A staff perspective on Lean maturity, well-being, and quality in primary care

Abstract: Background: Lean is commonly implemented in healthcare but it is unclear how much of Lean is adopted and whether Lean is associated with staff’s well-being and quality of care.Aim: To describe staff perception of Lean maturity in primary care, and to determine to what extent staff-rated Lean maturity is associated with staff rated thriving, exhaustion, and musculoskeletal complaints, as well as staff rated quality of care.Method: Survey data were collected in 2015 (n=481 staff) and 2016 (n=351 staff) at 48 primary care units; they were analyzed using confirmatory factor analysis (Paper I), and multiple regression analysis, taking nesting within units into account when possible (Paper II-IV). Interviews (n=12 staff) and observations (n=28 staff) were analyzed deductively.Results: The developed Lean in Healthcare Questionnaire, based on Liker’sdescription of Lean, generally showed acceptable psychometric properties (Paper I). Lean maturity varied within and between units. The highest maturity concerned staff adherence to routines, and the lowest concerned having a change agent at the unit (Paper II). Lean maturity was positively associated with staff satisfaction with care, both cross-sectionally (Paper II) and, mediated by increased resources, in a longitudinal analysis (Paper IV). The 12-month prevalence of musculoskeletal complaints in the shoulders, neck, and low back was 50-58%, and the 7-day prevalence 25-37% (PaperIII). Lean maturity was not associated with musculoskeletal complaints (PaperIII). Increased Lean maturity was, however, associated with increased thriving, mediated by increased job resources, as well as with decreased exhaustion, mediated by decreased job demands (Paper IV).Conclusion: Lean maturity varied in primary care. It was positively associated with staff-rated quality of care and thriving, and negatively associated with exhaustion. Musculoskeletal complaints were common, but not associatedwith Lean maturity.