sherbrooke, Sherbrooke, Canada (Dr Fournier).
Qual Manag Health Care. 2024;33(2):67-76. doi: 10.1097/QMH.0000000000000440. Epub 2023 Oct 11.
To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.
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.
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).
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.
了解信息技术（IT）部门中精益实施与医院绩效之间的关系，特别是在运营和财务成果方面。
主要数据来自对全美范围内 4500 家综合普通外科医院进行调查的《国家精益调查（NSL）/变革性绩效改进》中做出回应的 1222 家医院。辅助数据包括来自美国医疗机构评审联合委员会（AHRQ）和医疗保险和医疗补助服务中心（CMS）的医院绩效数据。我们使用从美国医院收集的数据进行了两组多变量回归，这些数据与 AHRQ 和 CMS 的绩效结果相关联。我们考察了 10 种不同的衡量财务绩效、护理质量和患者体验的结果，以及它们与医院 IT 部门中精益采用的关联。然后，我们仅关注那些在 IT 部门中采用精益的医院，以确定与绩效相关的具体实践。
在控制其他因素的情况下，采用精益 IT 管理与较低的住院时间（ b = -0.098， P =.018）和每次出院的住院费用（ b = -0.112， P =.090）相关。具体而言，使用可视化管理工具（例如，A3 故事板、状态表）与较低的调整后每次出院的住院费用（ b = -0.176， P =.034）和较高的息税折旧摊销前利润率（ b = 0.124， P =.042）相关。这些工具还与医院参与捆绑支付计划（比值比=2.326； P =.046；95%置信区间，0.979-5.527）和基于共享风险支付的净收入比例（ b = 0.188， P =.031）相关。
精益 IT 管理与积极的财务绩效相关，特别是与医院参与基于价值的支付有关。需要更详细的研究来了解其他有影响力的因素以及高功能 IT 如何通过何种工作流程、活动或机制为财务成果做出贡献。
