Using experts’ consensus to evaluate the Readiness Factors of Lean Implementation in Healthcare

Eni Beçi Bushi; Klejda Harasani; Andreas Kakouris; Delina Xhafaj

doi:10.18535/ijsrm/v10i08.mp03

Abstract

BACKGROUND: The core idea of the Lean philosophy in healthcare is a continuous improvement by minimizing waste and maximizing the value delivered to patients. Although there is growing interest in lean applications in healthcare organizations, the study of readiness factors for implementing Lean in this sector remains one of the reasons for Lean failure.

OBJECTIVE: This study aims to identify and validate the readiness factors that influence the successful and sustainable implementation of Lean in healthcare organizations.

METHODS: A systematic review of the literature was performed to synthesize readiness factors that help healthcare organizations implement lean practices. The Delphi method was used to validate the identified factors from the perspective of the healthcare experts.

RESULTS: This systematic review revealed eleven readiness factors that are important contributors to the success of Lean implementation in healthcare. After three rounds of Delphi, a moderate consensus (Kendall's W=0.519; P<0.001) was achieved among the experts’ panel regarding the nine readiness factors. Seven factors were extracted from the literature review and two were derived from experts’ suggestions.

CONCLUSIONS: The investigation of organizational readiness to implement lean may help healthcare organizations be better prepared for their initiation of the Lean journey and enable the sustainability of improvements.

Keywords

LeanHealthcareReadiness factorsDelphi

References

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Radnor ZJ, Holweg M, Waring J. Lean in healthcare: The unfilled promise? Social Science & Medicine 2012;74(3):364-371. https://doi.org/10.1016/j.socscimed.2011.02.011DOI ↗Google Scholar ↗
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http://www.isixsigma.com/methodology/Leanmethodology/why-Lean-manufacturing-failsGoogle Scholar ↗
Tavakol M, Dennick R. Making Sense of Cronbach’s Alpha. International Journal of Medical Education 2011;2:53-55. https://doi.org/10.5116/ijme.4dfb.8dfdDOI ↗Google Scholar ↗
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Van Rossum L, Aij KH, Simons FE, van der Eng N, ten Have WD. Lean healthcare from a change management perspective: The role of leadership and workforce flexibility in an operating theatre. Journal of Health Organization and Management 2016;30(3):475-493. https://doi.org/10.1108/JHOM-06-2014-0090DOI ↗Google Scholar ↗
De Souza LB, Pidd M. Exploring the barriers to Lean health care implementation. Public Money & Management 2011;31(1):59-66. https://doi.org/10.1080/09540962.2011.545548DOI ↗Google Scholar ↗
Waring JJ, Bishop S. Lean healthcare: Rhetoric, ritual and resistance. Social Science and Medicine 2010;71(7):1332-1340. https://doi.org/10.1016/j.socscimed.2010.06.028DOI ↗Google Scholar ↗
Papadopoulos T, Radnor Z, Merali Y. The role of actor associations in understanding the implementation of Lean thinking in healthcare, International Journal of Operations & Production Management 2011;31(2):167-191. https://doi.org/10.1108/01443571111104755DOI ↗Google Scholar ↗
Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM. Quality and Lean health care: a system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence 2011;22(6):673–689. https://doi.org/10.1080/14783363.2011.580651DOI ↗Google Scholar ↗
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[refR-2] Al‐Balushi S, Sohal AS, Singh PH, Al Hajri A, Al Farsi YM, Al Abri R. Readiness factors for Lean implementation in healthcare settings – a literature review. Journal of Health Organisation and Management 2014;28(2):135-153. https://doi.org/10.1108/JHOM-04-2013-0083DOI ↗Google Scholar ↗

[refR-3] Noori B. The critical success factors for successful Lean implementation in hospitals. International Journal of Productivity and Quality Management 2015;15(1):108-126. https://doi.org/10.1504/IJPQM.2015.065987DOI ↗Google Scholar ↗

[refR-4] Radnor Z. Implementing Lean in health care: making the link between the approach, readiness, and sustainability. International Journal of Industrial Engineering and Management 2011;2(1):1-12. https://www.ftn.uns.ac.rs/ijiemGoogle Scholar ↗

[refR-5] Radnor ZJ, Holweg M, Waring J. Lean in healthcare: The unfilled promise? Social Science & Medicine 2012;74(3):364-371. https://doi.org/10.1016/j.socscimed.2011.02.011DOI ↗Google Scholar ↗

[refR-6] Womack JP, Jones DT. Lean thinking: Banish waste and create wealth in your corporation. Journal of the Operational Research Society 1997;48(11):1148 https://doi.org/10.1057/palgrave.jors.2600967DOI ↗Google Scholar ↗

[refR-7] Antony J, Sunder MV, Sreedharan R, Chakraborty A, Gunasekaran A. A systematic review of Lean in healthcare: a global prospective. International Journal of Quality & Reliability Management 2019;36(8):1370-1391. https://doi.org/10.1108/IJQRM-12-2018-0346DOI ↗Google Scholar ↗

[refR-8] Thelen M. Why Lean manufacturing fails. 2014Google Scholar ↗

[refR-9] http://www.isixsigma.com/methodology/Leanmethodology/why-Lean-manufacturing-failsGoogle Scholar ↗

[refR-10] Tavakol M, Dennick R. Making Sense of Cronbach’s Alpha. International Journal of Medical Education 2011;2:53-55. https://doi.org/10.5116/ijme.4dfb.8dfdDOI ↗Google Scholar ↗

[refR-11] Kobus J, Westner M. Ranking-type Delphi studies in IS research: Step-by-step guide and analytical extension. Paper presented at the IADIS international conference in information systems 2016 Portugal: Vilamoura, Algarve.Google Scholar ↗

[refR-12] Habidin NF, Shazali NA, Ali N, Khaidir NA, Jamaludin NH. Exploring Lean healthcare practice and supply chain innovation for Malaysian healthcare industry. International Journal of Business Excellence 2014;7(3):394-410. https://doi.org/10.1504/IJBEX.2014.060782DOI ↗Google Scholar ↗

[refR-13] Eller A. Rapid Assessment and Disposition: Applying LEAN in the Emergency Department. Journal for Healthcare Quality 2009;31(3):17-22. https://doi.org/10.1111/j.1945-1474.2009.00026.xDOI ↗Google Scholar ↗

[refR-14] Tortorella G, van Dun DH, de Almeida AG. Leadership behaviors during Lean healthcare implementation: a review and longitudinal study. Journal of Manufacturing Technology Management 2019;31(1):193-215. https://doi.org/10.1108/JMTM-02-2019-0070DOI ↗Google Scholar ↗

[refR-15] Alnajem M, Garza-Reyes JA, Antony J. Lean readiness within emergency departments: a conceptual framework. Benchmarking: An International Journal 2019;26(6):1874-1904 https://doi.org/10.1108/BIJ-10-2018-0337DOI ↗Google Scholar ↗

[refR-16] Abdallah AB, Alkhaldi RZ. Lean bundles in health care: a scoping review. Journal of Health Organization and Management 2019;33(4):488-510. https://doi.org/10.1108/JHOM-09-2018-0263DOI ↗Google Scholar ↗

[refR-17] Jimmerson C, Weber D, Sobek D. Reducing Waste and Errors: Piloting Lean Principles at Intermountain Healthcare. The Joint Commission Journal on Quality and Patient Safety 2005;31(5):249-257.Google Scholar ↗

[refR-18] https://doi.org/10.1016/S1553-7250(05)31032-4DOI ↗Google Scholar ↗

[refR-19] Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of Lean Manufacturing Techniques in the Emergency Department. Journal of Emergency Medicine 2009;37(2):177-182. https://doi.org/10.1016/j.jemermed.2007.11.108DOI ↗Google Scholar ↗

[refR-20] Rees GH. Organisational readiness and Lean Thinking implementation: Findings from three emergency department case studies in New Zealand. Health Services Management Research 2014;27(1-2):1-9. https://doi.org/10.1177/0951484814532624DOI ↗Google Scholar ↗

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[refR-22] De Souza LB, Pidd M. Exploring the barriers to Lean health care implementation. Public Money & Management 2011;31(1):59-66. https://doi.org/10.1080/09540962.2011.545548DOI ↗Google Scholar ↗

[refR-23] Waring JJ, Bishop S. Lean healthcare: Rhetoric, ritual and resistance. Social Science and Medicine 2010;71(7):1332-1340. https://doi.org/10.1016/j.socscimed.2010.06.028DOI ↗Google Scholar ↗

[refR-24] Papadopoulos T, Radnor Z, Merali Y. The role of actor associations in understanding the implementation of Lean thinking in healthcare, International Journal of Operations & Production Management 2011;31(2):167-191. https://doi.org/10.1108/01443571111104755DOI ↗Google Scholar ↗

[refR-25] Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM. Quality and Lean health care: a system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence 2011;22(6):673–689. https://doi.org/10.1080/14783363.2011.580651DOI ↗Google Scholar ↗

[refR-26] Spagnol GS, Min LL, Newbold D. Lean principles in Healthcare: an overview of challenges and improvements. IFAC Proceedings 2013;46(24):229-234. https://doi.org/10.3182/20130911-3-BR-3021.00035DOI ↗Google Scholar ↗

[refR-27] Narayanamurthy G, Gurumurthy A, Subramanian N, Moser, R. Assessing the readiness to implement Lean in healthcare institutions – A case study. International Journal of Production Economics 2018;197:123-142. https://doi.org/10.1016/j.ijpe.2017.12.028DOI ↗Google Scholar ↗

[refR-28] Kollberg B, Dahlgaard JJ, Brehmer P. Measuring lean initiatives in health care services: issues and findings. International Journal of Productivity and Performance Management 2007;56(1):7-24. https://doi.org/10.1108/17410400710717064DOI ↗Google Scholar ↗

[refR-29] Almutairi AM, Salonitis K, Al-Ashaab A. Assessing the leanness of a supply chain using multi-grade fuzzy logic: a health-care case study. International Journal of Lean Six Sigma 2019;10(1):81-105. https://doi.org/10.1108/IJLSS-03-2018-0027DOI ↗Google Scholar ↗

[refR-30] Fillingham D. Can lean save lives? Leadership in Health Services 2007;20(4):231-241. https://doi.org/10.1108/17511870710829346DOI ↗Google Scholar ↗