title: Experiences of leaders in the implementation of Lean in a teaching hospital--barriers and facilitators in clinical practices: a qualitative study.
abstract: OBJECTIVE
  To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap.
  
  
  METHODS
  Semistructured, indepth interviews.
  
  
  METHODS
  One of largest teaching hospitals in the Netherlands.
  
  
  METHODS
  31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean.
  
  
  RESULTS
  The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion.
  
  
  CONCLUSIONS
  Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply 'implementing' facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase.
authors.affiliation: Department of Anaesthesiology & Operative Care, VU University Medical Center, Amsterdam, New Hampshire, The Netherlands.
authors.forename: Kjeld Harald
authors.initials: KH
authors.lastname: Aij
authors.forename: Frederique Elisabeth
authors.initials: FE
authors.lastname: Simons
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Widdershoven
authors.forename: Merel
authors.initials: M
authors.lastname: Visse
keywords: Medical Education & Training