"Multiple U.S. healthcare organizations have been recognized as successful in enterprise-level transformation to create healthcare delivery systems that are safe, effective, patient-centered, timely, efficient and equitable. Many of these organizations have specifically cited the development, deployment and integration of enterprise-level deployment of Lean Management Systems as key to their transformational efforts. Given the intense national interest in improving quality, efficiency and efficacy of healthcare delivery systems, a greater understanding of the strategies utilized by these organizations was required in order to provide an understanding of the mechanisms that drive successful, sustained, enterprise-level transformation. We conducted a realist review of large system transformation utilizing enterprise-level Lean Deployment methods within healthcare organizations. Synthesis and analysis of the results from this review indicate that there are five primary strategies associated with successful healthcare-based Lean deployments: Respect for People; Strategic Alignment; Strategic Deployment; Large Scale System Improvement Efforts; and Small-Scale, Local Improvement Efforts. Additional findings from this review indicate that the applications of the specific mechanisms with these strategies are emergent within multiple transitional phases spanning 6-8 years. To supplement the findings from the realist review, a series of dynamic hypotheses and system dynamics model was created in order to explore how the mechanisms and context interact to drive phase transitions within healthcare-based enterprise-level Lean deployments. The results from this model indicate that no steady state initial conditions exist that support sustained enterprise-level transformation and that the emergent nature of these deployments is necessary to overcome constraints related to the organizational capacity and capability. Additionally, we investigate the design and deployment of enterprise-level Lean programs in order to increase rate of success and decrease deployment cycles. "

Maternal health has been found to lag significantly behind in medical innovations compared to other branches of medicine such as radiology. Prenatal care, being part of maternal health, seems to be no different. Driven by this fact, this study first attempts to investigate the state of innovation implementation within the context of prenatal care in Sweden. Then, it continues with the identification of critical barriers and facilitators for the implementation of medical innovations within the same field and context as medical innovations are at some point necessary. Considering the nature of the issues at hand a qualitative study was deemed more suitable and hence was conducted. The overall work consists of a literature review alongside a planned and executed empirical study. The empirical study was conducted as a single case study comprising of three stakeholder groups that were of interest. These were: doctors, midwives, and healthcare managers. Participants were approached using a combination of convenience and snowball sampling. A series of semi-structured interviews were conducted with actors located throughout Sweden. With the help of thematic analysis, a holistic view supported by all three stakeholder groups was able to arise leading to multi-faceted insights. Results show that the medical innovation implementation state within prenatal care in Sweden could have been characterised as lethargic before the arrival of the COVID-19 pandemic as no significant medical innovations had emerged in the field until then. However, it is discovered that COVID-19 signalled the end of this reality and abruptly moved the existing innovation implementation climate. Furthermore, regarding the potential introduction of medical innovations in prenatal care, important barriers and facilitators were discovered. The findings of the study can be of use to actors attempting to implement medical innovations in the future within prenatal care or other clinical areas and contexts.