Lean adoption in hospitals: the role of contextual factors and introduction strategy

Abstract

Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting. Methodology The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy. Results The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level. Conclusion The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system.

Addressing critical failure factors and barriers in implementing Lean Six Sigma in Italian public hospitals

“…The system for evaluating the success of the implementation must be modelled on the LSS implementation strategy. Moreover, because of contextual factors, in most cases the implementation process is unique and does not always move along expected trajectories, so the evaluations of implementation in these different contexts will have to take this limitation into account (Rosa et al , 2021; Henrique and Godinho Filho, 2020; Vaishnavi and Suresh, 2020). As for the measures used to evaluate the success of the implementation, the most obvious and recommended in HSs are the performance improvements of clinical processes (Antony et al , 2018; Liberatore, 2013; Bhat et al , 2014; Woodard, 2005).…”

“…The success of LSS implementation should also be measured on a non-financial and nonperformance basis. An improved working environment, improved employee morale, crossfertilisation of staff, cross-functional teamwork, and the transformation of the organisational culture from reactive to proactive are key indicators, as they determine the spread of the methodology within the hospital and its principle-oriented application (Antony et al, 2007a(Antony et al, , 2007bRosa et al, 2021).…”

“…Continuous process improvement is an important aspect of the health-care literature (Antony et al , 2018; Henrique and Godinho Filho, 2020; McIntosh et al , 2014). The constant pressures on health-care costs, the growing demand for care and assistance and the high variability of operational performance have led hospitals to seek methods to increase the quality of service and the value for other stakeholders (Honda et al , 2018; Rosa et al , 2021). The search for solutions to these challenges has extended beyond the boundaries of the health-care field to examine organisational methods and paradigms that have been successfully implemented in other sectors (Feng and Manuel, 2008).…”

“…The failures in many cases were because of an improper integration between Lean and Six Sigma. This happens particularly in complex organisations, such as hospitals, at the entire-organisation level (Rosa et al , 2021; Antony et al , 2018; Glasgow et al , 2010). Nowadays, most researchers point out that the implementation of LSS in health-care settings is not self-evident.…”

“…This study is grounded in the differences between public and private hospitals; these differences (e.g. a shortage of management skills, a lack of opportunities for investment in human and structural resources, bureaucracy and so on) could influence significantly the implementation of LSS (Rosa et al , 2021).…”