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Examining the Relationship Between the Lean Management System and Quality Improvement Care Management Processes
Aaron A Tierney1, Stephen M Shortell, Thomas G Rundall
1Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley (Mr Tierney, Drs Shortell, Rundall, and Reponen, and Ms Blodgett); and Department of Perioperative, Intensive Care, and Pain Medicine and Central Lean Improvement Office, HUS Helsinki University Hospital, Helsinki, Finland (Dr Reponen).
Background And Objectives:
The United States has an underperforming health care system on both cost and quality criteria in comparison with other developed countries. One approach to improving system performance on both cost and quality is to use the Lean Management System based on the Shingo principles originally developed by Toyota in Japan. Our objective was to examine the association between hospital use of the Lean Management System and evidence-based or recommended quality improvement care management processes.
Methods:
A cross-sectional analysis of data from 223 hospitals that responded to both the 2017 National Survey of Healthcare Organizations and Systems and the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals was conducted.
Results:
Controlling for hospital organizational and market characteristics, the number of years using Lean was positively associated with use of electronic health record-based decision support, use of quality-focused information management, use of evidence-based guidelines, and support for care transitions at the P < .05 level. The degree of education and training in Lean methods and processes was also positively associated ( P < .05) with greater support for care transitions. The number of years using Lean was marginally associated with screening for clinical conditions at the P < .10 level. There was an unexpected negative association between education and training scores and screening for clinical conditions.
Conclusions:
Greater experience in using the Lean Management System is positively associated with several evidence-based and/or recommended quality improvement care management processes.
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