Lean Hospitals Research Articles

Assessment of the Level of Practical and Theoretical Knowledge as a Starting Point for the Implementation of Lean Hospital Concept

Background: The implementation of the Lean Hospitals concept can contribute to the improvement of internal processes in healthcare organizations. The level of a management team’s knowledge is an important part of effective implementation of Lean Hospital elements in hospitals. The purpose of this article is to determine the degree of theoretical and practical knowledge of Lean Hospitals (defined for the purposes of the study as a set of lean tools) among the management teams of Polish hospitals. The authors focused on examining the discrepancy between practical and theoretical knowledge to determine which of them is less prevalent in hospitals in order to correctly establish elements of the implementation procedures, which must be improved and perfected to more effectively implement the lean concept in healthcare. Methods: The research methods used to achieve the study objectives included, respectively, an analysis of the literature on the subject and gathering of data using the Qualtrics Platform with a CAWI survey. Respondents rated their level of knowledge regarding Lean Hospital tools on a Likert scale. Basic descriptive statistics and radar diagrams were used to analyze and present the data. Statistical analysis was performed using Excel spreadsheets. Results: It was established that the vast majority of management teams in the studied hospitals had limited basic knowledge about Lean Hospitals, if any. The greatest lack of knowledge was found in the field of practical (implementation) knowledge of Lean Hospital tools. The research found no significant discrepancy between the level of theoretical and practical knowledge at the level of general knowledge and detailed knowledge relating to the knowledge of individual lean tools. The standardized work tool was rated best in terms of self-assessing practical knowledge. The worst rated tools in terms of both theoretical and practical knowledge self-assessment were Kaizen, Kanban and TPM. Conclusions: The results of the conducted studies indicate a low level of knowledge and advancement in the implementation of the Lean Hospitals concept in selected Polish hospitals. Limited knowledge of the Lean Hospital concept was established for entire management teams. A low level of knowledge was noted in both theoretical and practical knowledge. Supplementing knowledge only at the theoretical level without taking care of the practical knowledge aspect may prolong the implementation procedure or stop it completely. Therefore, based on the result of the research, it can be concluded that the first stage of lean implementation in hospitals should focus on supplementing the knowledge and preparing the employees for work in a lean culture, diverting particular attention to the practical part of the training.

Relationships between leadership and culture, human resources and process improvement in lean healthcare

PurposeThis research aims to examine the relationships among leadership and culture, human resources and process improvement in lean hospitals from the socio-technical perspective.Design/methodology/approachThe survey instrument was developed from literature reviews, verified by experts and confirmatory factor analysis. Multiple responses were used to collect data from 473 care providers in 220 outpatient departments of Thai hospitals to improve reliability of the obtained data. Path analysis of structural equation modeling was applied to analyze the hypotheses.FindingsIt was found that human resources has a significant positive direct effect on process improvement. Leadership and culture not only has significant direct positive impacts on human resources and process improvement but also has a significant indirect positive impact on process improvement through human resources.Originality/valueThis is one of the first examples of research to present insights into the links between soft and hard factors of lean hospitals at strategic and operational levels.

Service Quality and Patient satisfaction in Lean hospitals, Malaysia during the Covid-19 pandemic

Patient satisfaction and healthcare service quality are tied together. During Covid-19 pandemic, Lean hospitals have experienced numerous of issues, resulting in drop in service quality and severe impact on patient satisfaction. To understand the patient expectation during the pandemic, service quality of Lean hospitals are further evaluate with employing the SERVQUAL model. 467 questionnaires were collected from the outpatient in the 52 Lean hospitals using non-probability quota sampling method. From the Partial least squares structural equation modelling (PLS-SEM) findings shows that all service quality aspects, reliability, assurance, tangibles, empathy and responsiveness has significant relationship with patient satisfaction. Particularly, patients view empathy as the most significant factor in service quality during the pandemic, whereas the healthcare reliability is discovered to have less influence in explaining the patient satisfaction. A success healthcare system's primary purpose is to ensure all people receive high service quality, respectful treatment and satisfaction to protect their health and well-being. Therefore, the findings provide valuable insights on the perception and expectation of patient towards the healthcare service quality measurement for future improvement. To safeguard the patient satisfaction, Lean hospitals must ensure that (1) sufficient care and attention given to patient to serve patient’s best interests, (2) be responsive to assist and provide prompt services, (3) regularly monitor and ensure the equipment condition and the healthcare environment are clean and appealing, (4) provide professional service throughout interactions to reassure patient with skills and knowledge, and (5) provide timely service with a high accuracy and consistency of medical information.

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

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.

Expert-Identified Practices for Achieving Measurable Performance Improvements With Lean Implementation.

Despite the rapid spread of Lean management in health care, few organizations have achieved measurable overall performance improvements with Lean. What differentiates these organizations from those that struggle with realizing the potential benefits of Lean management is unclear. In this qualitative study we explore measuring the impact of Lean and the recommended practices for achieving measurable performance improvements with Lean in health care organizations. Informed by preliminary quantitative results from analyses of high- and low-performing Lean hospitals, we conducted 17 semi-structured interviews with Lean health care experts on the Lean principles and practices associated with better performance. We conducted qualitative content analyses of the interview transcripts based on grounded theory and linking to core principles and practices of the Lean management system. The qualitative data revealed 3 categories of metrics for measuring the impact of Lean: currently used institutional measures, measures tailored to Lean initiatives, and population-level measures. Leadership engagement/commitment and clear organizational focus/prioritization/alignment had the highest weighted averages of success factors. The lack of these 2 factors had the highest weighted averages of biggest barriers for achieving measurable performance improvements with Lean implementation. Leadership engagement and organizational focus can facilitate achieving the organization's performance improvement goals, whereas their absence can considerably hinder performance improvement efforts. Many different approaches have been used to quantify the impact of Lean, but currently used institutional performance measures are preferred by the majority of Lean experts.

THE RELATIONSHIP BETWEEN ORGANIZATIONAL CULTURE AND TASK PERFORMANCE IN LEAN HOSPITALS: THE MEDIATING ROLE OF ORGANIZATIONAL CULTURE

This study aims to determine the mediating role of organizational culture in therelationship between organizational change and task performance of lean hospitals. Also, therelationships among organizational change, organizational culture, and task performance variableswere aimed to be determined in the research. Three main hypotheses were determined based on theresearch model. The structural equation model was performed to test hypotheses using the surveydata received from 300 employees of two lean hospitals operating in Turkey. In terms of therelationship between organizational change and organizational culture, there is a positiverelationship between adhocracy-clan culture and institutional policy in change, outcomes of change,and management style in change, while there is no significant relationship between resistance tochange and adhocracy-clan culture. In terms of the relationship between organizational culture andtask performance, there is a positive relationship between adhocracy-clan culture and taskperformance, while there is no significant relationship between market and hierarchy cultures andtask performance. Adhocracy-clan culture has a mediating role in the significant relationshipbetween institutional policy and outcomes of change and task performance, while market andhierarchy cultures not having a mediating role.As a result of the analysis, it has been revealed thatorganizational culture has a partial mediating role in the causality relationship betweenorganizational change and job performance in lean hospitals.

Lean hospitals jako koncepcja wspomagająca zrównoważony rozwój szpitali

Lean hospitals jako koncepcja wspomagająca zrównoważony rozwój szpitali

Manager traits and quality-of-care performance in hospitals.

This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha < 0.05) between lean (intermediate-) and low-performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

Book Review: Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement

Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement 2nd Edition Graban, Mark. (2012). Boca Raton, FL: CRC Press, Taylor & Francis GroupLean is most effective when everyone in the Gemba (the place were the work gets done) has a growing understanding of what the lean philosophy, process, and methods are all about. The sec- ond edition of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement is an effective resource for engaging everyone from the front line staff to executives in studying how to operationalize the Lean process in the healthcare setting. The book is organized into 12 chapters. The content is rich with practical examples that show how a Lean manufacturing culture is very applicable in the healthcare and service industry. The author, Mark Graban, BS, MS, MBA, started his career in the manufacturing industry and starts the book by reinforc- ing how well Lean translates to other service industries and especially healthcare.Lean Hospitals begins with a discussion about why Lean is needed and how it can be used in healthcare. Chapter 2 provides an overview of Lean that lays the foundation for the rest of the book. Each subsequent chapter provides definitions for terms unique to Lean, defines the value of Lean, educates the reader about the Lean process, and places the content into perspective using case studies and practical examples. Each chapter also provides a conclusion, Lean Lessons, and Points to Ponder for discussion. The organization of the book provides a perfect format for assigning chapters in a class setting for healthcare work teams and executives can read at the same content, discuss content and specific points in a formal setting, and implement the concepts in their work setting.The book discusses finding waste in work processes and teaches the reader the steps of value stream mapping and standardizing the work processes. The Kanban and 5S processes are described, which are processes that can be easily grasped and appreciated. Graban adds a sixth S specific to healthcare, safety, which is an important consideration. An entire chapter (Chapter 8) is devoted to preventing errors-critical to this industry. By the time the reader gets to Chapter 7, Graban has built excitement in the material with opportunities and examples that can be used in the reader's setting. The concept and process for A3 problem solving are introduced in the middle of Chapter 7, an appro- priate time for the reader's growing appetite for change. The author provides a systematic method for understanding the reader's current situation, conducting a root cause analysis, and identifying a counter measure and implementation. Not all hospitals initiate Lean with a system-wide initiative, and the A3 tool is perfect for individuals to get started on analyzing the problem with focused detail. For departments or work teams new to the Lean process, A3 problem solving empowers employees to personally own the improvement process, and ultimately create an organization of problem solvers, which is a key part of the Toyota culture. …

Lean hospitals: a new challenge for facility designers

This article presents a literature review of a wide array of implementation studies of Lean healthcare practices, performed worldwide. Firstly, we review some fundamentals of Lean thinking. Second, we describe the continuous work improvement cycle along with some commonly used Lean tools. We then examine how the implementation of Lean practices has affected hospitals and their users. Furthermore, we review the encountered challenges and opportunities. Finally, we present process- and technology improvement ideas to address the urgent needs and critical shortcomings of current healthcare practices. Lean practices are becoming increasingly widespread in the healthcare industry. Readers new to them might like to investigate their applicability more deeply.

Toyota's Quality Principles Drive Hospital's Reform Effort

Toyota's Quality Principles Drive Hospital's Reform Effort

Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction

Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction