Lean Readiness Assessment for sustainable Territorial Ambulatory Healthcare

In recent years, European healthcare systems have undertaken major reforms to strengthen territorial and primary care in response to demographic pressures, the rising prevalence of chronic diseases, and the need to ensure long-term sustainability. In Italy, this reorganization has been framed by Ministerial Decree 77/2022, which operationalizes the strategic goals of the National Recovery and Resilience Plan by reinforcing territorial care services, promoting ambulatory and home-based care, and fostering integration among different care providers. Within this evolving context, the adoption of structured managerial approaches is essential to improving the quality of care, patient safety, and satisfaction. Healthcare Lean Management (HLM) and Lean & Safety Management (L&SM) are two widely recognized approaches; however, despite their potential, many projects struggle to achieve long-term sustainability, underscoring the need to assess readiness before implementation. Building on these motivations, this study aims to develop and test an HLM Readiness Assessment Model as a tool to evaluate the preparedness of Territorial Ambulatory Healthcare (TAH) systems for sustainable HLM implementation. Methodologically, the research followed a Model Development approach structured around four phases: Scope, Design, Populate, and Test. The testing phase applied the model in three public TAH systems across Italian and international contexts, enabling the involvement of healthcare staff in identifying context-specific improvement opportunities. The findings confirm the model’s validity and its generalizability across diverse settings, while also providing preliminary insights into the main challenges affecting the sustainable implementation of HLM in TAH. Furthermore, the model was deemed suitable not only to support HLM implementation but also to inform L&SM initiatives, although this latter aspect requires further investigation. While these findings are significant, they are constrained by certain limitations, including the small number of settings explored, the limited respondent pool, and the fact that potential improvement solutions were identified but not implemented. These constraints highlight two directions for future research: first, applying the model prior to HLM and L&SM projects to empirically assess the effect of addressing readiness gaps on long-term sustainability; and second, deploying the model across a wider range of contexts with larger respondents samples, supported by integrated quantitative and qualitative methodologies. The study makes contributions from both academic and managerial perspectives by advancing understanding of the sustainability of HLM and L&SM in territorial healthcare and by providing managers with a structured tool for readiness assessment. In addition, it supports social sustainability by fostering staff engagement, enhancing patient well-being, promoting more personalized and effective care, and strengthening universal healthcare coverage.