--- title: "Lean mgmt system in primary care: facilitators and barriers. | Sutter Health" description: "Drivers of change included empowerment of staff, visual display of performance metrics, and a culture of innovation and collaboration. Barriers also described." url: "https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Lean mgmt system in primary care: facilitators and barriers. # Implementing a Lean management system in primary care: facilitators and barriers from the front lines. Hung D, Martinez M, Yakir M, & Gray C. _Qual Manag Health Care. 24(3):103-8. doi: 10.1097/QMH.0000000000000062._ 2015-07-01 ## Abstract BACKGROUND: Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. METHODS: This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. RESULTS: Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. CONCLUSION: Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/26115057) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Actions and processes that patients, family members, and physicians associate with patient- and family-centered care.](https://www.sutterhealth.org/research/publications/pt-and-family-centered-care-actions-and-processes-1055312507) Hsu C, Gray MF, Murray L, Abraham M, Nickel W, Sweeney JM, Frosch DL, Mroz TM, Ehrlich K, Johnson B, Reid RJ. BMC Fam Pract. 20(1):35. doi: 10.1186/s12875-019-0918-7. 2019 Feb 25 - Publication ### [Shared decision-making for syncope in the emergency department: a randomized controlled feasibility trial.](https://www.sutterhealth.org/research/publications/shared-decision-making-for-syncope-in-er-1055312729) Probst MA, Lin MP, Sze J, Hess EP, Breslin M, Frosch DL, Sun BC, Langan MN, Thiruganasambandamoorthy V, Richardson LD. Acad Emerg Med. doi: 10.1111/acem.13955. \[Epub ahead of print\] 2020 Mar 09 - Publication ### [A three-talk model for shared decision making: multistage consultation process.](https://www.sutterhealth.org/research/publications/shared-decison-making-three-talk-model-1055312442) Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, Cochran N, Frosch D, Galasinski D, Gulbrandsen P, Han PKJ, Härter M, Kinnersley P, Lloyd A, Mishra M, Perestelo-Perez L, Scholl I, Tomori K, Trevena L, Witteman HO, Van der Weijden T. BMJ. 2017 Nov 6;359:j4891. doi: 10.1136/bmj.j4891. 2017 Nov 06 - Publication ### [Time is up: increasing shadow price of time in primary-care office visits.](https://www.sutterhealth.org/research/publications/increasing-shadow-price-of-time-in-pc-visits-1055312555) Tai-Seale M, McGuire T. Health Econ. 21(4):457-76. doi: 10.1002/hec.1726. Epub 2011 Mar 27. 2012 Apr 01 - Publication ### [Capsule commentary on O'Malley et al., overcoming challenges to teamwork in patient-centered medical homes: a qualitative study.](https://www.sutterhealth.org/research/publications/comment-omalley-et-al-teamwk-challenges-pcmhs-1055312918) Tai-Seale M. J Gen Intern Med. 30(2):239. doi: 10.1007/s11606-014-3128-y. 2015 Feb 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Lean mgmt system in primary care: facilitators and barriers."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867#medicalscholarlyarticle","name":"Implementing a Lean management system in primary care: facilitators and barriers from the front lines.","headline":"Lean mgmt system in primary care: facilitators and barriers.","abstract":"BACKGROUND: Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. METHODS: This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. RESULTS: Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. CONCLUSION: Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.","description":"Drivers of change included empowerment of staff, visual display of performance metrics, and a culture of innovation and collaboration. Barriers also described.","keywords":["Health Services"],"datePublished":"2015-07-01","url":"https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26115057"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1097/QMH.0000000000000062"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26115057/","https://doi.org/10.1097/QMH.0000000000000062"],"isPartOf":{"@type":"Periodical","name":"Qual Manag Health Care"},"author":[{"@type":"Person","name":"Hung D"},{"@type":"Person","name":"Martinez M"},{"@type":"Person","name":"Yakir M"},{"@type":"Person","name":"Gray C"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/lean-mgmt-system-primary-care-facilitators-1055312867#breadcrumblist"}}} ```