The Development of Lean Healthcare Constructs for Quality of Healthcare Service: A Second-order Model of Lean Healthcare in Malaysia

Abstract

The increase of patients’ attendance due to Covid-19 cases, together with the rise of patients’ demand, long waiting time, rising cost of service, lack of quality personnel and government funding constraints has overwhelmed the healthcare system and resources. Lean is therefore introduced as one of the best strategies by improving the quality of healthcare service delivery through stakeholders’ centricity. Despite there are emerging literatures for Lean healthcare, there is less agreement on the primary constructs constituting under the Lean healthcare practices. This study aims to identify the Lean healthcare practices and provide valid and reliable constructs for Lean healthcare in Malaysia. With the inspiration of Complementary Theory and Sustainable Lean Iceberg Model, the Lean healthcare is conceptualized as second-order formatively measured construct with five first-order constructs namely Strategy and alignment; Leadership; Behavior and engagement; Process management; Tools, technologies and techniques and measure Lean healthcare association with healthcare service quality. Data were obtained from 500 healthcare practitioners and patients in Malaysia public lean hospitals. The result identified the valid and reliable Lean healthcare constructs which consists of five Lean healthcare practices with total 30 items. The study found that all the constructs are complementary and mutually supportive to present the Lean healthcare as holistic implementation and have significant association with the healthcare service quality. This study provides fundamental knowledge and direction for future research as well as practitioners to adopt and implement all the Lean healthcare practices in a holistic manner to enhance the quality of healthcare services.