Table 3 Conceptual framework domains and constructs to evaluate VA’s Lean Enterprise Transformation

1

Impetus to transform

• Leadership uses an identified impetus to engage staff in Lean Enterprise Transformation (LET) efforts

 --Initial impetus

 --Continued impetus

2

Leadership commitment to quality

• Senior leaders demonstrate a long-term strategy/vision for LET implementation that reflects an understanding of how the LET components interact and build over time.

• Leadership's commitment to overall LET implementation.

• Senior leaders engage and encourage middle management (service chiefs, nurse managers, frontline supervisors) to support their staff to participate in LET activities.

• Senior leaders participate themselves in a variety of Lean activities.

3

Organizational culture

• Problems, mistakes/errors, poor performance on metrics are seen as opportunities for growth, change, and improvement rather than an opportunity to blame (focusing on the system rather than the individual), a just culture.

• Senior leaders hold middle managers accountable for meeting LET objectives.

• Respect for People (culture of respect, constructive, respectful conflict, recognizing systems issues, etc) exists.

• Barriers to quality improvement are systematically identified and resolved.

• Improved processes and procedures are implemented in other appropriate areas of the organization (i.e., spread.)

4

Informed decision making

• Valid data and information are readily available for key Lean/improvement processes (e.g., TPOC, VSAs, RPIEs).

5

Integration across boundaries

• Staff from different work areas work together effectively and willingly across organizational boundaries on QI or Lean activities such as Value Stream efforts (e.g., engaging other services as needed to accomplish LET objectives).

• Staff from different disciplines work together effectively and willing across organizational boundaries on QI or Lean activities such as Value Stream efforts (e.g., engaging other services as needed to accomplish LET objectives).

6

Alignment - Alignment of improvement/ Innovation across the organization

• Leadership and managers effectively use incentives and reward structures to encourage involvement in LET efforts; they are not rewarded for maintaining the status quo.

• Members of leadership and/or service chiefs encourage or support improvement activities provides resources (e.g., protected time, supplies).

7

Alignment - Key initiatives aligned to strategies

• True North metrics/goals were observed.

• The organization’s Lean activities (e.g., continuous daily improvement and value stream efforts) are aligned with True North metrics/goals.

8

Communication

• Successes are celebrated and broadcasted to generate awareness and enthusiasm.

• Staff receive communication orally, on web site or physical displays from higher levels of the organization regarding Lean expectations, goals, etc.

• Staff input regarding Lean activities is received by higher levels of the organization and acknowledged.

9

Capability development

• Medical Center has a clear plan for training staff in Lean principles (which may include formal and on-the-job training).

• Staff have been trained in Lean principles.

• Staff who have gone through training are using skills in improvement work.

• Managers, supervisors and/or consultants such as sensei and systems redesign staff help staff use their newly-learned skills.

10

Veteran/patient engagement

• Voice of the Veteran (i.e., patient/family) is used as part of the improvement process.