Toward a Roadmap for Sustainable Lean Hospital Adoption: A Delphi Study

Abstract

Abstract Background: The benefits of lean adoption in healthcare include improved process efficiency and quality of patient care. Research however indicates that lean implementation in healthcare and specifically hospitals is often not sustained. Furthermore, there is a need for maturity models that guide lean implementation specifically in hospitals. This study develops a prescriptive maturity model named the Sustaining of Lean Adoption in Hospitals Roadmap (SOLAR) that acts as a practical guideline for the sustainable adoption of lean in hospitals. Methods: The SOLAR is based on three theoretical building blocks, namely the theory of lean implementation success factors in hospitals, implementation science, and change management theory. A systematic literature review was conducted to determine the lean implementation success factors in hospitals as the first building block. For the second building block, practices from implementation science were used to create the action items in the SOLAR. Ten change steps were elicited from change management theory as the third theoretical building block of the roadmap. We refined the roadmap through three Delphi rounds that verified the useability of our model in hospitals. Results: The final SOLAR consists of four maturity phases (prepare, plan, experiment and learn, and sustain) and includes action items for each phase related to the hospital’s strategy, resources, engaging of people, and culture. The action items and change management steps shown in the SOLAR are notintended as an exhaustive list but provide guidelines on aspects one certainly needs to consider for a hospital that aims to adopt lean sustainably. Conclusions: The strong theoretical base of the SOLAR enables hospitals to safely experiment and learn which implementation methods are best suited to their unique environment. The SOLAR is, therefore, an actionable guideline that informs both academics and practitioners involved in lean adoption in hospitals. This roadmap can guide future retrospective longitudinal or action research.