Lean practices for quality results: a case illustration

Lean and its impact on sustainability performance in service companies: results from a pilot study

Purpose

The purpose of this empirical research is to understand the application of Lean practices (technical and social) and tools in the service sector, whose implementation is less studied, despite its economic relevance. The study aims to extend previous studies that focused on the relationship between Lean and operational and financial performance, and analyzing the impact on sustainability, encompassing economic, social and environmental perspectives.

Design/methodology/approach

A pilot survey was conducted with Lean experts in European service companies. The authors have utilized various professional contacts on LinkedIn and a satisfactory response rate was obtained for analysis.

Findings

The results of the study showed that there are several motivating factors for the implementation of Lean, the highlights being improving customer satisfaction, efficiency, delivery and cost reduction. The most frequently used Lean tools are related to the identification of improvement opportunities and causes of problems. The pilot survey also made it possible to identify the greater use of technical practices than social practices. The sustainability performance analysis showed that the better performance of service companies is in the economic dimension.

Originality/value

The authors have identified no empirical studies linking Lean and sustainable performance in the service sector. This study bridges this cognitive gap through a pilot study and therefore makes an original contribution to the current literature.

An evaluation of Lean and Six Sigma methodologies in the national health service

Purpose

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

Design/methodology/approach

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Findings

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

Originality/value

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

Construction of nursing knowledge in commodified contexts: A discussion paper

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.

Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care

Background

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4502-6) contains supplementary material, which is available to authorized users.

Lean and Green: practices, paradigms and future prospects

Purpose

The purpose of this paper is to present an overview of the conceptual framework related to the Lean and Green practices, paradigms, future prospects and problems, indicating points of convergence and divergence between them.

Design/methodology/approach

Based on this premise, through vast literature systematization, the authors sought to categorize studies in order to consolidate constructs, reinforcing aspects regarding the positive and negative approaches and pointing out the gaps in the current state of the art. Broad literature systematization was carried out; the authors found 107 articles published between 2014 and 2018, separated into 10 categories.

Findings

The main constructs confirmed are the positive approximation of the Lean and Green union, evidenced by studies premised on the independent variable category demonstrating that their union influences other environmental performance variables.

Research limitations/implications

The present research is a systematization of the literature, so its results have to be confirmed by other studies.

Practical implications

The study supports the Lean and Green theme, confirming converging issues between the two areas and launching new topics for future research.

Social implications

The study contributed to the environmental theme by confirming synergies of the Lean and Green union and presenting new research themes.

Originality/value

To assert that Lean and Green systems union is sustainable, with regard to the tripod of sustainability, more studies on the social category are necessary.

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.

Features and Results of Conducted Studies Using a Lean Management Approach in Emergency Department in Hospital: A Systematic Review

Objective:

To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance.

Method:

The necessary information in the first stage was collected by searching these keywords: "Lean principles" “Lean Six Sigma", "Lean Process", “Lean thinking”, “Lean Methodology”, “Toyota Production System lean processing”, "lean techniques", "emergency department”, “emergency medicine”, “emergency room” and “emergency care ” . And in the next stage the keywords such as “lean management” and “emergency” was collected from SID, Medlib, IranDoc, Google Scholar, MagIran, IranMedex data bases. For extracting the data data-extracting forms was prepared. The information we got from the forms was organized in information-extracting forms and was analyzed manually. The diagrams were drawn in Excel: 2010.

Results:

Finally, 26 essays have been included. Most of the studies were accomplished in Canada and U.S.A. only in one of the cases, the authors used the control group. Each of these terms, “lean techniques” and “lean principals”, with five times repetitions had the highest frequency. The most important team of implementation of lean management included: hospital management team or the manager of Emergency department, physicians, nurses, staffs and external counselors. Generally, 51 indicators were studied which among them the length of stay and the timing had the most frequency. After implementation of lean management, almost all studied indicators have significantly improved. 14 barriers, 14 facilitators and 10 effective factors were recognized in implementing the lean management.

Conclusion:

According to the studies, responsibility of organization’s senior management and his/her supports; increasing the knowledge of the characteristics and dimension of lean among the providers of health service; and decreasing the resistance and consulting with external counselors can have great effect on the success of lean management.

Lean maturity and quality in primary care

PURPOSE

The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker's description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

DESIGN/METHODOLOGY/APPROACH

Data were collected using a survey based on Liker's four principles, divided into 16 items ( n=298 staff in 45 units). Complementary observations ( n=28 staff) were carried out at four units.

FINDINGS

Lean maturity varied both between and within units. The highest Lean maturity was found for "adhering to routines" and the lowest for "having a change agent at the unit." Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.

PRACTICAL IMPLICATIONS

Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker's principles and using the results as guidance for further development.

ORIGINALITY/VALUE

This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker's principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

Lean Perspectives: A Case for Implementing Parent-Child Relational Problem Screening

The purpose of the current study was to make a case for instituting parent-child relational problem (PCRP) screening as a standard of care in pediatric inpatient psychiatric units due to increasing evidence that PCRP may be an underreported problem that affects more adolescents than currently realized. Adolescents who are admitted to the hospital for mood exacerbation, suicidal ideation, self-harm behavior, or behavioral escalation may improve and be discharged. However, these adolescents often are readmitted, which may be associated with parent-child relational factors. By identifying adolescents with PCRP and initiating holistic therapy/intervention that addresses the underlying cause of their PCRP, it may be possible to improve the parent-adolescent relationship and break the cycle of admission, discharge, and readmission. PCRP is increasingly recognized as a risk factor for development and progression of childhood mental illnesses. Investment in screening and treatment for PCRP may result in significant cost savings from prevention or reduction of rehospitalization and/or amelioration of disability. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 27-32.].

SUCCESSFUL IMPLEMENTATION OF LEAN AS A MANAGERIAL PRINCIPLE IN HEALTH CARE: A CONCEPTUAL ANALYSIS FROM SYSTEMATIC LITERATURE REVIEW

PURPOSE

The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare.

DESIGN

A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period.

FINDINGS

Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities.

PRACTICAL IMPLICATIONS

A conceptual analysis of systematically reviewed studies of Lean leadership and management point to certain traits as being typical when adapting Lean thinking to health care. The concept of a managerial windshield is useful when categorizing and analyzing essential managerial skills and capabilities for Lean implementation. Findings are beneficial when learning and educating the skills required for Lean transformation in healthcare organizations.

Hospital-supplier integration and hospital performance: evidence from Saudi Arabia

Purpose

The purpose of this paper is to develop a comprehensive conceptual model for the impact of hospital-supplier integration on the overall performance of healthcare organisations. It also investigates the moderating role of lean practices between hospital-supplier integration and hospital performance.

Design/methodology/approach

Data were collected from 498 public and private hospitals in Saudi Arabia using a survey. Structural equation modelling was used for data analysis.

Findings

The results indicate that hospital-supplier integration has a positive impact on the hospital performance. These effects are even more notable when adopting lean practices in the hospitals.

Research limitations/implications

The data were collected from one developing country, namely Saudi Arabia. Thus, the findings may be relevant to the Saudi context but not those of other developing countries. Second, the data were collected from the hospitals’ end but not from the suppliers, so the latter’s perspectives on the themes covered here are not known. Future research may investigate the validity of the model in various developing countries whose healthcare systems have different characteristics, and the relationships between hospitals and their suppliers may follow different governance models.

Practical implications

The developed model and results will help hospitals in the Saudi health system to make better decisions on managing their logistics and supply partners.

Originality/value

This study extends the current research by developing a model that highlights the impact of hospital-supplier integration on the overall performance of healthcare organisations and tests this model to confirm its validity. To the authors’ knowledge, this study would be one of the first that uses both lean thinking and relational view of competitive advantage theory combined to examine the moderating role of lean practices on the inter-organisational relationships in Saudi Arabia.

How much of Toyota's philosophy is embedded in health care at the organisational level? A review

AIMS

Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies.

BACKGROUND

No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care.

EVALUATION

Sixty studies were identified for the final analysis.

KEY ISSUE(S)

Some Toyota Way principles appear more deeply embedded in health care institutions than others are.

CONCLUSION

Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse.

IMPLICATIONS FOR NURSING MANAGEMENT

This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level.

Budget impact analysis of a breast rapid diagnostic unit

BACKGROUND

The Odette Cancer Centre's recent implementation of a rapid diagnostic unit (rdu) for breast lesions has significantly decreased wait times to diagnosis. However, the economic impact of the unit remains unknown. This project defined the development and implementation costs and the operational costs of a breast rdu in a tertiary care facility.

METHODS

From an institutional perspective, a budget impact analysis identified the direct costs associated with the breast rdu. A base-case model was also used to calculate the cost per patient to achieve a diagnosis. Sensitivity analyses computed costs based on variations in key components. Costs are adjusted to 2015 valuations using health care-specific consumer price indices and are reported in Canadian dollars.

RESULTS

Initiation cost for the rdu was $366,243. The annual operational cost for support staff was $111,803. The average per-patient clinical cost for achieving a diagnosis was $770. Sensitivity analyses revealed that, if running at maximal institutional capacity, the total annual clinical cost for achieving a diagnosis could range between $136,080 and $702,675.

CONCLUSIONS

Establishment and maintenance of a breast rdu requires significant investment to achieve reductions in time to diagnosis. Expenditures ought to be interpreted in the context of institutional patient volumes and trade-offs in patient-centred outcomes, including lessened patient anxiety and possibly shorter times to definitive treatment. Our study can be used as a resource-planning tool for future rdus in health care systems wishing to improve diagnostic efficiency.

Quality improvement in physiotherapy services

Purpose The purpose of this paper is to evaluate a process change in physiotherapy services and to explore factors that may have influenced the outcomes. Design/methodology/approach This is a multiple case study and information was gathered from eight physiotherapy teams over 24 months. Findings The process change was successfully implemented in six teams. It had a clear, positive effect on service quality provided to patients in three teams. Whilst quality also improved in three other teams, other issues make changes difficult to assess. Factors that enabled process change to be effective are suggested. Research limitations/implications The findings are based on results achieved by only eight English teams. Practical implications This process change may be appropriate for other teams providing therapy services if attention is paid to potential enabling factors, and a learning approach is adopted to designing and introducing the change. Originality/value To the best of the authors' knowledge, no other longitudinal process change study in therapy services has been published.

Prioritizing lean practices for implementation in IT support services

Purpose

– The purpose of this study is to capture the perception of the IT support service practitioners regarding the applicability of the lean practices and prioritize them after analyzing the gaps with respect to current usage and importance from practitioners’ perspective.

Design/methodology/approach

– It involved development of an instrument to capture the perceptions of the IT support service practitioners. The data collected was quantitatively analyzed by using statistical techniques and it involved testing of the hypotheses.

Findings

– The study conducted a gap analysis on the perceived current usage of the lean practices versus the perceived ideal usages of the lean practices from practitioners’ perspective. The gap analysis report revealed that gaps of all practices are not same from the practitioners’ viewpoint. This gap analysis was useful for prioritizing of the practices and resource allocation.

Originality/value

– This study was conducted in a relatively new domain, where mature empirically based studies are scarce. This study set out to determine the practitioners’ perception of the applicability of lean practices in IT support service organizations. It provides a sound basis for further research on lean implementation in IT support service area.