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Lean practices for quality results: a case illustration

Pauline Hwang (Department of Nursing, Pennsylvania State University, Hershey, Pennsylvania, USA)
David Hwang (Department of Finance and Supply Chain Management, Shippensburg University of Pennsylvania, Shippensburg, Pennsylvania, USA)
Paul Hong (Department of Information Systems and Operations Management, University of Toledo, Toledo, USA)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 7 October 2014




Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations.


The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital.


Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals.

Practical implications

An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices.

Social implications

Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks.


Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.



Hwang, P., Hwang, D. and Hong, P. (2014), "Lean practices for quality results: a case illustration", International Journal of Health Care Quality Assurance, Vol. 27 No. 8, pp. 729-741.



Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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