Abstract：
BACKGROUND: Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping.
METHODS: Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source.
RESULTS: At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement.
CONCLUSIONS: A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings.
CONCLUSIONS: These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.
METHODS: Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source.
RESULTS: At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement.
CONCLUSIONS: A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings.
CONCLUSIONS: These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.
摘要：
背景：精益，特别是价值流图越来越多地用于医院优化流程。这种方法,起源于汽车行业，使参与该过程的所有员工都能使其对客户更加友好。尽管精益项目取得了广泛的成功，他们在某些情况下失败了。本研究调查了有助于成功实施价值流映射的环境因素和机制。
方法：将价值流图应用于四个乳腺癌中心的出院过程。混合方法分两步使用。首先,为了验证成功实施，定义为时间优化，在三个时间点进行时间测量,并使用ANOVA进行分析.第二,对环境因素的分析与基于规范化过程理论的机制的定性内容分析相结合，使用常规数据，会议协议,字段注释,和采访笔录作为数据源。
结果：在四个乳腺癌中心之一，前导和等待时间大大减少；在其他方面，这些减少没有发生。失败/成功不能用医院的规模来解释，案件数量或人员配备水平。可变的项目团队组成是显而易见的，尤其是领导参与。
结论：进行了比较分析，以确定导致成功的因素。这些因素是:与该进程相关的所有领导人的参与，在出院过程中，包括医疗和护理领导；将项目团队的变化传播给同事，包括讨论它的感觉和可能性；在定期的工作团队会议中共同反映实施过程。
结论：这些结果证实了领导在实施项目中的重要作用。领导支持启用了所发现的机制。来自管理研究和实施科学的理论方法的结合确定了解释，应在实施科学中更频繁地应用。
方法：将价值流图应用于四个乳腺癌中心的出院过程。混合方法分两步使用。首先,为了验证成功实施，定义为时间优化，在三个时间点进行时间测量,并使用ANOVA进行分析.第二,对环境因素的分析与基于规范化过程理论的机制的定性内容分析相结合，使用常规数据，会议协议,字段注释,和采访笔录作为数据源。
结果：在四个乳腺癌中心之一，前导和等待时间大大减少；在其他方面，这些减少没有发生。失败/成功不能用医院的规模来解释，案件数量或人员配备水平。可变的项目团队组成是显而易见的，尤其是领导参与。
结论：进行了比较分析，以确定导致成功的因素。这些因素是:与该进程相关的所有领导人的参与，在出院过程中，包括医疗和护理领导；将项目团队的变化传播给同事，包括讨论它的感觉和可能性；在定期的工作团队会议中共同反映实施过程。
结论：这些结果证实了领导在实施项目中的重要作用。领导支持启用了所发现的机制。来自管理研究和实施科学的理论方法的结合确定了解释，应在实施科学中更频繁地应用。
