Operational inefficiency and perceived quality in a paediatric day hospital: a lean-informed study of patient flow, caregiver and staff perceptions

Background: Lean management is widely promoted in healthcare to improve efficiency; however, evidence is sparse concerning how Lean-informed organisational settings directly influence patient experience and frontline staff perceptions of Lean processes, particularly in paediatric day hospital (DH) environments where clinical complexity and family-centred care create inherent conflicts between standardisation and adaptability. Methods: We conducted an observational cross-sectional study using several quantitative data sources, supplemented by qualitative insights from semi-structured staff interviews in an Italian paediatric DH following staff introduction to Lean concepts (Sept–Nov 2024). We integrated: (i) Value Stream Mapping and timed caregiver tracking to evaluate patient flow and waiting; (ii) a caregiver satisfaction survey at discharge; and (iii) a staff survey plus interviews capturing perceptions of Lean. Analyses were descriptive and exploratory. Results: Process performance: The DH exhibited substantial variation; only 11.4% of procedures occurred precisely on schedule, and non–value-added time constituted approximately 65% of each stay. Patient experience: Despite these inefficiencies, caregiver satisfaction remained consistently high (median 5/5). Satisfaction was only weakly correlated with waiting times or schedule deviations but strongly associated with transparent information and respectful staff interactions. Staff perceptions: The majority viewed Lean as practical and valuable, especially among those previously trained; however, many cited obstacles such as insufficient managerial support and resistance to change, with older staff expressing more scepticism than younger colleagues. Conclusions: High caregiver satisfaction coexisted with considerable operational inefficiencies, suggesting that relational care mitigates the impact of delays. These findings demonstrate that efficiency metrics alone do not fully represent perceived quality in paediatric settings. Lean implementation should balance efficiency, clinical adaptability, and family-centred care.