Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems

Associations Between Lean IT Management and Financial Performance in US Hospitals

BACKGROUND AND OBJECTIVES

To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.

METHODS

Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance.

RESULTS

Controlling for other factors, adoption of Lean IT management was associated with lower length of stay (b = -0.098, P = .018) and inpatient expense per discharge (b = -0.112, P = .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge (b = -0.176, P = .034) and higher earnings before interest, taxes, depreciation, and amortization margin (b = 0.124, P = .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P = .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis (b = 0.188, P = .031).

CONCLUSIONS

Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes.

Impact of lean principles on operational performance in high uncertainty

Purpose

The purpose of this research is to study the impact of perceived adoption of Lean principles on operational performance in Lebanese pharmaceutical industries.

Design/methodology/approach

A quantitative method was implemented using a questionnaire that targeted 253 respondents working in eight good manufacturing practices (GMP) certified Lebanese pharmaceutical companies. Reliability analysis was performed using SPSS, and the research hypotheses were tested using regression analysis.

Findings

The results demonstrated that Lean principles positively and directly affected operational performance. It also positively affected operational performance factors of quality, cost and time. However, the analysis of each of Lean principles impact on operational performance cost was analyzed perfection, value, and value stream mapping (VSM) significantly increased operational performance. In addition, pull only positively augmented the cost reduction, whereas flow did not show any effects on any of operational performance’s factors.

Practical implications

In addition to enhancing operational performance, the positive effect of the perceived adoption of Lean principles on performance is also explained by managers’ efforts in studying the flow of actions in their processes to reduce wastes. To face uncertainty, training and building a workforce that is able to implement Lean principles, equipping this workforce with needed artifacts, and promoting a high-performance culture are crucial for the successful implementation of Lean principles.

Originality/value

Lean approach has become a major pathway of improvement especially in pharmaceutical companies. Few studies analyzed the impact of each of the Lean principles on the operational performance in companies that operate in era of uncertainty. Furthermore, the perceived adoption of Lean principles is under investigated in the Middle East in general and in Lebanon in particular.

Lean ICU Layout Re-Design: A Simulation-Based Approach

Healthcare facilities require flexible layouts that can adapt quickly in the face of various disruptions. COVID-19 confirmed this need for both healthcare and manufacturing systems. Starting with the transfer of decision support systems from manufacturing, this paper generalizes layout re-design activities for complex systems by presenting a simulation framework. Through a real case study concerning the proliferation of nosocomial cross-infection in an intensive care unit (ICU), the model developed in systems dynamics, based on a zero order immediate logic, allows reproducing the evolution of the different agencies (e.g., physicians, nurses, ancillary workers, patients), as well as of the cyber-technical side of the ICU, in its general but also local aspects. The entire global workflow is theoretically founded on lean principles, with the goal of balancing the need for minimal patient throughput time and maximum efficiency by optimizing the resources used during the process. The proposed framework might be transferred to other wards with minimal adjustments; hence, it has the potential to represent the initial step for a modular depiction of an entire healthcare facility.