title: Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.
abstract: BACKGROUND
  Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers.
  
  
  METHODS
  This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care.
  
  
  RESULTS
  Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts.
  
  
  CONCLUSIONS
  Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Hung
authors.forename: Meghan
authors.initials: M
authors.lastname: Martinez
authors.forename: Maayan
authors.initials: M
authors.lastname: Yakir
authors.forename: Caroline
authors.initials: C
authors.lastname: Gray
mesh_terms: D000554:Ambulatory Care Facilities; D002140:California; D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D006801:Humans; D007407:Interviews as Topic; D008503:Medical Staff; D019982:Organizational Case Studies; D011320:Primary Health Care / Q000458:organization & administration; D016730:Program Development; D036301:Qualitative Research; D017749:Total Quality Management / Q000379:methods*