Article Title

Acceptance and Adoption of Lean Redesigns Among Frontline Providers in Primary Care

Publication Date



Lean process redesign, implementation measures/success


Background/Aims: This study examines the implementation and scale-up of Lean methodology for enhancing value in a large ambulatory care delivery system. While evidence suggests that Lean techniques can lead to higher quality care at lower cost, its success or failure is inextricably tied to the views and activities of frontline care providers who are the daily implementers of new workflows. This study explores how frontline views and activities impacted systemwide efforts to redesign primary care.

Methods: This work stems from a collaborative, mixed-methods evaluation of a major operational initiative to implement Lean as a common platform across the organization. The current analysis was guided by a modified version of the Consolidated Framework for Implementation Research, which defines various “measures” of success when implementing process redesigns. Drawing on over 100 in-depth interviews with physicians and staff conducted between January 2012 and March 2014, we sought to understand the extent to which new Lean workflows were accepted and adopted into practice, and the contextual factors that impact successful implementation.

Results: Frontline views on Lean’s potential to enhance value were impacted in part by: local dynamics of each care team; perceived skill or competency of team members (namely, medical assistants and licensed vocational nurses) in taking on new roles or scopes of work; and physicians’ own perceived efficiency prior to the introduction of Lean redesigns. The implementation strategy used by the organization was also critical. Physicians and staff who viewed the effort as “top-down” or “inflexible” were less likely to comply with changes. Even those who expressed positive views about Lean as an overall strategy for redesigning care, but who found the implementation process excessively top-down, were less likely to accept and adopt new modes of operation.

Discussion: Gaining “buy-in” from frontline providers is critical to implementing workflows that are designed to improve the delivery of health care. Understanding how clinical insiders’ views inform their decision to embrace or reject changes is important for managing change, and may also be instructive for organizations attempting to implement similar, operational initiatives.




April 6th, 2015


April 28th, 2015