8 It has also been suggested that lean practices may be more successful when applied to services characterised by a low degree of complexity. 8–10 Studies on the types of organisational processes involved have shown that lean has mainly concerned manufacturing-like processes, such as laboratory processes, 11 and processes within one unit and not across organisational boundaries. The types of outcomes addressed have mainly focused on operational aspects of performance, while little attention has been paid to sociotechnical aspects, such as employees' health, well-being and creativity. 5, 7 Plausible explanations for some of the observed limitations can be found in the scope of the lean improvement efforts. 3, 4 However, sustainability of results after the initial period of short-term gains has been proven difficult to achieve, 5, 6 and there is only limited understanding of factors influencing variation in results across organisational settings. 2 There is promising evidence that lean helps to improve efficiency and quality in the short term. 1 Lean is based on the continuous improvement of processes achieved by either increasing customer value or reducing non-value-adding activities, and by reducing process variation and poor work conditions. The management practice lean has become one of the most commonly used improvement approaches in healthcare.
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