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Barriers to Lean & Safety Management Implementation in Primary Care Settings: Insights from an Unsuccessful Case
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DOI：10.2147/RMHP.S610926.png)
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Abstract
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Anna Tiso, Caterina Pozzan, Chiara Pamich, Chiara Verbano Department of Management Engineering, University of Padua, Vicenza, Italy *These authors contributed equally to this work Correspondence: Chiara Verbano, Department of Management and Engineering, University of Padua, Vicenza, Italy, Email chiara.verbano@unipd.it Background: Primary care is widely recognized as a cornerstone of universal health coverage, providing high-quality care in community-based settings. Structured managerial approaches such as Lean & Safety Management (L&SM) can support quality improvement in healthcare by reducing waste and risk and enhancing patient safety and satisfaction. However, evidence on the sustainable implementation of L&SM—defined as the ability to complete implementation and maintain improvements over time—remains limited in primary care. This study aims to identify key challenges affecting the sustainability of L&SM implementation in community healthcare centers. Methods: An unsuccessful L&SM implementation was analyzed through an in-depth case study of an Integrated Family Medicine Centre in Italy. The project, based on the DMAIC framework, was discontinued after the Define phase. A structured three-step methodology was adopted: 1) selection of a failed implementation case using predefined suitability criteria; 2) identification of implementation barriers through a systematic assessment of Critical Success Factors for sustainable Lean and Safety implementation adapted from the literature; and 3) validation of findings and exploration of corrective actions through a stakeholders focus group. Results: The analysis identified multiple barriers that contributed to implementation failure. These barriers were synthesized into three interrelated themes: organizational readiness, stakeholder ownership and engagement, and governance fragmentation. Together, these factors limited coordination, reduced commitment to improvement activities, and hindered the sustainability of the implementation process. Conclusion: Sustainable L&SM implementation in primary care requires organizational readiness, committed leadership, stakeholder engagement, adequate training, and robust data infrastructure. Addressing these factors may improve the successful adoption and long-term sustainability of quality improvement initiatives in community-based settings. Keywords: healthcare lean management, lean and safety management, territorial healthcare, sustainability, critical success factors
Keywords:
healthcare lean management
lean and safety management
territorial healthcare
sustainability
critical success factors
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