Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Z Evid Fortbild Qual Gesundhwes. 2024 May;186:52-61. doi: 10.1016/j.zefq.2024.03.006. Epub 2024 Apr 21.
Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping.
Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source.
At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement.
A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings.
These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.
精益，尤其是价值流映射，在医院中越来越多地用于优化流程。这种起源于汽车行业的方法使所有参与流程的员工都能使流程更加以客户为中心。尽管精益项目的广泛报道取得了成功，但在某些情况下它们还是失败了。本研究调查了有助于成功实施价值流映射的情境因素和机制。
在四个乳腺癌中心应用价值流映射进行出院流程。采用混合方法分两步进行。首先，为了验证成功实施，定义为时间优化，在三个时间点进行时间测量，并使用方差分析进行分析。其次，根据规范化进程理论，结合对情境因素的分析和对机制的定性内容分析，使用常规数据、会议协议、现场记录和访谈记录作为数据源。
在四个乳腺癌中心中的一个中心，lead-time 和 waiting-time 显著减少；在其他中心，这些减少并未发生。失败/成功不能用医院的规模、病例数量或人员配备水平来解释。项目团队组成的变量是明显的，特别是领导力的参与。
进行了比较分析，以确定导致成功的因素。这些因素是：与流程相关的所有领导的参与，在出院流程的情况下，包括医疗和护理领导；将变革从项目团队传播到同事，包括讨论的意义和可能性；在定期的工作团队会议上共同反思实施过程。
这些结果证实了领导力在实施项目中的重要作用。领导支持使发现的机制得以实施。所使用的管理研究和实施科学的理论方法的组合决定了解释，应该在实施科学中更经常地应用。
