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Understanding resistance in lean implementation in healthcare environments: an institutional logics perspective
Production Planning & Control ( IF 8.3 ) Pub Date : 2020-10-09 , DOI: 10.1080/09537287.2020.1823510
Adeel Akmal 1 , Jeff Foote 2 , Nataliya Podgorodnichenko 3 , Richard Greatbanks 2 , Robin Gauld 1
Affiliation  

Abstract

While lean thinking has been used in healthcare for almost two decades, its efficacy has been debated extensively by researchers and practitioners alike. This ongoing debate is largely due to the varied results of its implementation; and resistance to change is considered to be the primary reason behind this variation. This study adopts an institutional logics perspective to analyze the nature of this resistance by drawing attention to how clinical staff make judgements about the appropriateness, acceptability and legitimacy of lean thinking. To conceptualize resistance, a systematic literature review based on 33 published studies depicting lean implementations was conducted, which helped to develop a nuanced understanding of resistance and its causes. Subsequently, 47 semi-structured interviews were undertaken with Quality Improvement managers regarding their experience with implementing lean thinking in 15 New Zealand District Health Boards. These interviews were used to identify and evaluate strategies used to minimize resistance within the implementation of lean initiatives in healthcare organizations. The findings of this research suggest that typically there are three strategies adopted by quality improvement managers—(1) communication strategies to create a better narrative for lean implementation; (2) cooperation strategies, which encourage the adherents of lean and medical logics to work together on shared problems, creating opportunities for them to learn about other logics; and (3) performance management strategies with the help of incentives and commitment devices to create a supportive environment for lean implementation. Together, these strategies work to improve the availability, accessibility, and activation of lean thinking logic in healthcare.



中文翻译:

了解医疗环境中精益实施的阻力:制度逻辑视角

摘要

虽然精益思想已在医疗保健领域使用了近 20 年,但其功效一直受到研究人员和从业者的广泛争论。这种持续的辩论主要是由于其实施的不同结果;抵制变化被认为是这种变化背后的主要原因。本研究采用制度逻辑的视角,通过关注临床工作人员如何判断精益思维的适当性、可接受性和合法性来分析这种阻力的性质。为了将阻力概念化,基于 33 项已发表的描述精益实施的研究进行了系统的文献回顾,这有助于对阻力及其原因进行细致入微的理解。随后,与质量改进经理进行了 47 次半结构化访谈,了解他们在 15 个新西兰地区卫生委员会实施精益思维的经验。这些访谈被用来识别和评估用于在医疗保健组织实施精益计划时尽量减少阻力的策略。这项研究的结果表明,质量改进经理通常采用三种策略——(1)沟通策略,为精益实施创造更好的叙述;(2)合作策略,鼓励精益逻辑和医学逻辑的追随者共同解决共同的问题,为他们创造学习其他逻辑的机会;(3)借助激励和承诺机制的绩效管理策略,为精益实施创造支持性环境。这些策略共同致力于提高医疗保健中精益思维逻辑的可用性、可访问性和激活。

更新日期:2020-10-09
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