Lean and Safety Management in Primary Care Centres: an Italian Case Study


  • Caterina Pozzan University of Padova
  • Anna Tiso University of Padova
  • Fabrizio Ronchi University of Padova
  • Chiara Verbano https://orcid.org/0000-0002-2300-7235




Lean Management, Lean Healthcare, Risk Management, Quality Management, Primary Care Centres


The primary care sector is globally recognised as the pillar of an efficient and patient-centred care model. Despite its importance, many countries fail to ensure equitable access and individualised care. This problem significantly impacts the most vulnerable part of the population, such as chronic and elderly patients. In this context, considering the large number of people affected by multiple diseases, multidisciplinary and multi-organisation teamwork has become fundamental to guarantee high levels of quality, increasing patient satisfaction, and continuity of care. Furthermore, working in a multidisciplinary primary care team can improve information exchange between care providers and patients, positively impacting on clinical performance. Despite these opportunities, the primary care workforce is often overloaded in its daily activities and not adequately organised and coordinated to avoid burnout experiences and inefficient skills deployment. In this context, implementing Lean and Safety Management (L&SM) as a process improvement methodology can increase care pathways performance and integration, patient safety and satisfaction through the reduction of wastes and risks. The current study aims to implement L&SM in a primary care centre in Italy, with the final goal of increasing productivity and effectiveness in daily activities performed by primary care physicians. This project is carried out following the DMAIC cycle; a managerial approach that combines qualitative and quantitative techniques to support process improvement. The implementation roadmap will combine HLM and CRM, planning to achieve the main steps listed as follows: mapping the care demand and the available resources to define the focus of the study; identifying the most representative and critical patients; mapping the target care pathway; identifying wastes and risk and their root causes; identifying critical aspects and improvement events; implementing countermeasures; evaluating and monitoring results. The expected results of the forthcoming months consist of measurable improvements within the healthcare pathway, supporting the optimisation of the primary care centre. Moreover, this initiative may represent a pilot case for other similar projects, contributing to spread L&SM culture throughout primary care centres with benefits for both patients and clinical staff.