Table 5 Sustaining of lean adoption in hospitals Roadmap (SOLAR)
From: Toward a roadmap for sustainable lean adoption in hospitals: a Delphi study
Theme | Phase 1 - Prepare | Phase 2 - Plan | Phase 3 - Experiment and Learn | Phase 4 - Sustain |
|---|---|---|---|---|
Strategy | • Develop shared hospital vision and common strategic direction • Determine hospital’s improvement and change needs • Research and evaluate past lean implementations and identify potential adoption barriers in the organisation • Identify all stakeholders that will benefit from the value that lean might unlock | • Plan which adaptations should be made to adopt lean in the operating environment • Determine lean adoption strategy • Create a task specific adoption plan • Define stakeholder value and specify the criteria according to which the value that lean might realise will be assessed and measured against • Establish schedule for monthly lean performance meetings at top management level | • Top management to support lean adoption process • Contextualise lean for the specific hospital environment • Plan and create short-term wins • Document and monitor adaptations and learnings established during the adoption process • Measure the value that lean unlocks for all stakeholders according to planned criteria • Set lean performance meetings in place on a tactical and operational level | • Ensure organisational momentum by maintaining the strategy and common direction • Institutionalise lean goal setting across the entire hospital • Continuously measure the realised value of lean for all stakeholders and adapt strategy accordingly • Institutionalise lean performance meetings at strategic, tactical and operational level |
Resources | • Assess which current supporting resources are available • Assess whether there is any current lean adoption and to what extent stakeholders have already been exposed to lean | • List and invest in supporting resources required • Obtain (external) experts who will provide employees with lean in healthcare training | • Put necessary supporting resources in place • Enlist external experts to co-guide adoption • Develop internal experts that will be involved in lean adoption and training of staff • Make process changes to align initial change vision with organisational processes | • Keep supporting resources such as technology up to date • Institutionalise change into current systems, SOPs and structures |
Engaging people | • Obtain and ensure management commitment for lean adoption • Engage with all stakeholders and introduce the Lean philosophy • Create a sense of urgency emphasising change is necessary | • Identify lean champions from all levels of each organisational unit that can act as guiding change coalition • Appoint adoption team consisting of lean champions and other (front-line) employees • Specify supportive roles, processes and responsibilities of internal implementation team • Empower adoption team to lead the change by training them on lean principles, leadership and change management principles • Ensure the message that is conveyed about lean contributes to initial acceptance of lean and does not cause resistance to lean • Adopt organisational structure to ensure that hierarchies do not hinder teamwork to create value • Develop organisational performance feedback system • Communicate shared vision and common direction to all stakeholders | • Regularly evaluate performance of adoption team members related to lean adoption and commitment • Provide lean adoption feedback throughout the hospital • Communicate lean adoption progress to all stakeholders • Ensure performance feedback system triggers employee remedial action • Train all other staff on lean and empower them to identify waste in their respective processes • Establish inter-departmental cooperation • Gain acceptance of lean philosophy amongst all staff | • Provide continuous training and support to all staff |
Culture | • Assess employee readiness for change • Assess hospital culture to determine whether the lean philosophy aligns with cultural philosophy | • Manage employee resistance to change and provide positive attention to those who embrace change • Establish supportive lean culture of continuous improvement • Identify and separate from past behaviour that is not conducive to a lean culture | • Reinforce lean culture of continuous improvement • Ensure management displays exemplary lean behaviour | • Normalise supportive lean culture of continuous improvement |
Change stepsa | 1: Assess the opportunity motivating the change 2: Select and support a guiding coalition 3: Formulate a clear compelling vision 5: Mobilise energy for change | 2: Select and support a guiding coalition 4: Communicate the vision 5: Mobilise energy for change 6: Empower others to act 7: Develop and promote change-related knowledge and ability | 2: Select and support a guiding coalition 4: Communicate the vision 5: Mobilise energy for change 6: Empower others to act 7: Develop and promote change-related knowledge and ability 8: Identify short-term wins and use as re-enforcement of the change process 9: Monitor and strengthen the change process | 9: Monitor and strengthen the change process 10: Institutionalise the change in company culture and practices |