Moving beyond initial implementation: a multiple case study of lean as an organizational-wide strategy

Lean has shown to deliver significant performance improvement in healthcare organizations. However, its practical implementation remains challenging and the ability to deliver in the long term is an under investigated issue. By using a three-step research protocol, the study draws on the main streams of literature on implementation science and lean management healthcare to explore: (i) the relevant organizational conditions for implementing lean; (ii) the continuous process of reciprocal interdependence between lean as a system-wide strategy and its context of application, and (iii) the influence of these mutual adaptation mechanisms on the sustainability of the implemented practices. As emerged from the empirical analysis, the implementation and the maintenance of lean efforts over time is the result of a continuous process of adjustments and modifications occurring in the overall change program and in its context of application. In particular, the use of a socio-technical system framework to systematize the emerged evidence points out some key interrelated change patterns: decentralizing responsibilities to practically work on lean; stable guidance and sponsorship at all organizational levels; structuring an intermediate level between the top management and professionals; launching internal events; continuous learning and improvement process; comprehensive approach to the optimization of hospital production processes.