Abstract
BackgroundU.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence.MethodsThe English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria.ResultsThe reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.ConclusionDespite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.
Highlights
U.S healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance
The inability of many organizations to ensure transformation along both these dimension may explain a number of previous failings of lauded approaches like process reengineering or continuous quality improvement (CQI) to be viewed by employees and staff as anything different than a passing management fad [9,10]
Six Sigma 'Six Sigma is an organized and systematic method for strategic process improvements and new product and service development that relies on statistical methods and the scientific method to make dramatic reductions in customer defined defect rates' [18]
Summary
U.S healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. Required are transformational changes in health organizations that fundamentally alter practices and culture, and lead to more effective and efficient healthcare. Simple innovation routinization is not a sufficient condition, given that definitions of transformation incorporate shifts of collective behavior or values pointing to organization-wide culture change. The inability of many organizations to ensure transformation along both these dimension may explain a number of previous failings of lauded approaches like process reengineering or continuous quality improvement (CQI) to be viewed by employees and staff as anything different than a passing management fad [9,10]
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