Purpose: The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker's description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.
Design/methodology/approach: Data were collected using a survey based on Liker's four principles, divided into 16 items ( n=298 staff in 45 units). Complementary observations ( n=28 staff) were carried out at four units.
Findings: Lean maturity varied both between and within units. The highest Lean maturity was found for "adhering to routines" and the lowest for "having a change agent at the unit." Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.
Practical implications: Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker's principles and using the results as guidance for further development.
Originality/value: This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker's principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.
Keywords: Healthcare; Lean principles; Liker; Observations; Qualitative.