Search results

The purpose of the study is to measure the performance of Indian hospitals, both operationally and financially, by using hospital KPI's. The assessment is predominantly done by linking it to the existing Lean practices in Indian hospitals.

An empirical study based on cross-sectional survey of hospital managers and specialists in various private healthcare facilities across India was conducted to validate the proposed Lean framework. From an extensive literature survey, the authors identified quality, delivery, efficiency, accessibility and patient centeredness to be the main operational performance (OP) indicators for hospitals. Business or financial performance was measured based on parameters which are average revenue per occupied bed (ARPOB), earnings before interest, tax, depreciation and amortization (EBITDA) and operating revenue. Confirmatory Factor Analysis (CFA) was carried out using a specialized technique, called Structural Equation Modelling(SEM) and an explicit factor structure was hypothesized.

Management commitment towards Lean in hospitals is statistically proven to have impacted operational and financial performance. However, leanness in technology and business processes showed no statistical significance on either operational or financial performance parameters. Hospital stakeholders showed statistical significance on though it had no impact on the financial performance. Results obtained from the statistical analysis indicate a positive impact of hospital Lean practices on timely delivery of services and improved service quality. Efficiency, accessibility of services and patient centered behavior in hospital operations could not be statistically proven to have impacted the financial performance.

Effectiveness of Lean management (LM) principles in improving hospital operations is largely dependent on patient centered behavior. Empowered employees who are trained to add value from a customer view point, make hospital operations safe and improved. Properly trained and communicated employees who are committed to quality improvements can make a positive impact on patients' quality of life and thus positively impact the society. The study lists ways to attain the required outcomes.

This paper is among the very few that has attempted to suggest ways to link implementation of Lean practices more effectively in Indian hospitals to improve hospital performance at operational and financial levels.

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.

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.

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.

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.

Although there are general methodologies for lean implementation in manufacturing companies, a specific methodology for the implementation of lean healthcare in hospitals has not been addressed by the literature. Addressing this gap, the purpose of this paper is to develop a practice-driven methodology for implementing lean in hospital operations.

Three case studies were conducted to collect evidence on the lean implementation process in Brazilian hospitals. From empirical evidence and literature, the implementation methodology was proposed and submitted to critical assessment by experts from the field.

The process of lean implementation was very similar in all cases, triggered by strategic planning and operationalized by continuous improvement projects. On the other hand, in all cases, the lean implementation teams had to deal with employees’ resistance. These findings were valuable inputs to the development of the implementation methodology. After refinement, it was proposed a feasible, useful and user-friendly methodology.

The proposed methodology was raised from the practice through case study research. However, the proposed methodology was not fully applied, and the associated performance measures were not elaborated in this paper. Therefore, more case studies and applications will be necessary to generalize the findings.

The methodology provides practical guidelines that support lean implementation in hospital operations. Although it demands adaptations for each specific hospital setting, this initial step may encourage hospital managers to start the lean journey.

This study addressed the gap in the literature regarding the lack of methodologies for implementing lean healthcare in hospital operations. The methodology synthesizes the knowledge, principles and tools of lean thinking that can be applied in hospital operations.

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

Lean practices are one of the fundamental practices adopted by health-care organizations to improve service quality and to reduce cost. In this context, the measurement of leanness in health-care organizations has become imperative. The purpose of this study is to measure the leanness of a hospital using fuzzy logic.

The design of the research includes two major steps. First, the identification of enablers, criteria and attributes of leanness constitutes the measures of assessment. Second, the above measures in the case hospital are assessed by using fuzzy logic approach.

This study suggests that leanness assessment is essential to identify the current lean capability of a health-care organization. This would help the health-care organizations to improve their lean performance further. The findings of the study suggest that the leanness of the case hospital is “Lean” (fuzzy range: 5.61, 7.24 and 8.91).

This study brings in three important implications from managerial point of view. First, it helps the management to assess the current level of leanness of the hospital. Second, it identifies the attributes that prevent the organization from being more lean. Third, it provides suggestive measures to address the weaker attributes and enables the enhancement of lean performance further.

The leanness assessment framework developed in the hospital operations is found to be original, and it adds value to the leanness assessment in health-care operations.

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.

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.

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

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.

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.

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.

There has been little empirical research focused on the effect of lean on hospital performance in the form of a consolidated methodology. This paper aims to apply a more sophisticated approach to examine whether hospitals’ decision for lean implementation is endogenous and test the effects of lean on hospital performance.

This study uses a publicly available data set of hospitals across the USA from 2002 to 2019 and performs two-stage least squares (2SLS) analysis. In the first stage, a probit model is used to estimate hospitals’ decision to implement lean. The fitted probability values from the first stage are used in the second stage to test the relationship between lean and hospital performance. Ordinary least squares (OLS) regression results are compared with those of the 2SLS approach.

The decision to implement lean is significantly associated with hospital-specific characteristics (the complexity of care, size and cost-to-charge ratio), indicating hospitals’ decision for lean implementation is endogenous. Moreover, there is strong evidence that lean implementation is positively associated with hospital financial and operational performance. The Hausman F-tests confirm the presence of endogeneity and this, in turn, suggests that OLS regressions result in unreliable estimates.

The findings of this study can help hospital managers benchmark performance and explore opportunities for profit and efficiency improvement. The findings are also relevant to policymakers who strive to lower health-care spending.

This study is motivated by the challenges facing the health-care industry. This study is among the first to investigate endogeneity in lean implementation and the association between lean and hospital performance using large-scale archival panel data. The use of the 2SLS approach provides more confidence in statistical findings.

Healthcare provision is costly, and patient expectations are increasing. Lean implemented within healthcare settings is one possible solution for dealing with this issue, with much of the current research in this respect mostly focused on developed countries. The research examines the applicability of lean in the healthcare sector of a developing country, specifically Oman.

Interviews were conducted with 32 individuals representing four public sector hospitals, along with two major hospital suppliers and the Ministry of Health. The readiness of lean thinking was assessed against seven criteria. Data were then analyzed thematically.

The authors found that Oman's healthcare sector is strong on leadership support, understanding value and customer groups, ability to undertake an end-to-end process view and engaging in the required training for lean. Interviewees showed awareness of the challenges, including aligning lean with the strategic agenda of healthcare settings, aligning measurement and reward systems to lean thinking and matching demand and capacity levels. The authors conclude that Oman's healthcare sector is ready for widespread application of lean, and if executed successfully, will generate strong strategic and operational outcomes.

This paper provides evidence of the applicability of lean in a very different context to the one that has been generally reported in the literature. The authors propose that lean thinking can be applied in countries and regions with similar cultural contexts such as the Middle East.

The purpose of this study is to document the experience and impact of implementing lean thinking (LT) in an Indian healthcare institution.

A detailed review of literature documenting the experience of implementing LT in healthcare institutions is carried out. Review revealed that there is a dearth of documentation on implementation of LT in Indian healthcare institutions. To address this gap, the experience of implementing LT in an Indian case hospital is documented by adopting a single case study research methodology.

Lean practices adopted by the Indian case hospital are documented. Performance measures before and after implementation of lean practices in the case hospital are compared. Based on this experience, a framework for implementing LT is proposed for healthcare institutions.

The current study documents the experience of an Indian case hospital, which is only at its initial stages of LT implementation. Future studies can be undertaken to assess the long-term impact of implementing LT in a healthcare institution. Similarly, the proposed framework for implementing LT can be validated by using the same in different healthcare institutions.

Review of lean principles, practices and performance measures discussed in the literature on implementing LT in healthcare institutions can act as a ready reckoner for practitioners. Framework proposed based on the experience of the case hospital is expected to guide healthcare practitioners in their lean journey.

This study is unique, as it documents the experience of implementing LT in an Indian healthcare institution and proposes a framework for implementing LT for future validation.

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.