Lean healthcare from a change management perspective.

Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

[1]  J. Kaczorowski,et al.  Why are response rates in clinician surveys declining? , 2012, Canadian family physician Medecin de famille canadien.

[2]  Donald N. Sull,et al.  Closing the Gap Between Strategy and Execution , 2007 .

[3]  Richard J Holden,et al.  Lean Thinking in emergency departments: a critical review. , 2011, Annals of emergency medicine.

[4]  Michael Pidd,et al.  Exploring the barriers to lean health care implementation , 2011 .

[5]  G. Kalton,et al.  Handling missing data in survey research , 1996, Statistical methods in medical research.

[6]  P Walley,et al.  Designing the accident and emergency system: lessons from manufacturing , 2003, Emergency medicine journal : EMJ.

[7]  J. Kotter.  Leading change: why transformation efforts fail , 2009, IEEE Engineering Management Review.

[8]  Richard Janssen,et al.  Application of lean thinking to health care: issues and observations , 2009, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[9]  Dag Swartling,et al.  The daily work of Lean leaders – lessons from manufacturing and healthcare , 2013 .

[10]  J. J. Dahlgaard,et al.  Measuring lean initiatives in health care services: issues and findings , 2006 .

[11]  Michael C. Mankins,et al.  Turning great strategy into great performance. , 2005, Harvard business review.

[12]  Durward K. Sobek,et al.  Reducing waste and errors: piloting lean principles at Intermountain Healthcare. , 2005, Joint Commission journal on quality and patient safety.

[13]  T. Porter-O’Grady,et al.  The Leadership Revolution in Health Care: Altering Systems, Changing Behaviors , 1995 .

[14]  Barrie Oxtoby,et al.  Developing Organisational Change Capability , 2002 .

[15]  Deanne N. Den Hartog,et al.  Transactional versus transformational leadership: An analysis of the MLQ. , 1997 .

[16]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[17]  Michael G Trisolini.  Applying business management models in health care. , 2002, The International journal of health planning and management.

[18]  Pamela Mazzocato,et al.  Lean thinking in healthcare: a realist review of the literature , 2010, Quality and Safety in Health Care.

[19]  Nick Sevdalis,et al.  Teamwork in the operating theatre: cohesion or confusion? , 2006, Journal of evaluation in clinical practice.

[20]  Christopher S Kim,et al.  Lean health care: what can hospitals learn from a world-class automaker? , 2006, Journal of hospital medicine.

[21]  Peter F. Drucker.  The Theory of the Business , 2017 .

[22]  Jens J. Dahlgaard,et al.  Quality and lean health care: A system for assessing and improving the health of healthcare organisations , 2011 .

[23]  B. Bass,et al.  Superiors' evaluations and subordinates' perceptions of transformational and transactional leadership. , 1988 .

[24]  Jordana M. K. Signer,et al.  Performance Improvement Capability: Keys to Accelerating Performance Improvement in Hospitals , 2003 .

[25]  J. Klein,et al.  Using industrial processes to improve patient care , 2004, BMJ : British Medical Journal.

[26]  C. Aitken,et al.  A very low response rate in an on‐line survey of medical practitioners , 2008, Australian and New Zealand journal of public health.

[27]  Melissa L Dougherty,et al.  Redesigning care at the Flinders Medical Centre: clinical process redesign using “lean thinking” , 2008, The Medical journal of Australia.

[28]  E. Dickson,et al.  Use of lean in the emergency department: a case series of 4 hospitals. , 2009, Annals of emergency medicine.

[29]  D. Gibson,et al.  The Effects of Flexibility in Employee Skills, Employee Behaviors, and Human Resource Practices on Firm Performance , 2005 .

[30]  M. Crema,et al.  Guidelines for overcoming hospital managerial challenges: a systematic literature review , 2013, Therapeutics and clinical risk management.

[31]  Kevin Neailey,et al.  UK health visiting: challenges faced during lean implementation , 2010 .

[32]  S Undre,et al.  Developing observational measures of performance in surgical teams , 2004, Quality and Safety in Health Care.

[33]  Craig L. Pearce,et al.  Book Review: Shared Leadership: Reframing the Hows and Whys of Leadership , 2005 .

[34]  H. P. Sims,et al.  Vertical versus shared leadership as predictors of the effectiveness of change management teams: An examination of aversive, directive, transactional, transformational, and empowering leader behaviors. , 2002 .

[35]  S. Floyd,et al.  Managing strategic consensus: the foundation of effective implementation , 1992 .

[36]  Gary S Kaplan,et al.  Why Lean doesn't work for everyone , 2014, BMJ quality & safety.

[37]  S. Novak-Weekley,et al.  Commentary: The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology , 2014, Journal of Clinical Microbiology.

[38]  Gwen Fontenot,et al.  Innovation in healthcare: Issues and future trends☆ , 2012 .

[39]  John P. S. Verver,et al.  Lean Six Sigma in Healthcare , 2006, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[40]  B. Bass.  LEADERSHIP AND PERFORMANCE BEYOND EXPECTATIONS , 1985 .

[41]  H. J. Smith,et al.  The power of business models , 2005 .

[42]  Airica Steed,et al.  An Exploration of the Leadership Attributes and Methods Associated With Successful Lean System Deployments in Acute Care Hospitals , 2012, Quality management in health care.

[43]  Jay B. Carson,et al.  Shared leadership in teams: An investigation of antecedent conditions and performance , 2007, IEEE Engineering Management Review.

[44]  Heike Bruch,et al.  Fully Charged: How Great Leaders Boost Their Organization's Energy and Ignite High Performance , 2011 .

[45]  H. P. Sims,et al.  Shared Leadership: Relationship Management to Improve NPO Effectiveness. , 2001 .

[46]  Patricia Klarner,et al.  Organizational Change Capacity in Public Services: The Case of the World Health Organization , 2008 .

[47]  David Mann,et al.  The missing link: Lean leadership. , 2009, Frontiers of health services management.

[48]  A. Deehan,et al.  Surveying general practitioners: does a low response rate matter? , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.