title: Agile, a guiding principle for health care improvement?
abstract: OBJECTIVE
  The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness.
  
  
  METHODS
  An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis.
  
  
  RESULTS
  Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies.
  
  
  CONCLUSIONS
  Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management.
  
  
  CONCLUSIONS
  While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.
authors.affiliation: Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Tolf
authors.forename: Monica E
authors.initials: ME
authors.lastname: Nyström
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
authors.forename: Johan
authors.initials: J
authors.lastname: Hansson
mesh_terms: D017598:Efficiency, Organizational; D017408:Guidelines as Topic; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009936:Organizational Innovation; D058996:Quality Improvement
keywords: Agile; Health care; Lean; Organizational development