Lean-ajattelu ja lean-päivittäisjohtaminen yliopistosairaaloissa

Lean thinking and daily Lean management in health care. Lean thinking, which is increasingly used in health care, as well, emphasises constant improvement and the provision of added value to clients. The elements of daily Lean management comprise visual monitoring with the aid of metrics and charts, responsibility for actions and short daily multiprofessional team meetings. The aim of this study was to identify elements of daily Lean management and the competence associated with it, and the usefulness of Lean thinking in university hospitals. The material was gathered in four university hospitals from experts who apply Lean thinking using surveys (N = 41) and theme interviews (N = 15) between November 2017 and June 2018. The data were analysed using data- and theory-oriented content analysis. The principles of Lean thinking are well suited for university hospitals. Applying Lean thinking calls for coach-style management and commitment on the part of the entire staff, at different levels of the organisation. Its implementation is restricted by some of the features of the health care culture: its hierarchical nature, rigid procedures and unclear processes. It seems likely that Lean principles and tools will continue to be used in the future, but it is expected that the model will be fine-tuned and bring more benefits when Lean thinking is combined with other management and development models. According to the respondents’ assessment, daily Lean management in the university hospitals was not standardised; however, some features of it were identified, together with the need to strengthen them. These features are communication, measurement and monitoring, competence management, coach-style management, supporting teamwork and change, continuous improvement, elimination of waste, as well as operation in line with strategy and setting goals. The systematic implementation of Lean thinking in university hospitals calls for clear visions and goals defined in a strategy, a dissemination plan and commitment to it on the part of management and staff. To strengthen daily Lean management, systematic development of methods and monitoring instruments aiming at continuous improvement are required.