title: Healthcare workers' perceptions of lean: a context-sensitive, mixed methods study in three Swedish hospitals.
abstract: As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.
authors.affiliation: Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Center for Health Informatics Research & Innovation (CHIRI), Indianapolis, IN, USA. Electronic address: rjholden@iupui.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
authors.affiliation: School of Technology and Health, Royal Institute of Technology (KTH), Stockholm, Sweden.
authors.forename: Andrea
authors.initials: A
authors.lastname: Eriksson
authors.affiliation: School of Technology and Health, Royal Institute of Technology (KTH), Stockholm, Sweden; School of Health Sciences, University of Borås, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Andreasson
authors.affiliation: School of Technology and Health, Royal Institute of Technology (KTH), Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Williamsson
authors.affiliation: School of Technology and Health, Royal Institute of Technology (KTH), Stockholm, Sweden; School of Health Sciences, University of Borås, Sweden.
authors.forename: Lotta
authors.initials: L
authors.lastname: Dellve
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006739:Hospital Administration / Q000379:methods*; D006757:Hospital Units; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D062072:Patient Acuity; D010465:Perception; D010819:Physician's Role; D058996:Quality Improvement / Q000458:organization & administration; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Lean healthcare; Macroergonomics; Mixed methods