Identification and development of Lean and Safety projects

Nowadays, healthcare systems are forced to perform highly from dissimilar perspectives. Solutions that combine diverse managerial approaches could be helpful to face this challenge. To this extent, this paper aims at studying how to implement Health Lean Management (HLM) projects with benefits of Clinical Risk Management (CRM). Considering the innovativeness of the topic, a multiple case study has been conducted selecting HLM projects with patient safety improvements (L&S projects) from operative units of different hospitals. Data were collected by executing semi-structured interviews. In-depth interviews, observations and analysis of relevant documentation were also performed to triangulate the information about hospital context, organizational and managerial aspects. Based on these data, a cross-case analysis was performed. Categorizing the cases, three clusters with distinguishing profiles emerged. Significant propositions were grasped highlighting the organizational and managerial characteristics of L&S projects. In particular, cases regarding front-office processes show distinct features and projects with intentional direct impacts on patient safety report peculiar characteristics, highlighting the need of CRM involvement to achieve multiple objectives. Besides interesting common evidences, indications distinguished by clusters are delineated. Patient safety improvements are intentionally obtained by managing wastes and errors, while they are unexpectedly reached by identifying and solving organizational issues. This research contributes to define guidelines for implementing L&S projects, which are still missing in literature, but which constitute a support for hospital managers who operate in a complex and turbulent context.