Knowledge and Experience of Lean Thinking Amongst Senior Health Care Managers in Selected South African Public Hospitals (original) (raw)
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Lean SPRInT: A management tool for initiating Lean in public hospitals in KwaZulu-Natal
Journal of Contemporary Management, 2019
South African public hospitals are beset with barriers to the realisation of strategic health outcomes owing to operational inefficiency. The Lean SPRInT aids managers with Lean implementation by assessing their hospitals' readiness status for Lean to improve operational efficiency. An observational descriptive study employing quantitative methods was conducted across 73 public hospitals in KwaZulu-Natal (KZN). Simple random sampling was used to attain a minimum sample size of 218 senior managers who completed semi-structured questionnaires. Exploratory Factor Analysis was used to identify latent constructs. Confirmatory Factor Analysis was used to determine the reliability and validity of factors. Structural Equation Modelling assessed the acceptability of the model. The participant response rate was 96.8% (n=211). Three Critical Success Factors (strategic leadership and organisational attitude; integration of Lean elements, tools and techniques; and basic stability in operational processes), from which the electronic Lean SPRInT was developed, were derived after several iterations of Exploratory Factor Analysis (EFA). All reliability and validity conditions have been met, thus rendering the model reliable and valid Lean SPRInT is a management tool for assessing hospitals' readiness status for Lean. A six-step process for the deployment of Lean SPRInT is proposed. A phasic approach for Lean implementation, together with close monitoring using the HLA tool is recommended. Unified efforts and decentralised decision-making are more likely to lead to effective implementation.
Human Resources for Health, 2019
Background: Lean thinking is one of several operations-management techniques which have yet to be fully embraced in the South African health care sector. In most health care managers' service delivery mandates, what needs to be done might be known, but it is how it should be done which might be alien to most managers. In order to recognise the "how", one needs to know the critical success factors for Lean initiation. Methods: The research took the form of an observational descriptive study with quantitative methods. The objectives were to identify the key variables for the successful initiation of Lean and then to conduct factor analysis and structural equation modelling (SEM) on these variables leading to the identification of critical success factors (CSFs) for Lean initiation. Simple random sampling was applied to select the participants from various categories of 500 senior managers across 73 KwaZulu-Natal (KZN) public hospitals. The sample size was 218, with a response rate of 96.8% (n = 211). For the purpose of identifying key variables for the successful initiation of Lean and then of conducting factor analysis and SEM on these variables, a self-administered, structured questionnaire was used. Data were reduced using exploratory factor analysis (EFA) to identify latent constructs. Confirmatory factor analysis (CFA) was used to determine the reliability and validity of these factors. Structural equation modelling (SEM) fit indices were then applied to assess acceptability of the measurement model. Results: Certain variables were eliminated during EFA if they cross-loaded onto more than one factor, since this caused discriminant validity problems. In addition, if variables loaded weakly onto a factor, they were not retained. Three critical success factors (CSFs) were identified in this study: strategic leadership and organisational attitude; integration of Lean elements, tools, and techniques; and basic stability in operational processes. All reliability and validity conditions have been met (RMSEA = 0.085; CFI = 0.956 and χ 2 /df = 2.513), consequently rendering the model reliable and valid. Conclusion: None of the three CSFs can be viewed in isolation, as they all have significance at different dimensions of capability within the organisation. The use of these CSFs and the context, content, application, and outcome of Lean should be viewed in light of the organisation's strategic, technical, structural, and cultural environment. Further research in the effectiveness of these CSFs for the rollout of Lean in South African hospitals would be of benefit to the Lean body of knowledge.
Mitigating the Sustainability Challenge in Lean Healthcare
2023
Although the Lean Management System has helped healthcare facilities improve their bottom-line performance, many remain transitional and have not yet fully transformed into Lean organisations. In order to provide workable ways to counteract these typical trends, this mixed method study investigates the sustainability challenges undermining Lean healthcare to decipher what is restraining South African healthcare institutions from fostering, sustaining and spreading Lean. The study involved a survey of 620 clinicians and 20 key informant interviews-with Lean champions, clinical operations managers and Lean experts involved in Lean initiation in South African hospitals. As indicated in the quantitative findings, the participants' rating of significant obstacles to healthcare quality improvement shows that resource and budget constraints and supply chain inefficiencies are the most predominant challenges. Further, healthcare institutions' management must adopt a strategic approach to Lean; the challenges of leadership style and commitment, staff shortages, information technology resources, and supply chain inefficiencies must be mitigated to make Lean sustainable. The study offers practical solutions to improve the traditional trends.
Factors Affecting the Sustainability of Lean in Healthcare: A Systematic Literature Review
South African Journal of Industrial Engineering
The application of Lean in healthcare has been steadily climbing since 2000. However, Lean implementation in healthcare environments has experienced high failure rates that could be attributed to a lack of sustainable implementation. A knowledge gap has therefore been identified, in both practice and research, to understand the reason for failure and the impact of Lean sustainability on Lean success. The aim of the main study is to explore the factors that affect the sustainability of Lean healthcare in South African hospitals. This paper reports on the first part of the study, a systematic literature review (SLR) that identifies the factors that affect the sustainability of Lean healthcare in hospitals. Through the SLR, 50 factors affecting Lean sustainability in hospitals were identified and grouped into 12 themes. These themes were then tested against Lean principles. The results showed that the adaptation of Lean so that it makes sense to healthcare staff and is compatible with ...
Lean-Thinking: Implementation and Measurement in Healthcare Settings
Engineering Management Journal, 2019
Despite positive reports about lean approaches to spearhead quality and patient safety improvement efforts, it is still difficult to determine if healthcare employees have transformed into effective lean thinkers. Lean thinking refers to individuals who operate with thoughtful reflection on organizational issues, are committed to continuous improvement efforts, and demonstrate the willingness to lead change. The objective of this theory building research is to contribute a survey instrument and conceptual model to measure individual transformation to lean thinking. Our learnings from the case study suggest that healthcare a professional's transition to lean thinking via a complex combination of awareness issues at both the unit and individual levels, and both levels should be considered when moving individuals toward readiness and through a personal transformation to lean thinking.
BMJ open, 2013
To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Semistructured, indepth interviews. One of largest teaching hospitals in the Netherlands. 31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to pos...
BMJ Open, 2014
Objective: Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute.
Journal of Health Organization and Management, 2021
PurposeThe 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/approachA 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.FindingsThe 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 impleme...
Application of lean thinking to health care: Issues and observations
International Journal for Quality in Health Care, 2009
Background. Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care.
Lean management in the health sector – illusion or delusion ?
2014
There has been considerable interest in implementing practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach attracting particular interest is Lean management, which is explored in this article. Design/methodology/approach: The exploratory research focuses on Lean management in the health sector. It is based on extensive secondary data and it is a practical in implication. Data provided both background and context. Findings: Despite widespread enthusiasm about Lean management's potential, evidence about its contribution to higher performance is inconsistent. Research limitations/implications: Major Lean operations management and human resource management concepts, including just-in-time (JIT), total quality management (TQM) and total productive maintenance (TPM) are explored. Practical implications: This article contributes to the healthcare organizational management literature by showing that although Lean management seems to have the potential to improve organizational performance; it is far from a panacea for underperforming hospitals. The article informs policy-making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than adopting practices from any particular managerial approach. Originality/value: A critical evaluation on Lean's impact on informing healthcare policy is presented, which contributes to healthcare organisational management literature by showing that even though Lean management in healthcare appears to have the potential to improve performance; there remain problems with its application.