How to combine lean and safety management in health care processes: A case from Spain

Resource reduction and need to assure high quality levels in healthcare have induced hospitals to develop projects that report multiple performances. In order to pursue patient safety and efficiency improvements simultaneously, "lean & safety" projects (L&S projects) could be implemented, combining Health Lean Management (HLM) and Clinical Risk Management (CRM). This research aims to understand how L&S projects can be implemented. The analyzed case is an exemplary one, as it has been triggered by who is in charge of patient safety and required firstly to reduce incidents and secondly to obtain efficiency improvements. Using an interview protocol grasped from literature, data have been collected conducting semi-structured interviews, analyzing relevant archival documentation and executing observations on the field. A new framework of analysis has been created answering the research purpose. This research represents one of the first studies that investigate characteristics of an HLM project adopted to solve CRM issues. The results suggest HLM and CRM should be considered in a new synergic methodology. First indications about how developing it are provided boosting future research. The outcomes of this research is valuable for hospital units and health organizations that need to achieve efficiency enhancement, improving patient safety at the same time. For managing clinical processes properly, hospital managers could consider the results of this research to solve their CRM problems. The emerged evidences contribute to the development of guidelines for the implementation of "L&S" projects, pursuing multiple objectives and contributing to the growth of more safe and sustainable health care systems. (C) 2015 Elsevier Ltd. All rights reserved.