Abstract
Quality and costs of healthcare have become a focus for the public and governments alike. Not only are the public rightly concerned with the relative risk to them of both of these issues; governments and insurers are particularly mindful from a funding and efficacy point of view. This explains the innate attraction of the health system to interventions that enhance quality while simultaneously maintaining value for money. As such, over the last ten years healthcare systems and institutions have begun to employ operations management techniques within their hospitals to better organise work, enhance flows and improve productivity.
Modern manufacturing methods have been led by the globalisation of the Toyota Production System; a system that integrates quality and waste reduction activities into the production tasks as they are performed. Lean Thinking is the generic label that has been given to this combination of a management philosophy and activities that aim to improve quality and reduce waste. Moreover, these manufacturing and service improvement principles are being used in an increasing number of sectors including healthcare services.
This thesis seeks to explore the implementation of Lean Thinking in New Zealand hospital Emergency Departments (EDs). New Zealand‘s healthcare system is a recent adopter of Lean Thinking. As this formal roll out of Lean Thinking is new to New Zealand hospitals, it provides an opportunity to examine in detail the implementation sites and discover how the implementation of Lean Thinking progressed and why the resulting outputs and outcomes were achieved.
The research adopts a multiple site design using case studies as the primary research method. Three sites from three different District Health Boards (DHBs) were studied. An analysis framework was developed from key questions posed by the literature and by crafting three best practice exemplar cases from which to compare and contrast the progress of the New Zealand implementations. Thus the analysis was conducted firstly at the case level, then at the cross case level and finally, reviewed against a framework of best practice indicators found in the exemplar cases.
All of the sites achieved a mixture of success in terms of improved patient flow; in effect achieving some form of process redesign. Therefore, Lean Thinking can provide sought after improvements in waiting times and operational waste reductions however, without organisational commitment there is risk of sub-optimisation.
This research concludes that organisations that had an existing continuous quality culture or strategy were able to integrate Lean and achieve inter-department admission initiatives. These hospitals were somewhat more prepared for change and already had structures or processes in place that facilitated the Lean implementation. The thesis concludes by offering a practical range of indicators developed from the best practice exemplars and used for the data analysis, which could be employed by organisations to ascertain their readiness for a system implementation of Lean Thinking within a healthcare environment.