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Article
Publication date: 21 July 2020

Rui M. Lima, José Dinis-Carvalho, Thiago A. Souza, Elisa Vieira and Bruno Gonçalves

Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that…

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Abstract

Purpose

Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified.

Design/methodology/approach

As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas.

Findings

The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement.

Originality/value

The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

Details

International Journal of Lean Six Sigma, vol. 12 no. 2
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 9 February 2021

Marta Marsilio and Martina Pisarra

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to…

Abstract

Purpose

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.

Design/methodology/approach

A systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.

Findings

The 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.

Originality/value

This work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

Details

Journal of Health Organization and Management, vol. 35 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Book part
Publication date: 12 December 2022

Dorothy Y. Hung, Justin Lee and Thomas G. Rundall

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We…

Abstract

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.

Details

Responding to the Grand Challenges in Health Care via Organizational Innovation
Type: Book
ISBN: 978-1-80382-320-1

Keywords

Article
Publication date: 31 August 2023

Albi Thomas and M. Suresh

This paper aims to “identify,” “analyse” and “categorise” the readiness factors of lean sustainability in health-care organisation using total interpretive structural modelling…

Abstract

Purpose

This paper aims to “identify,” “analyse” and “categorise” the readiness factors of lean sustainability in health-care organisation using total interpretive structural modelling (TISM).

Design/methodology/approach

To obtain the data, a closed-ended questionnaire was used in addition to a scheduled interview. To identify how the factors interact, the TISM approach was used, and the matriced’ impacts croise’s multiplication applique’e a UN classement (MICMAC) analysis was used to rank and categorise the lean sustainability readiness factors.

Findings

This study identified ten lean sustainability readiness factors for health-care organisation. The identified factors are resources utilization practice (F1), management commitment and leadership (F2), operational flexibility (F3), workforce engagement and time commitment (F4), sustainability motivational factors (F5), awareness of lean and sustainable practice (F6), hospital design (F7), energy efficiency practices in hospitals (F8), responsible autonomy (F9) and new system adoptability training (F10). The key/driving factors are identified in this study are operational flexibility, sustainability motivational factors, management commitment and leadership, new system adoptability training.

Research limitations/implications

The study focussed primarily on lean sustainability factors for the health-care sector.

Practical implications

This research will aid key stakeholders and academics in the better understanding the readiness factors that influence lean sustainability in health-care organisation. This study emphasises the factors that must be considered when applying lean sustainable practices in health care as a real-world application in a health-care organisation. These readiness factors for lean sustainability can be used by an organization to comprehend more about the concept and the components that contribute to health-care lean sustainability.

Originality/value

This study proposes the TISM technique for health care, which is a novel attempt in the subject of lean sustainability in this sector.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 18 no. 1
Type: Research Article
ISSN: 1750-6123

Keywords

Article
Publication date: 12 June 2019

Ayman Bahjat Abdallah and Rasha Zuhair Alkhaldi

The purpose of this paper is to review original research on lean management (LM) in health care to identify potential research gaps and present recommendations for future…

Abstract

Purpose

The purpose of this paper is to review original research on lean management (LM) in health care to identify potential research gaps and present recommendations for future research. The paper also discusses the current state of implementing LM practices in health care. In addition, it presents and highlights “lean bundles” imported from manufacturing, namely, total quality management (TQM), human resource management, just-in-time and total productive maintenance, as a potential implementation strategy of LM in hospitals to optimize overall health care performance.

Design/methodology/approach

The scoping review was conducted based on the guidelines specified by Arksey and O’Malley (2005). Relevant included studies were retrieved by searching various electronic databases. The PRISMA guidelines were applied to identify and select eligible studies.

Findings

The majority of previous studies used selected practices to measure LM in health care. In most cases, these practices reflected a narrow and biased view of LM. Lean bundles which comprehensively view LM and reflect all its aspects have rarely been discussed in the health care literature. Evidence about the contribution of lean bundles to hospital performance needs to be addressed in future studies.

Practical implications

This paper demonstrates the implementation of the four lean bundles in hospitals. It argues that, instead of adopting one dimension or selected practices of LM, hospitals viewing LM as a comprehensive multi-dimensional approach through the adoption of the four lean bundles are expected to maximize their performances.

Originality/value

This is one of the first works to comprehensively review and discuss lean bundles in the context of health care. It argues that the adoption of the four lean bundles by hospitals will enable them to yield the maximum LM performance benefits. In addition, a proposed survey questionnaire based on the literature review is provided to assist researchers in conducting future empirical studies.

Details

Journal of Health Organization and Management, vol. 33 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 5 June 2017

Pernilla Ingelsson and Ingela Bäckström

The purpose of this paper is to investigate the effects a lean initiative has on the health-related quality management (QM) values, “Leadership Commitment” and “Participation of…

Abstract

Purpose

The purpose of this paper is to investigate the effects a lean initiative has on the health-related quality management (QM) values, “Leadership Commitment” and “Participation of Everybody,” as well as on perceived co-worker health in the public sector.

Design/methodology/approach

A case study was carried out at a municipal division that had been working with lean for approximately 18 months. A questionnaire was used to measure the effect on health-related QM values both before and after the initial 18 month period. Documents from the intended lean implementation were studied at the starting point and after 18 months; this was followed up by examining new documents. The results from the questionnaires were analyzed using SPSS and the documents were analyzed by means of document comparisons and consensus discussion in the research group.

Findings

The effects on the health-related QM values; “Leadership Commitment” and “Participation of everybody” in this study showed that the values still permeated the organization to a relatively high extent after 18 months but that no statistical differences can be shown between the two measurement points. When measuring what effects a lean initiative has on values, a period of 18 months might be too short, if significance changes are expected. None the less, the results can be a way of monitoring the development of these softer values. Something that is equally important is to see if there have been any major changes, as a way of keeping the work with building a new culture alive and in focus. The results strengthen the assumption that a long-term mindset is needed when QM initiatives such as lean are applied within an organization especially when changes to values and workplaces are expected.

Originality/value

This study has further explored the QM in relation to lean in the respect of how the QM values “Leadership commitment” and “Participation of Everybody” are effected by a lean initiative.

Details

International Journal of Workplace Health Management, vol. 10 no. 3
Type: Research Article
ISSN: 1753-8351

Keywords

Article
Publication date: 27 July 2012

Rajeev Chadha, Amita Singh and Jay Kalra

Patient satisfaction and quality care are important indicators for the success of any health care enterprise. The critical nature of health care operations entails that some…

4559

Abstract

Purpose

Patient satisfaction and quality care are important indicators for the success of any health care enterprise. The critical nature of health care operations entails that some excess capacity is stored in the system to provide the necessary flexibility of response. To prepare health care organizations to deliver high quality services at lower costs, this paper aims to report a lean health care (LEAN‐HC) transformation model that integrates queuing theory and lean methodology to improve the dynamic performance of the health care system.

Design/methodology/approach

This paper reviews and evaluates an emergency department health care system that adopts a system dynamic model, redesigned the process using value stream mapping to eliminate non‐value‐added activities to achieve just‐in‐time (JIT) services. This study was conducted at SD Mission Hospital, India. The LEAN‐HC model includes three steps. First, the patient arrival flow is assessed and adjusted, using physicians at the front of the queue to separate patients at triage into major, medium, and minor injury classes. Second, a cross‐functional team consisting of process, information and clinical experts maps the hospital's current state to identify and eliminate wasteful non‐value‐added activities. Third, the process is continually de‐bottlenecked using a variety of lean techniques, such as 5S visual management, one‐piece‐flow to reduce service lead time, and adoption of standard operating procedures.

Findings

The authors' results reveal that a lean integration to queuing methodology frees up capacity in the health care system, providing necessary flexibility of response. The implementation of the LEAN‐HC model resulted in the following improvement. First, an improved process flow and increased capacity. Second, emergency department length of stay for all patient classes decreased. Third, value stream mapping was found to be useful in detecting opportunities to decrease patient turnaround. Fourth, the service bottleneck could be identified and shifted to where it could be most easily controlled, adhering to the principle of one piece flow. No changes in resource availability and safety or quality issues occurred during the implementation of lean methodology.

Originality/value

This study demonstrates how to apply lean methodology in conjunction with the queuing modeling in the health care industry, particularly with regards to the patient wait time and reduction in medical errors. The LEAN‐HC model delivers more efficient service by increasing hospital capacity while reducing non‐value‐added times and overhead costs.

Details

Clinical Governance: An International Journal, vol. 17 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 5 January 2022

Najla Alemsan, Guilherme Tortorella, Carlos Manuel Taboada Rodriguez, Hadi Balouei Jamkhaneh and Rui M. Lima

The importance of a lean health-care supply chain is increasingly discussed. However, it is still not very clear how lean practices relate to resilience capabilities, as there are…

1108

Abstract

Purpose

The importance of a lean health-care supply chain is increasingly discussed. However, it is still not very clear how lean practices relate to resilience capabilities, as there are synergies and divergences between them. This study aims at identifying the relationship between lean practices and resilience capabilities in the health-care supply chain.

Design/methodology/approach

This study conducted a scoping review based on five databases, which allowed the content analysis of 44 articles. Such analysis allowed the verification of trends and volume of studies on this topic. Further, the descriptive numerical and thematic analyses enabled the proposition of a conceptual framework, relating the adoption of lean practices to the development of resilience capabilities according to the tiers of the health-care supply chain in different value streams.

Findings

Three research directions were derived from this scoping review: empirical validation of the contribution of lean practices to resilience capabilities in the health-care supply chain; systemic implementation of lean practices across tier levels of the health-care supply chain; and complementary approaches to lean implementation toward a more resilient health-care supply chain.

Practical implications

The understanding of these relationships provides health-care managers arguments to prioritize the application of lean practices to improve desired resilience capabilities in the entire health-care supply chain.

Originality/value

To the best of the authors’ knowledge, there is no similar study in the literature.

Details

International Journal of Lean Six Sigma, vol. 13 no. 5
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 2 September 2019

Abdulaziz Marzouq Almutairi, Konstantinos Salonitis and Ahmed Al-Ashaab

The main purpose of this paper is to present lean implementation in hospital supply chain management (HSCM) and propose a new conceptual framework tailored specifically to the…

1458

Abstract

Purpose

The main purpose of this paper is to present lean implementation in hospital supply chain management (HSCM) and propose a new conceptual framework tailored specifically to the needs of Saudi health-care organizations.

Design/methodology/approach

This paper starts with an in-depth review of existing frameworks or models for lean implementation in health care in general and in HSCM specifically. Based on the literature studies and taking experts’ opinions into account, a new framework for lean implementation in the Saudi HSCM is presented.

Findings

A new lean implementation framework is offered to decision-makers in the health-care organization for implementing a lean approach in HSCM practices.

Research limitations/implications

This study focused on health-care organizations, which were selected from hospitals operated by the Ministry of Health and only those hospitals that are accredited by both the Saudi Central Board for Accreditation of Healthcare Institutions and the Joint Commission International. The framework is limited to Saudi health care.

Practical implications

The lean supply chain management (LSCM) framework is easy to understand and use without much complexity. This simplicity makes the LSCM applicable in health-care settings. Further, LSCM was validated in three different hospitals, and it helped them to identify and improve their non-added activities, thereby readying them for lean deployment in HSCM.

Originality/value

Little attention has been paid to implementing a lean approach by health-care providers in developing countries. This study presents a new framework that is considered the first of its kind for implementing lean in HSCM in Saudi. This framework could help HSCMs’ decision-makers to implement lean successfully in HSCM practices.

Details

International Journal of Lean Six Sigma, vol. 11 no. 3
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 20 November 2017

Susanna Hihnala, Lilja Kettunen, Marjo Suhonen and Hanna Tiirinki

The purpose of this paper is to discuss health services managers’ experiences of management in a special health-care unit and development efforts from the point of view of the Lean

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Abstract

Purpose

The purpose of this paper is to discuss health services managers’ experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers’ work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments.

Design/methodology/approach

These data were collected through a number of thematic interviews. The participants were nurse managers (n = 7) and medical managers (n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis.

Findings

A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills.

Practical implications

Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care.

Originality/value

The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers’ experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used in the training of health services managers in the health-care industry worldwide and to help them survive the pressure to change repeatedly.

Details

Leadership in Health Services, vol. 31 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

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