Evaluating lean implementation: Challenges in developing a research agenda for lean enterprise transformation in healthcare

Edward Miech, Dawn Bravata, Heather Woodward-Hagg

Research output: Chapter in Book/Report/Conference proceedingConference contribution

1 Scopus citations


This paper describes a prospective, mixed methods evaluation of Lean Enterprise Transformation (LET) within the context of healthcare. The Consolidated Framework for Implementation Research (CFIR) served as the general framework for this evaluation. The evaluation supported the successful implementation of Lean Healthcare Enterprise Deployment at seven pilot VA Medical Centers (VAMCs) and included a special focus on the impact of local context on implementation, piloting a "context matrix" approach for integrating unstructured data from multisite initiatives into a single cumulative project file to assist with rapid-cycle reporting and real-time access to data. A persistent challenge throughout the evaluation involved achieving a balance across three different kinds of questions: if change occurred, how change occurred, and how well specific components of LET had been implemented. This evaluation drew upon the ongoing major collaboration between the VA Stroke Quality Enhancement Research Initiative (QUERI) and the Veterans Engineering Resource Center (VERC) program within the VA, where the combined disciplines of industrial engineering and implementation science helped to develop a deeper understanding of LET implementation and the complex phenomenon of the influence of local context on transformation initiatives.

Original languageEnglish (US)
Title of host publicationIIE Annual Conference and Expo 2015
PublisherInstitute of Industrial Engineers
Number of pages9
ISBN (Electronic)9780983762447
StatePublished - 2015
EventIIE Annual Conference and Expo 2015 - Nashville, United States
Duration: May 30 2015Jun 2 2015


OtherIIE Annual Conference and Expo 2015
CountryUnited States



  • Enterprise transformation
  • Healthcare
  • Lean
  • Program evaluation
  • Quality improvement

ASJC Scopus subject areas

  • Control and Systems Engineering
  • Industrial and Manufacturing Engineering

Cite this

Miech, E., Bravata, D., & Woodward-Hagg, H. (2015). Evaluating lean implementation: Challenges in developing a research agenda for lean enterprise transformation in healthcare. In IIE Annual Conference and Expo 2015 (pp. 2172-2180). Institute of Industrial Engineers.