The cross-national applicability of lean implementation measures and hospital performance measures: a case study of Finland and the USA.
Int J Qual Health Care 2021;
33:6308766. [PMID:
34165147 PMCID:
PMC8886912 DOI:
10.1093/intqhc/mzab097]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/04/2021] [Accepted: 06/24/2021] [Indexed: 01/16/2023] Open
Abstract
Background
Health-care organizations around the world are striving to achieve
transformational performance improvement, often through adopting process
improvement methodologies such as lean management. Indeed, lean management
has been implemented in hospitals in many countries. But despite a shared
methodology and the potential benefit of benchmarking lean implementation
and its effects on hospital performance, cross-national lean benchmarking is
rare. Health-care organizations in different countries operate in very
different contexts, including different health-care system models, and these
differences may be perceived as limiting the ability of improvers to
benchmark lean implementation and related organizational performance.
However, no empirical research is available on the international relevance
and applicability of lean implementation and hospital performance measures.
To begin understanding the opportunities and limitations related to
cross-national benchmarking of lean in hospitals, we conducted a
cross-national case study of the relevance and applicability of measures of
lean implementation in hospitals and hospital performance.
Methods
We report an exploratory case study of the relevance of lean implementation
measures and the applicability of hospital performance measures using
quantitative comparisons of data from Hospital District of Helsinki and
Uusimaa (HUS) Helsinki University Hospital in Finland and a sample of 75
large academic hospitals in the USA.
Results
The relevance of lean-related measures was high across the two countries:
almost 90% of the items developed for a US survey were relevant and
available from HUS. A majority of the US-based measures for financial
performance (66.7%), service provision/utilization (100.0%)
and service provision/care processes (60.0%) were available from HUS.
Differences in patient satisfaction measures prevented comparisons between
HUS and the USA. Of 18 clinical outcome measures, only four (22%)
were not comparable. Clinical outcome measures were less affected by the
differences in health-care system models than measures related to service
provision and financial performance.
Conclusions
Lean implementation measures are highly relevant in health-care organizations
operating in the USA and Finland, as is the applicability of a variety of
performance improvement measures. Cross-national benchmarking in lean
healthcare is feasible, but a careful assessment of contextual factors,
including the health-care system model, and their impact on the
applicability and relevance of chosen benchmarking measures is necessary.
The differences between the US and Finnish health-care system models is most
clearly reflected in financial performance measures and care process
measures.
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