--- title: "Sustaining Lean redesigns in primary care. | Sutter Health" description: "Staff buy-in, change ownership, and availability of time for improvement activities are critical to long-term success of Lean implementation in primary care." url: "https://www.sutterhealth.org/research/publications/sustaining-lean-redesigns-in-primary-care-1055312397" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Sustaining Lean redesigns in primary care. # Sustainment of Lean redesigns for primary care teams. Hung DY, Gray CP, Truong QA, & Harrison MI. _Qual Manag Health Care. 28(1):15-24. doi: 10.1097/QMH.0000000000000200._ 2019-01-01 ## Abstract BACKGROUND: Quality improvements are notoriously followed by "backsliding" or relapse to the status quo. This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. METHODS: We conducted qualitative interviews of 57 leaders and frontline providers, and fielded post-Lean implementation surveys to 1164 physicians and staff in 17 primary care clinics across the system. We analyzed interviews and conducted independent sample t tests to identify key factors that facilitated the sustainment of new workflows among primary care teams. All analyses were conducted after Lean redesigns were implemented and scaled across the system in 3 consecutive phases. RESULTS: Adherence to Lean redesigns was highest in the pilot clinic, despite having the longest postdesign measurement period. Members of the pilot clinic reported greatest participation in designing workflows, were most highly engaged in quality improvement efforts, and held most favorable beliefs about Lean changes. Adherence to redesigns was lowest among clinic members in the second phase of implementation; these members also reported highest levels of burnout. CONCLUSIONS: Staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=12) ## 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 ### [Five decades of HSR-by words and figures.](https://www.sutterhealth.org/research/publications/five-decades-hsr-words-figures-1055312369) Luft HS. Health Serv Res. 52(3):908-918. doi: 10.1111/1475-6773.12717. 2017 Jun 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 - Publication ### [Recognition as a patient-centered medical home: fundamental or incidental?](https://www.sutterhealth.org/research/publications/recognition-as-a-patient-centered-medical-home-1055312554) Dohan D, McCuistion MH, Frosch DL, Hung DY, Tai-Seale M. Ann Fam Med. 11 Suppl 1:S14-8. doi: 10.1370/afm.1488 2013 May 01 - Publication ### [Comparison of outpatient satisfaction survey scores for Asian physicians and non-Hispanic white physicians.](https://www.sutterhealth.org/research/publications/outpt-satisfaction-survey-scores-asian-vs-nhw-mds-1055312501) Garcia LC, Chung S, Liao L, Altamirano J, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. JAMA Netw Open. 2(2):e190027. doi: 10.1001/jamanetworkopen.2019.0027. 2019 Feb 01 - Publication ### [Quality management and perceptions of teamwork and safety climate in European hospitals.](https://www.sutterhealth.org/research/publications/qual-mgmt-teamwork-safety-european-hospitals-1055312928) Kristensen S, Hammer A, Bartels P, Suñol R, Groene O, Thompson CA, Arah OA, Kutaj-Wasikowska H, Michel P, Wagner C. Int J Qual Health Care. pii: mzv079. \[Epub ahead of print\] 2015 Oct 06 [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/sustaining-lean-redesigns-in-primary-care-1055312397#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":"Sustaining Lean redesigns in primary care."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/sustaining-lean-redesigns-in-primary-care-1055312397#medicalscholarlyarticle","name":"Sustainment of Lean redesigns for primary care teams.","headline":"Sustaining Lean redesigns in primary care.","abstract":"BACKGROUND: Quality improvements are notoriously followed by \"backsliding\" or relapse to the status quo. This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. METHODS: We conducted qualitative interviews of 57 leaders and frontline providers, and fielded post-Lean implementation surveys to 1164 physicians and staff in 17 primary care clinics across the system. We analyzed interviews and conducted independent sample t tests to identify key factors that facilitated the sustainment of new workflows among primary care teams. All analyses were conducted after Lean redesigns were implemented and scaled across the system in 3 consecutive phases. RESULTS: Adherence to Lean redesigns was highest in the pilot clinic, despite having the longest postdesign measurement period. Members of the pilot clinic reported greatest participation in designing workflows, were most highly engaged in quality improvement efforts, and held most favorable beliefs about Lean changes. Adherence to redesigns was lowest among clinic members in the second phase of implementation; these members also reported highest levels of burnout. CONCLUSIONS: Staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. 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