Continuous improvement and dynamic actor associations

The influence of soft and hard TQM on quality performance and patient satisfaction in health care: investigating direct and indirect effects

PURPOSE

The present study conceptualizes total quality management (TQM) in terms of soft and hard aspects and examines their effects on quality performance and patient satisfaction. The indirect effects of soft and hard TQM on patient satisfaction through quality performance are also investigated.

DESIGN/METHODOLOGY/APPROACH

A multi-item questionnaire was prepared to gather primary data from a sample of 312 medical employees in private hospitals in Jordan. The measurement model was evaluated for validity and reliability and determined to be acceptable. Structural equation modeling (SEM) was applied to test the research hypotheses.

FINDINGS

The results revealed that soft TQM has a strong positive effect on quality performance and patient satisfaction. Hard TQM was found to positively affect quality performance but to a lesser extent compared to soft TQM. The effect of hard TQM on patient satisfaction, meanwhile, was not significant. Quality performance positively mediated the relationship between TQM - both soft and hard - and patient satisfaction.

ORIGINALITY/VALUE

This study is one of the first to conceptualize TQM in terms of soft and hard aspects in a health care context. It offers valuable insights for managers of private hospitals looking to enhance quality performance and patient satisfaction. The results reveal that soft TQM is the primary driver of quality performance and patient satisfaction in the health care context, which is in stark contrast to the manufacturing sector.

Comparative analysis of ranking the lean supply chain enablers: An AHP, BWM and fuzzy SWARA based approach

Purpose

In the recent scenario, there has been an increasing trend toward lean practices and implementation in production systems for the improvement of an organization’s performance as its basic nature is to eliminate the wastes. The increasing interest of customers in customized products and the fulfillment of customers’ demand with good productivity and efficiency within time are the challenges for the manufacturing organization; that is why adopting lean manufacturing concept is very crucial in the current scenario.

Design/methodology/approach

In this paper, the authors considered three different methodologies for fulfilling the objective of our research. The analytical hierarchy process, best–worst method and fuzzy step-wise weight assessment ratio analysis are the three methods employed for weighting all the enablers and finding the priority among them and their final rankings.

Findings

Further, the best results among these methodologies could be used to analyze their interrelationships for successful lean supply chain management implementation in an organization. In this paper, 35 key enablers were identified after the rigorous analysis of literature review and the opinion of a group of experts consisting of academicians, practitioners and consultants. Thereafter, the brainstorming sessions were conducted to finalize 28 lean supply chain enablers (LSCEs).

Practical implications

For lean manufacturing practitioners, the result of this study can be beneficial where the manufacturer is required to increase efficiency and reduce cost and wastage of resources in the lean manufacturing process.

Originality/value

This paper is the first of the research papers that considered deep literature review of identified LSCEs as the initial step, followed by finding the best priority weightage and developing the ranking of various lean enablers of supply chain with the help of various methodologies.

Healthcare Engineering: A Lean Management Approach

This work tries to answer the following question: can healthcare be engineered using lean management tools? Lean is known to achieve successful results when implemented in the manufacturing sector. Typical results are operational cost reduction, cycle time reduction, and higher customer satisfaction. The service sector, however, has seen mixed results. For the last two decades, educators and healthcare professionals are trying to implement lean tools in healthcare. Some reported success and many did not, for variety of reasons. In this paper, we search the literature and reveal the special nature of healthcare services, success factors, and barriers facing implementation of lean in healthcare. We then conduct a survey of 18 elite Jordanian hospitals to study the case holistically. Statistical analysis of the survey results confirmed some of what the literature revealed; organizational leadership seems to be the most dominant factor, followed by knowledge of employees about lean, training, and patient satisfaction (customer focus). Another important finding, not captured by the literature, is that lean implementation success depends on educating physicians about continuous improvement and lean and ensuring they are part of the improvement team. Based on the revealed enablers and obstacles, we created a full lean implementation framework. This framework was then used along with selected engineering tools to implement lean in a major hospital successfully. Implementation results showed 60% of reduction in cycle time, 80% reduction in operational cost, and many other benefits.

Social and ecological approaches in urban interfaces: A sharing economy management framework

Urban interfaces have undergone changes due to the population growth and business models brought about by the sharing economy. The sharing economy benefits many sectors of society. Sustainable practices, servitisation, and disruptive technologies work together with the sharing economy to improve the sustainable value chains. This research study proposes a sharing economy management framework with social and ecological approaches in urban interfaces. The literature review was developed between October 24th, 2018 and March 19th, 2019. The first stage of the search was based on the terms "share OR sharing" and "sustainability OR sustainable." In the second stage, the search was based on the terms "share OR sharing" AND "sustainability OR sustainable." Based on the literature review, the authors created seven sustainable sharing factors: landscape, mobility, knowledge, production and consumption, sustainable practices, digital, and geographical which are the foundations of the management framework. The connections between these sustainable sharing factors can help to create sustainable value chains. The authors conclude that this connection is based on the need for digital insertion and disruptive technologies, enabling the sharing of knowledge and the support of new transportation models. Sustainable practices also enhance this connection, encouraging responsible production and consumption together with other factors. This transformation impacts the variables of the landscape factor. The management framework presents the analysis of the sustainable sharing factors and the social and ecological approaches in the urban interfaces.

IT’S MINE, I DECIDE WHAT TO CHANGE: THE ROLE OF PSYCHOLOGICAL OWNERSHIP IN EMPLOYEES’ PROCESS INNOVATION BEHAVIOUR

Employees play a major role in enabling organizations to innovate their processes. While conditions for participation have to be established, barriers have to be lowered and trainings take place, the motives of employees to participate in incremental and discontinuous process innovation are not well understood. One important soft factor not addressed yet sufficiently is psychological ownership of non-managerial employees that can contribute to increase process innovation activities. We apply a multi-time survey design gathering quantitative data which is analysed with structured equation modelling. The findings suggest that psychological ownership is important in fostering innovation behaviour with incremental innovation behaviour being an important mediator for the effect on radical innovation behaviour. We show how psychological ownership is useful in fostering process innovation behaviour with data from the financial services sector. Organisations should invest in establishing psychological ownership on the level of operations to increase process innovation.

Assessing the state of lean and six sigma practices in healthcare in Mexico

PURPOSE

The purpose of this study is to assess the state at which lean and six sigma (LSS) are used as a management system to improve the national health system national health system of Mexico.

DESIGN/METHODOLOGY/APPROACH

Cross-sectional survey-research. The survey was administered at 30 different hospitals across six states in Mexico. These were selected using convenience sampling and participants (N = 258) were selected through random/snowball sampling procedures, including from top managers down to front-line staff.

FINDINGS

Only 16 per cent of respondents reported participation in LSS projects. Still, these implementations are limited to using isolated tools, mainly 5s, failure mode and effects analysis (FMEA) and Fishbone diagram, with the lack of training/knowledge and financial resources as the top disabling factors. Overall, LSS has not become systematic in daily management and operations.

RESEARCH LIMITATIONS/IMPLICATIONS

The sampling procedure was by convenience; however, every attempt was made to ensure a lack of bias in the individual responses. If still there was a bias, it is conjectured that this would likely be in overestimating the penetration of LSS.

PRACTICAL IMPLICATIONS

The penetration of LSS management practices into the Mexican health system is in its infancy, and the sustainability of current projects is jeopardized given the lack of systematic integration. Hence, LSS should be better spread and communicated across healthcare organizations in Mexico.

ORIGINALITY/VALUE

This is the first research work that evaluates the use of LSS management practices in a Latin American country, and the first journal paper that focuses on LSS in healthcare in Mexico.

Lean bundles in health care: a scoping review

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.

Lean implementation in healthcare supply chain: a scoping review

Purpose

The purpose of this paper is to identify the lean production (LP) practices applied in healthcare supply chain and the existing barriers related to their implementation.

Design/methodology/approach

To achieve that, a scoping review was carried out in order to consolidate the main practices and barriers, and also to evidence research gaps and directions according to different theoretical lenses.

Findings

The findings show that there is a consensus on the potential of LP practices implementation in healthcare supply chain, but most studies still report such implementation restricted to specific unit or value stream within a hospital.

Originality/value

Healthcare organizations are under constant pressure to reduce costs and wastes, while improving services and patient safety. Further, its supply chain usually presents great opportunities for improvement, both in terms of cost reduction and quality of care increase. In this sense, the adaptation of LP practices and principles has been widely accepted in healthcare. However, studies show that most implementations fall far short from their goals because they are done in a fragmented way, and not from a system-wide perspective.

TQM and lean strategy deployment in Italian hospitals

Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM-Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals. Findings Results from the interviews show that there is a specific deployment path for TQM-Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers' commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits. Research limitations/implications The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry. Practical implications Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals. Originality/value The results of this research show that there is a specific, new deployment path for implementing TQM-Lean strategy in some public hospitals.

V. Lean services: a systematic review

Purpose

The purpose of this paper is to highlight the importance of Lean methodology through an exhaustive literature review, and its implications and application in the service industry right from its initiation in 1990s till date.

Design/methodology/approach

The paper summarises the evolution of Lean in services and has systematically classified the reviewed literature in four dimensions, namely time, publisher, region and content. Further under “time” dimension, the literature is classified into Pre-Lean era, Lean awareness era, Lean Exploration era and Lean implementation era. Under the “content” dimension, the categories include theoretical foundation, frameworks/models and application/case studies.

Findings

The analysis inferred; Lean is gaining roads in services, though the research is still at nascent stage. Lean is applicable in services though transfer of Lean manufacturing principles to services has certain limitations because of the characteristics of services. The need is to focus on process difference between services and manufacturing. Respect for people and employment engagement is critical to Lean in service. The authors identified the necessity to standardise the Lean service definition, principles, and tools and to develop guidelines for structured implementation in service industry.

Research limitations/implications

Though multiple databases have been taken-up but that does not assume that the literature presented in this paper is by any means comprehensive. Development of a standard model/framework for Lean services is critical for future research. Rigorous industry-specific studies, specifically in developing nations are another area for future research. Future studies could analyse the impact of join applications and possible links between Lean service and other approaches like TQM, Six Sigma, etc., with an aim of process improvement.

Practical implications

This paper would serve as a resource for Lean practitioners as well as researchers as a fundamental platform, contributing to Lean body of knowledge.

Social implications

Service industry has special significance to the society in large. Many services including governments, public interest services, non-profit organisations, healthcare, banking, consulting, etc., has a significant share across markets. Lean being a proven methodology for successful process improvements has to be looked at from a services perspective. This paper helps in such interest.

Originality/value

Publications reviewing the adoption of Lean in services is scarce in literature. This paper serves as an excellent resource for research on the subject and will facilitate academicians and practitioners to objectively understand Lean in service sector.

LEAN HEALTHCARE: UNA REVISIÓN BIBLIOGRÁFICA Y FUTURAS LÍNEAS DE INVESTIGACIÓN

La filosofía Lean a través del tiempo ha evolucionado y ha sido implementada en varios tipos de empresas tanto en el sector manufacturero como en el de los servicios, lo cual se evidencia en el gran número de estudios que investigan sobre la implementación de lean en dichos sectores. El propósito de este estudio es analizar las tendencias de las publicaciones, identificar los autores más influyentes y describir las futuras investigaciones en la aplicación de Lean en el sector salud. En esta investigación se presentan los resultados de un análisis bibliométrico realizadas a las publicaciones científicas acerca de la filosofía Lean Healthcare durante el periodo 1990-2015, en la base de datos: Isi Web of Knowladge, Scopus y PubMed. Los resultados de esta investigación contribuyen a identificar tópicos emergentes y ser un marco de referencia para futuras investigaciones en este tema de investigación.

Health LEADS Australia and implications for medical leadership

Purpose

– The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services.

Design/methodology/approach

– The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated.

Findings

– For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable.

Originality/value

– This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.