Table 2.

Barriers to and facilitators of lean implementation

Barrier/facilitator	Meaning
Senior management support and commitment	Leaders are important in acting as role models to exemplify the desired behaviours for Lean implementation. As with all change and improvement programmes, support and commitment from senior management is critical to a Lean initiative. The ‘management commitment’ barrier referred to whether top management was involved in Lean implementation, spent time in the workplace to supervise the process as part of their support and provided the necessary resources to implement lean in the workplace
Resources	Because the availability of resources is a primary concern in healthcare organisations, it must be properly considered when implementing lean. The ‘resources’ barrier has two meanings. The majority of the respondents mentioned that implementation was hindered because of insufficient available time. Others mentioned that a lack of personnel resources hindered the implementation
Strategy and purpose	One of the drivers for the success of Lean is to have a clear, well-communicated strategy. Constant changes in an improvement strategy inhibit the continuity of potentially successful programmes
Resistance to change	Resistance to change is a significant problem in any improvement programme in any organisation. Resistance deserves special attention from those attempting to implement Lean because staff empowerment, which is a key issue in Lean theory, is needed for engaging healthcare professionals
Multidisciplinary collaboration	Collaboration (or the lack thereof) within a multidisciplinary team was experienced as a barrier in most cases
Functional and professional silos	The fragmentation of healthcare organisations into silos (professional or functional) imposes a major barrier to the flow of patients, goods and information and consequently to the implementation of Lean techniques in an organisation
Training and education	The successful implementation of Lean requires employees to be effective problem solvers and learners, thereby eliminating errors and making operating improvements. The knowledge that is acquired in the LTP and the transfer of this knowledge into practice were perceived as constituting a barrier. Moreover, this barrier referred to the lack of experience in the principles, methods and tools of Lean thinking and working

LTP, Lean Training Programme; VUmc, VU University medical center.