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Abstract
This paper presents a mixed-methods case study of process improvement at the information technology (IT) Department of ThedaCare, a Northeast Wisconsin community health system. As part of its broader goal to improve care, ThedaCare launched a “Lean” improvement project directed at IT support or “fix work” services. IT Department staff, IT support service customers, and a Lean facilitator participated in a weeklong rapid improvement event. Participants identified opportunities for process improvement, collected baseline measures on how (and how well) the IT Department was providing support services, and jointly developed a preliminary solution centered on a new team-based organization of support services. Rather than forwarding service requests to groups of support staff organized by IT application type, service requests would now be resolved on-the-spot by a team with distributed knowledge of multiple applications. Six and twelve months post-intervention, there was some evidence of success, including performance improvement and staff buy-in. We use realistic evaluation as an organizing framework to describe potential links between the intervention content and process, the surrounding context, and the outcomes of the intervention. We hypothesize four mechanisms that mediate this link: work standardization; connections between people; seamless flow; and participatory problem solving. We conclude that other organizations can learn as much from ThedaCare's participatory rapid improvement process and Lean approach to transformational change as from the actual implemented changes. Supplemental materials are available for this article. Go to the publisher's online edition of IIE Transactions on Healthcare Systems Engineering to view the free supplemental file.