Lean management of crisis response and post-pandemic outcomes in US primary care practices

BACKGROUND: Primary care forms the basis for valued outcomes in health systems, including population health, high quality care, and reduced health expenditures. However, the primary care system in the United States (US) faces many difficulties, including financial pressures and clinician burnout that accelerated following the Covid-19 pandemic. This study examines the ability of primary care practices to adapt to post-pandemic challenges using a lean management system for quality and process improvement. METHODS: We used data from the National Survey of Healthcare Organizations and Systems II, a nationally representative sample of 1,245 physician practices located across the US. We first described the status of lean implementation among these primary care practices. We then conducted bivariate analyses followed by multivariate logistic regressions to examine relationships between lean implementation and outcomes of interest, including pandemic response activities, financial performance after the pandemic, and impacts of workforce shortages on patient care. RESULTS: Practices that adopted lean management were significantly larger in size (p < 0.05), affiliated with a health system or federally qualified health center (p < 0.0001), had a higher percentage of revenue from Medicaid (p < 0.0001) but lower percentage from Medicare insurance (p < 0.05), participated in more capitated payment arrangements and Accountable Care Organization contract types (p < 0.01), and were more evenly distributed across geographic regions of the country (p < 0.001). Controlling for these contextual features, we found that lean practices were more likely to participate in an incident command system for pandemic response (OR = 2.45, 95% CI: 1.24-4.82), engage in efforts to address clinician burnout (OR = 1.29, 95% CI: 1.03-1.60), and report stronger financial performance after the pandemic (OR = 2.57, 95% CI: 1.40-4.73). Additionally, after adjusting for all other lean processes, practice use of rapid improvement events (OR = 0.20, 95% CI: 0.06-0.70) and real-time data analysis tools (OR = 0.31, 95% CI: 0.11-0.90) was associated with lower reported impacts of workforce shortages on patient care. CONCLUSION: Health systems continue to face challenges, making them vulnerable to major disruptions as experienced with the recent pandemic. Lean management may enhance organizational resilience and theability of primary care practices to respond to rapidly evolving environments.