The Impact that ‘Lean Healthcare’ and the Productive Ward: Releasing Time to Care Initiative has on Employees. A Review of the literature.
The emphasis in health care is rapidly shifting from a model of low-cost provision to one that embraces low-cost, improvement and high-quality (Mazur, 2012). The Productive Ward: Releasing Time to Care (RTC) is an improvement initiative specifically led by nurses which has been relatively well accepted, adopted (Robert et al., 2011) and spread internationally (Clews, 2013). It was designed and developed using improvement principles of ‘Lean Manufacturing’ and formally introduced in Ireland in 2011. Lean and Lean-thinking have their origins in the Toyota Production System (Womack et al., 1990). It is a philosophy that loathes waste and strives to eliminate defects and continually attacks both in a never-ending pursuit of perfection (Liker, 2004). Lean thinking discourages the process of ‘workarounds’ and encourages resolution at the root of the problem (Womack and Jones, 1998). The term ‘Lean Healthcare’ is a relatively new term with a focus on efficiency and patient satisfaction (de Souza, 2009).
Purpose: This paper reviews the Lean Healthcare Productive Ward: Releasing Time to Care (RTC) Literature and extracts the reported effects and impacts on employees who implement it. The study aims to identify and investigate the strength of the connection between the two models and discusses the implications for implementation.
Design: This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented.
Findings: This study outlines the similar employee effects and impacts that exist between Lean-type initiatives and the Productive Ward: RTC programme. It discusses and explores the three top themes of: Empowerment, Leadership and Engagement. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact that is well cited in the Lean-type improvement initiatives and poorly reported in the Productive Ward: RTC literature to date. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system (Radnor et al., 2012; Joosten et al., 2009).
Research limitations: Because of the research methods used, the variety of Lean-type methodologies examined, models of implementation reported in the literature and the contextual factors involved in each organisation, these results although valid lack generalisability and can only be applied to the health care sector.
Originality/value: This study brings new insights into Lean-type improvement initiatives currently being imported into health care and provides a comprehensive list of reported employee impacts and effects of value to health care leaders involved with introducing or implementing improvement initiatives.
Clews, G. (2013) 'Productive ward goes global', Nursing times.net, (3 May 2011), pp. 1.
de Souza, B. L. (2009) 'Trends and approaches in lean healthcare', Leadership in Health Services, 22(2), pp. 121-139.
Joosten, T., Bongers, I. and Janssen, R. (2009) 'Application of lean thinking to health care: issues and observations', International Journal for quality in Health Care, 21(5), pp. 341-347.
Liker, J. (2004) The toyota Way: 14 Management Principles from the worlds greatest manufacturer., New York: McGraw-Hill.
Mazur, L. (2012) 'Facilitating Lean Learning and Behaviors in Hospitals During the Early Stages of Lean Implementation', vol. 24, no. 1 (Mar 2012), p. 11-22(
Radnor, Z. J., Holweg, M. and Waring, J. (2012) 'Lean in healthcare: The unfilled promise?', Social Science & Medicine, 74(3), pp. 364-371.
Robert, G., Morrow, E., Maben, J., Griffiths, P. and Callard, L. (2011) 'The adoption, local implementation and assimilation into routine nursing practice of a national quality improvement programme: the Productive Ward in England', Journal of Clinical Nursing, 20(7/8), pp. 1196-1207.
Womack, J. P. and Jones, D. T. (1998) Lean thinking: banish waste and create wealth in your corporation, London: Touchstone.
Womack, J. P., Jones, D. T., Roos, D. and Massachusetts Institute of, T. (1990) The machine that changed the world: based on the Massachusetts Institute of Technology 5-million dollar 5-year study on the future of the automobile, New York: Rawson Associates.