Lean rapid process improvement workshops: An economic evaluation and systematic study of employee experience in a a healthcare setting

Many studies purport that Lean is a useful approach to improving quality in healthcare, however, there are calls for better research designs to evaluate its effectiveness. This study used a mixed-methods approach to investigate Lean Rapid Process Improvement Workshops (RPIWs) applied to surgical services in a large health system. The main objective was to conduct an economic evaluation using the Return on Investment (ROI) method. Quantifying improvements at the event level to calculate ROI was not feasible, so the analysis defaulted to examining the cumulative effects of six separate RPIWs at two facilities. The results did not produce sufficient evidence to claim that the outcomes justify the investments. The study went beyond ROI by using various statistical analyses to examine the effects of RPIWs on key performance measures of surgical volumes, sick time, and overtime; with generally non-significant findings. To capture the intangible effects of Lean, key informant interviews explored the richness of participants’ experiences while a survey was used to gather data on experience and engagement from a larger number of participants. The RPIWs produced positive results when considered through a qualitative lens – respondents to the interviews and survey indicated that Lean RPIWs are a desirable method for improving healthcare. Thirteen in-depth interviews yielded six thematic enablers to engagement (a culture of improvement, dedicated time, gradual engagement, improvement interest, social aspects, and participants’ like for Lean). In addition, four themes that represent barriers to engagement were identified (apathy, finances, mis-fit, and resistance). Ten themes also emerged as recommendations for making Lean more engaging. This study contributes to the field by demonstrating the difficultly of empirically calculating the ROI of RPIWs, which leads us to challenge any unfounded claims of monetary benefit from improvement initiatives. It also stresses the importance of qualitatively understanding employees’ experience of Lean and the process of engagement, which is critical for any healthcare organization that wishes to improve its services, client care, and overall performance. The findings invite us to turn our attention away from discussions of financial ROI and toward other evidence that helps us understand how Lean can provide value in healthcare.