From: The sustainability of Lean in pediatric healthcare: a realist review
Author, year, country | Design | Theoretical framework | QI method and QI purpose | Study purpose | Implementation leaders | Setting and system level |
---|---|---|---|---|---|---|
Primary research studies (n = 6) | ||||||
Tekes, 2015, USA [42] | Pre-post survey | No mention at all | Lean, Six Sigma, clinical | Determine if multi-disciplinary LSS could reduce reliance on head CT in pediatric hydrocephalus population by 50% within 6 months, 24/7. | Multi-disciplinary team, project leader (neuroradiologist), and a physician champion. | Division of pediatric radiology and neuro radiology (meso) |
Czulada, 2015, USA [43] | Multi-methods | No mention at all | Lean, Six Sigma, process | Describes the inclusion of a family advisor on an improvement project team to increase communication opportunities. | Multi-disciplinary team, medical director, nurse manager, family advisor. | Pediatric intensive care unit (meso) |
Harrison, 2016, USA [45] | Mixed-methods | Explicit statement of theoretical framework and/or constructs applied to the research. | Lean, process and system | Examine how internal organizational context affected the implementation and outcomes of organization-wide Lean initiatives and cycle Lean process redesign projects, were embedded within the “initiatives.” | Senior leadership support, middle management, multi-disciplinary teams, internal or external Lean experts, organizations (added Lean to existing QI practices). | Five organizations, one was a pediatric care continuity (meso). |
Northway, 2015, Canada [47] | Multi-methods | No mention at all | Lean and other QI “classic” methods, process and system | Report the long-term sustainability of a transfer protocol. | Multi-disciplinary team, physician and clinical leaders, external Lean experts. | Pediatric intensive care unit (meso). |
Mazzacato, 2014, Sweden [48] | Mixed-methods | Explicit statement of theoretical framework and/or constructs applied to the research | Lean, process | Explain how different emergency services adopt and adapt the same hospital-wide Lean-inspired intervention and how this is reflected in hospital process performance data. | Hospital management strategic-hospital-wide Lean-inspired program. Multi-disciplinary improvement teams, internal improvement coaches, physician leaders. | Seven emergency service departments (2 pediatric) (meso) |
Mazzacato, 2012, Sweden [49] | Mixed-methods | No mention at all | Lean, process and system | To unpack how and why such a lean application may work. | Multi-disciplinary team, physician lead, internal process improvement coaches, hospital management. | Pediatric emergency unit (meso). |
Quality improvement reports (n = 5) | ||||||
Wong, 2016, Canada [44] | Commentary/descriptive | No mention at all | Lean, process and system | Illustrate how an implicit mental model pervades in the healthcare system based on deeply held but unexamined assumptions that arise from heuristics and biases, that can be examined by objective data and how we can build a new mental model. | Multi-disciplinary team, process improvement team and senior hospital management support. | Pediatric eye clinic (micro). |
Luton, 2015, [46] | Commentary/descriptive | No mention at all | Lean, Six Sigma, IHI Model for Improvement, clinical and process | To describe how a program to prevent feeding errors was developed, implemented, and evaluated. | Multi-disciplinary team, QI project manager, executive task force support (leaders). | Newborn center (three discrete NICUs, milk bank, and formula room) (meso) |
Carman, AHRQ, 2014, USA [50] | Commentary/descriptive | No mention at all | Lean, process and system | To examine the ways in which each organization has implemented Lean and identify the factors that influenced progress within individual Lean projects and on the ultimate outcomes. | Executive managers, CEO, clinical managers, external Lean consultants, management engineers, and multi-disciplinary front-line teams. | Five case studies of organizations that implemented Lean-blended adult and pediatrics. Case 1, four hospitals, 3 are pediatrics (macro) |
Hung, AHRQ, 2016, USA [51] | Multi-methods | Explicit statement of theoretical framework and/or constructs applied to the research. | Lean, process and system | Study the scaling and sustainability of Lean redesigns as an organization wide initiative, with a particular focus on analyzing contextual factors affecting the success of implementation efforts. | Ambulatory care system-wide Lean initiative, executive leadership, external Lean consultants, clinical leaders, physicians and multi-disciplinary front-line staff. | Ambulatory care system with primary care departments (includes pediatrics) across Palo Alta Medical Foundation (macro) |
Rotter, 2014, Canada [52] | Multi-methods | Explicit statement of theoretical framework and/or constructs applied to the research. | Lean, process and system | Evaluate the early stages of the implementation of Lean (Saskatchewan’s Lean Management System) in the provincial health system. | Ministry strategy policy makers, executive management support, external Lean consultants, clinical leaders, Kaizen promotion office, multi-disciplinary teams. | Saskatchewan Healthcare System (twelve regions)–focus on four regions for realist evaluation (pediatric data) (macro) |