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The Application of Multiple Interrupted Time Series Analysis for Evaluating the Impact of Lean

Lookup NU author(s): Professor Christian Hicks, Professor Tom McGovern, Dr Adrian SmallORCiD


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Healthcare organisations have sought to increase quality and efficiency through implementing Lean. Previousevaluations of Lean programmes have reported positive results but many of these studies were based upon singlecases. Hierarchies of evidence classify research designs according to the extent to which findings can beattributed to the intervention. Ideally health professionals should incorporate scientific evidence when makingmanagement decisions; a lack of proof that Lean leads to improvements may be a barrier to adoption. To date themost robust designs used for Lean evaluations in healthcare have been before-and-after designs. Previousresearch has not adopted multiple interrupted time series designs (with controls).This paper evaluates a case study of a psychosis pathway that had been subject to a Rapid Process ImprovementWorkshop (RPIW) intervention using a multiple ITS design with five controls sites. Time series were obtainedfor the time taken from referral-to-assessment over a 31 month period. The data were skewed with clumping atzero. The research, therefore, adopted a two-part model to test two hypotheses: the number of patients assessedon the day-of-referral would increase; and the time from referral-to-assessment would decrease.The results of the study did not support the hypotheses. However, there were improvements at both theintervention and control sites, but these could not be attributed to the RPIW. If the research had excluded thecontrols, the evaluation would have indicated positive results, which would have been in accordance with themany success stories published in the literature.

Publication metadata

Author(s): Hicks C, McGovern T, Small A, Steen N, Whitty P, Erskine J, Hunter DJ

Editor(s): Grubbstrom, RW; Hinterhuber, H;

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Nineteenth International Working Seminar on Production Economics

Year of Conference: 2016

Number of Volumes: 4

Pages: 183-194

Print publication date: 23/02/2016

Acceptance date: 24/01/2015