In a recently published article in BMJ Quality and Safety, Pokinska and colleagues did not find improved patient satisfaction in Swedish primary care centers that had implemented lean. The authors used mixed-methods to examine lean implementation and its impact on patient satisfaction. Two qualitative case studies in primary care centers with well established and successful experience with lean found that the most consistent focus was on improving efficiency. For example, when using techniques such as Value Stream Mapping, the focus tended to be on eliminating waste from the staff perspective and did not include significant consideration of value from the patient perspective. Findings in a quantitative study comparing 23 primary care centers that had implemented lean to 23 centers that had not were in line with the case studies – the lean centers did not have higher patient satisfaction or improved patient satisfaction over time.
A responding editorial (Blackmore and Kaplan 2017) by the Director of the Center for Health Care Improvement and the CEO of the Virginia Mason Health System discussed the study findings and stressed the importance of incorporating the patient perspective in how success is defined in lean transformation:
“No doubt all healthcare institutions identify patients as the first priority. However, do the needs of the patient truly come first? The results presented should provoke us all to re-evaluate our own priorities and, if we are applying Lean, to understand from which perspective waste is defined. In a sense, we would view the Lean implementation described in the Poksinska paper as a lost opportunity. The time and resources devoted to applying Lean to address the needs of the health system could be better used to improve value for the patients primarily, as well as all providers and staff. Cost-saving may then be expected to accrue from improved patient outcomes, and from better workforce engagement, productivity and efficiency.”
What do you think? How have you been able to ensure that priority is given to the patient experience in implementing lean and defining its success in healthcare?