The social benefits of kaizen initiatives in healthcare: an empirical study

Purpose The purpose of this paper is to identify the most influential determinants of healthcare employees’ problem-solving capabilities and attitudes towards kaizen initiatives, and clarify how these determinants are related to social outcomes. Design/methodology/approach Drawing on the input-process-outcome framework, applied to kaizen initiatives, the determinants of the input and process factors are embodied in hypotheses concerning the direct effects of input and process factors on social outcomes and the indirect effects of input factors on social outcomes resulting from process factors. The hypotheses are tested through multiple regressions using data from 105 kaizen initiatives drawn from two hospitals. Findings Of the 14 determinants investigated, goal clarity, team autonomy, management support, goal difficulty and affective commitment to change (ACC) are the most influential determinants of kaizen capabilities and/or employees’ attitude. Goal clarity, goal difficulty, team autonomy and management support are also found to influence social outcomes directly and/or indirectly through ACC, internal processes and/or an action orientation. Practical implications The results support healthcare practitioners to understand how to establish “focused kaizen” actions to leverage specific determinants that positively influence social outcomes. Originality/value This study provides an original contribution to the literature concerning effective kaizen initiatives in healthcare operations by empirically testing a comprehensive model of the relationship between kaizen initiative determinants and social outcomes. Unlike previous studies, which are mostly anecdotal or focused on one or few determinants, this research adopts a holistic view, and investigates a pluralist set of determinants on social outcomes through a systematic and quantitative approach.

[1]  Pietro Romano,et al.  A Systematic Literature Review on Recent Lean Research: State‐Of‐The‐Art and Future Directions , 2018 .

[2]  Pietro Romano,et al.  The transfer process of lean practices in multi-plant companies , 2017 .

[3]  Olga Matthias,et al.  Implementing operations strategy through Lean processes within health care , 2016 .

[4]  Pamela Mazzocato,et al.  Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement , 2016, BMJ Open.

[5]  Pietro Romano,et al.  Implementation of lean production in multinational corporations: A case study of the transfer process from headquarters to subsidiaries , 2016 .

[6]  Stephane Heritier,et al.  Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial , 2016, BMJ Open.

[7]  Essono E. Fabiene,et al.  Determinants of Employee’s Commitment among Healthcare Professionals , 2016 .

[8]  Moacir Godinho Filho,et al.  Lean healthcare: review, classification and analysis of literature , 2016 .

[9]  Jon Engström,et al.  Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care , 2016, BMJ Quality & Safety.

[10]  Dorothy Y. Hung,et al.  Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines , 2015, Quality management in health care.

[11]  Pietro Romano,et al.  Leveraging fitness and lean bundles to build the cumulative performance sand cone model , 2015 .

[12]  Manimay Ghosh,et al.  A problem-solving routine for improving hospital operations. , 2015, Journal of health organization and management.

[13]  Shengyong Wang,et al.  Improving Kaizen event success in healthcare through shorter event duration , 2014 .

[14]  Matthew J. Thompson,et al.  Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA , 2014, BMJ Open.

[15]  Erik Drotz,et al.  Lean in healthcare from employees' perspectives. , 2014, Journal of health organization and management.

[16]  T. Ingebrigtsen,et al.  Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews , 2014, BMJ Open.

[17]  Peter Hasle,et al.  Lean Production—An Evaluation of the Possibilities for an Employee Supportive Lean Practice , 2014 .

[18]  Joanne Lyubovnikova,et al.  Illusions of team working in health care. , 2013, Journal of health organization and management.

[19]  Jiju Antony,et al.  Applications of Lean Six Sigma in an Irish hospital , 2013 .

[20]  Nick Rich,et al.  Losing patients: a systems view on healthcare improvement , 2013 .

[21]  E. Hollnagel,et al.  Resilient Health Care , 2013 .

[22]  Mark Graban,et al.  The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization , 2013 .

[23]  Robert L. Wears,et al.  Resilient health care: Resilient Health Care , 2013 .

[24]  M. Euwema,et al.  Care pathways lead to better teamwork: results of a systematic review. , 2012, Social science & medicine.

[25]  Selena Hariharan,et al.  Patients are Not Cars and Staff are Not Robots: Impact of Differences between Manufacturing and Clinical Operations on Process Improvement , 2012 .

[26]  Ross W Simon,et al.  A practical guide to applying lean tools and management principles to health care improvement projects. , 2012, AORN journal.

[27]  E. Viles,et al.  Healthcare teamwork best practices: lessons for industry , 2011 .

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

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

[30]  Bozena Poksinska,et al.  The Current State of Lean Implementation in Health Care: Literature Review , 2010, Quality management in health care.

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

[32]  G. Salvendy,et al.  Human Factors and Ergonomics in Manufacturing & Service Industries , 2009 .

[33]  James R. Langabeer,et al.  Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective , 2009 .

[34]  M. Hollander,et al.  Increasing value for money in the Canadian healthcare system: new findings on the contribution of primary care services. , 2009, Healthcare quarterly.

[35]  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.

[36]  Sabi Singh,et al.  Application of lean manufacturing techniques in the Emergency Department. , 2009, The Journal of emergency medicine.

[37]  Dante Morra,et al.  Leading Lean: a Canadian healthcare leader's guide. , 2009, Healthcare quarterly.

[38]  Toni L. Doolen,et al.  Critical success factors for human resource outcomes in Kaizen events: An empirical study , 2009 .

[39]  James M. LeBreton,et al.  Answers to 20 Questions About Interrater Reliability and Interrater Agreement , 2008 .

[40]  Toni L. Doolen,et al.  Learning From Less Successful Kaizen Events: A Case Study , 2008 .

[41]  G. Wennecke.  Kaizen--LEAN in a week: how to implement improvements in healthcare settings within a week. , 2008, MLO: medical laboratory observer.

[42]  Matthew S. Fritz,et al.  Distribution of the product confidence limits for the indirect effect: Program PRODCLIN , 2007, Behavior research methods.

[43]  Cindy Jimmerson,et al.  A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste , 2007 .

[44]  Michael Ballé,et al.  Lean as a learning system in a hospital ward. , 2007, Leadership in health services.

[45]  L. Lemieux-Charles,et al.  What Do We Know about Health Care Team Effectiveness? A Review of the Literature , 2006, Medical care research and review : MCRR.

[46]  J. Cutcher-Gershenfeld,et al.  Lean Thinking , 2019, Encyclopedia of Sustainable Management.

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

[48]  Eric Molleman,et al.  The multilevel nature of team‐based work research , 2005 .

[49]  N. Bateman.  Sustainability: the elusive element of process improvement , 2005 .

[50]  S. Mickan,et al.  Evaluating the effectiveness of health care teams. , 2005, Australian health review : a publication of the Australian Hospital Association.

[51]  The development and implementation of a strategic and tactical planning framework at Mayo Clinic Arizona. , 2005, Journal of healthcare information management : JHIM.

[52]  Gary A. Ballinger,et al.  Using Generalized Estimating Equations for Longitudinal Data Analysis , 2004 .

[53]  Harry Boer,et al.  Jump‐starting continuous improvement through self‐assessment , 2003 .

[54]  Thomas H. Brush,et al.  HETEROGENEITY AND TRANSFERRING PRACTICES: IMPLEMENTING FLOW MANUFACTURING IN MULTIPLE PLANTS , 2003 .

[55]  Chay Hoon Lee,et al.  Creating value for employees: investment in employee development , 2003 .

[56]  John P. Meyer,et al.  Commitment to organizational change: extension of a three-component model. , 2002, The Journal of applied psychology.

[57]  A. Langley,et al.  The Corruption of Managerial Techniques by Organizations , 2002 .

[58]  Wen‐Jun Zhang,et al.  Comparison of different methods for variable selection , 2001 .

[59]  E. Sundstrom,et al.  Work groups: From the Hawthorne studies to work teams of the 1990s and beyond. , 2000 .

[60]  P. Bliese.  Within-group agreement, non-independence, and reliability: Implications for data aggregation and analysis. , 2000 .

[61]  Stuart R. Lipsitz,et al.  Review of Software to Fit Generalized Estimating Equation Regression Models , 1999 .

[62]  Bradley L. Kirkman,et al.  Beyond Self-Management: Antecedents and Consequences of Team Empowerment , 1999 .

[63]  Steven A. Melnyk,et al.  Short-term action in pursuit of long-term improvements: Introducing Kaizen events , 1998 .

[64]  S. G. Cohen,et al.  What Makes Teams Work: Group Effectiveness Research from the Shop Floor to the Executive Suite , 1997 .

[65]  D. Vinokur-Kaplan,et al.  Treatment Teams that Work (and those that don't): An Application of Hackman's Group Effectiveness Model to Interdisciplinary Teams in Psychiatric Hospitals , 1995 .

[66]  Richard P. Bagozzi,et al.  Assessing Construct Validity in Organizational Research , 1991 .

[67]  P. Senge.  THE FIFTH DISCIPLINE , 1997 .

[68]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[69]  L. James,et al.  Estimating within-group interrater reliability with and without response bias. , 1984 .