The doctoral thesis of Kirsi Leivonen, MHSc, covered the implementation of lean management in Finnish health care. The research underlying this thesis represents an empirical, multi-method case study that was performed to assess the extent to which lean management has been applied at a university hospital as well as demonstrate how continuous improvement affects the functionality of the working community at this hospital. The research was conducted between 2016–2020, and comprises two consecutive sub-studies.
The first sub-study focused on assessing the extent to which lean management had been adopted at one university hospital. The study concerned all of the staff members at the hospital. Data (n=1202) were collected at the turn of the year 2016/2017 using an instrument that had been validated for assessing lean service adoption in service organisations. The obtained data were analysed using statistical methods. On average, the respondents rated the level of lean management adoption at the university hospital as 2.53 on a scale of 1 to 5. Regarding the 14 measured components of lean management, respondents gave the highest scores to capabilities of supervisors, standardisation of work, and internal quality control. Visualisation, infrastructure and resourcing development activities, and value stream mapping were the lean management components that received the lowest scores. One-third of respondents were not able to assess the pull component. The assessments of seven lean management components were found to be influenced by whether or not the respondent worked in a managerial position, while assessments of six components were associated with the respondent’s age. Managers and respondents belonging to the oldest age group reported – on average - more positive views of the extent to which lean management has been adopted than their younger colleagues.
The second sub-study focused on continuous improvement of operations at one surgical inpatient unit by using lean methods. The research used a participatory action approach, with the multiprofessional staff of an inpatient unit as the target group. Qualitative data (n=39) were collected in 2017 through participatory observations, target group interviews, field journals, individual and collective reflection of the implemented changes, and notes taken during meetings. Thematic mapping was used in the qualitative content analysis of the data. The key result of the study was that the continuous improvement of operations had predominantly positive effects on the functionality of the multiprofessional working community. These effects were observed in all of the factors concerning the functionality of the working community and the basic task of the unit. A multiprofessional patient rounding model was re-designed, described and implemented during the research process. The new operating model was evaluated by time measurements. The implementation of the operating model affected the work roles and responsibilities of different professional groups, along with the collective ground rules of the working unit. The commitment of supervisors and employees, particularly physicians, to the continuous improvement of operations was found to be crucial to achieving the desired changes.
The research presented in this thesis produced new knowledge about the extent to which lean management has been applied at a Finnish university hospital and how continuous improvement impacts the functionality of a multiprofessional working community. In addition to the introduction of a new patient rounding model, staff members reported concrete changes in work practices and environment. The research underlying this thesis also strengthened the knowledge base for using a validated instrument to assess the implementation of lean management in the operating environment of specialised Finnish medical care. Furthermore, the research covered in this thesis presents how an action research approach can be used to evaluate the continuous improvement of inpatient care activities.
The results presented in this study can be utilised to transform health care management, develop key processes at hospital organisations, and improve the functionality of multiprofessional working communities. The presented methodology for assessing lean management adoption can also be applied to other hospital organisations, with the university hospital discussed in this thesis serving as the national benchmark for the implementation of lean management.
The doctoral dissertation of Kirsi Leivonen, Master of Health Sciences, entitled Lean-management in health care – Case study at a university hospital, will be examined at the Faculty of Health Sciences. The public examination will be held in Finnish on 4 December 2020. The Opponent in the public examination will be Docent Heljä Lundgren-Laine of the University of Turku, and the Custos will be Professor Katri Vehviläinen-Julkunen of the University of Eastern Finland.
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