Production
https://prod.org.br/article/doi/10.1590/0103-6513.20180080
Production
Research Article

Assessment methodology for Lean Practices in healthcare organizations: case study in a Brazilian public hospital

Guilherme Tortorella; Byanca Pinheiro Augusto; Sérgio Luiz Braga França; Rapinder Sawhney

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Abstract

Abstract: Paper aims: This article aims at proposing a methodology for assessing lean practices in healthcare organizations that are undergoing a lean implementation.

Originality: The proposed methodology evaluates healthcare organizations and help managers identify the relationships intensities between their problems and lean practices. This application occurs in a case study in an Emergency Department from a Brazilian public hospital.

Research method: The proposed methodology provides a theoretical framework that addresses lean practices according to fundamental aspects of the organization, such as people, partnerships, results, processes and leadership, corroborating to a systemic view of lean implementation and facilitating its long-term sustainability.

Main findings: Our findings provide guidelines for the public hospital leadership, allowing a clear focus on the improvement efforts that can mitigate problems.

Implications for theory and practice: Due to contextual diversity, the understanding of the critical success factors for lean implementation under such conditions deserves attention. Hence, the proposed method allows practitioners and academics to better comprehend the lean implementation within healthcare organizations. Such enhanced comprehension allows to anticipate potential issues throughout the lean implementation, entailing more assertive efforts. Moreover, accounting for specific problems when designing the lean implementation avoids the utilization of a general and ineffective approach.

Keywords

Lean healthcare, Assessment, Public hospital

References

Achanga, P., Shehab, E., Roy, R., & Nelder, G. (2006). Critical success factors for lean implementation within SMEs. Journal of Manufacturing Technology Management , 17(4), 460-471. http://dx.doi.org/10.1108/17410380610662889.

Al-Balushi, S., Sohal, A., Singh, P., Al Hajri, A., Al Farsi, Y., & Al Abri, R. (2014). Readiness factors for lean implementation in healthcare settings: a literature review. Journal of Health Organization and Management, 28(2), 135-153. http://dx.doi.org/10.1108/JHOM-04-2013-0083. PMid:25065107.

Anvari, A., Zulkifli, N., & Arghish, O. (2014a). Application of a modified VIKOR method for decision-making problems in lean tool selection. International Journal of Advanced Manufacturing Technology, 71(5-8), 829-841. http://dx.doi.org/10.1007/s00170-013-5520-x.

Anvari, A., Zulkifli, N., Sorooshian, S., & Boyerhassani, O. (2014b). An integrated design methodology based on the use of group AHP-DEA approach for measuring lean tools efficiency with undesirable output. International Journal of Advanced Manufacturing Technology , 70(9-12), 2169-2186. http://dx.doi.org/10.1007/s00170-013-5369-z.

Augusto, B., & Tortorella, G. (2017). Literature review on Lean Healthcare implementation: assessment methods and practices. International Journal of Services and Operations Management

Ballé, M., & Régnier, A. (2007). Lean as a learning system in a hospital ward. Leadership in Health Services, 20(1), 33-41. http://dx.doi.org/10.1108/17511870710721471. PMid:20690474.

Bastian, N., Munoz, D., & Ventura, M. (2016). A mixed-methods research framework for healthcare process improvement. Journal of Pediatric Nursing, 31(1), e39-e51. http://dx.doi.org/10.1016/j.pedn.2015.09.003. PMid:26453414.

Ben-Tovim, D. I., Bassham, J. E., Bennett, D. M., Dougherty, M. L., Martin, M. A., O’Neill, S. J., Sincock, J. L., & Szwarcbord, M. G. (2008). Redesigning care at the Flinders Medical Center: clinical process redesign using lean thinking. The Medical Journal of Australia , 188(6), 27-31.

Bessant, J., & Francis, D. (1999). Developing strategic continuous improvement capability. International Journal of Operations & Management, 19(11), 1106-1119. http://dx.doi.org/10.1108/01443579910291032.

Bhasin, S. (2011). Measuring the leanness of an organisation. International Journal of Lean Six Sigma, 2(1), 55-74. http://dx.doi.org/10.1108/20401461111119459.

Bhat, S., Gijo, E., & Jnanesh, N. (2014). Application of Lean Six Sigma methodology in the registration process of a hospital. International Journal of Productivity and Performance Management, 63(5), 613-643. http://dx.doi.org/10.1108/IJPPM-11-2013-0191.

Braaten, J., & Bellhouse, D. (2007). Improving patient care by making small sustainable changes: a cardiac telemetry unit’s experience. Nursing Economics , 25(3), 162-166. PMid:17802999.

Bush, R. (2007). Reducing waste in US health care systems. Journal of the American Medical Association, 297(8), 871-874. http://dx.doi.org/10.1001/jama.297.8.871. PMid:17327529.

Carlile, P., & Christensen, C. (2004). The cycles of theory building in management research. Boston: Harvard Business School, Boston University. Working paper 05-057, version 5.0.

Carvalho, J., Ramos, M., & Paixão, C. (2013). A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service. Risk Management and Healthcare Policy, 7, 1-10. http://dx.doi.org/10.2147/RMHP.S49535. PMid:24376365.

Casey, J., Brinton, T., & Gonzalez, C. (2009). Utilization of lean management principles in the ambulatory clinic setting. Nature Clinical Practice: Urology , 6(3), 146-153. PMid:19265856.

Cookson, D., Read, C., Mukherjee, P., & Cooke, M. (2011). Improving the quality of Emergency Department care by removing waste using Lean Value Stream mapping. The International Journal of Clinical Leadership, 17(1), 25-30.

Costa, L., & Godinho Filho, M. (2016). Lean healthcare: review, classification and analysis of literature. Production Planning and Control, 27(10), 823-836. http://dx.doi.org/10.1080/09537287.2016.1143131.

D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: a comprehensive review. Health Policy, 119(9), 1197-1209. http://dx.doi.org/10.1016/j.healthpol.2015.02.002. PMid:25737260.

Dahlgaard, J. J., & Mi Dahlgaard-Park, S. (2006). Lean production, six sigma quality, TQM and company culture. The TQM Magazine, 18(3), 263-281. http://dx.doi.org/10.1108/09544780610659998.

Dahlgaard, J., Pettersen, J., & Dahlgaard-Park, S. (2011). Quality and lean health care: a system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence, 22(6), 673-689. http://dx.doi.org/10.1080/14783363.2011.580651.

Daultani, Y., Chaudhuri, A., & Kumar, S. (2015). A decade of lean in healthcare: current state and future directions. Global Business Review, 16(6), 1082-1099. http://dx.doi.org/10.1177/0972150915604520.

Dickson, E., Singh, S., Cheung, D., Wyatt, C., & Nugent, A. (2009). Application of lean manufacturing techniques in the emergency department. The Journal of Emergency Medicine, 37(2), 177-182. http://dx.doi.org/10.1016/j.jemermed.2007.11.108. PMid:18722732.

Drotz, E., & Poksinska, B. (2014). Lean in healthcare from employees’ perspectives. Journal of Health Organization and Management, 28(2), 177-195. http://dx.doi.org/10.1108/JHOM-03-2013-0066. PMid:25065109.

Esain, A., Williams, S., & Massey, L. (2008). Combining planned and emergent change in a healthcare lean transformation. Public Money & Management, 28(1), 21-26.

Fillingham, D. (2007). Can lean save lives? Leadership in Health Services , 20(4), 231-241. http://dx.doi.org/10.1108/17511870710829346. PMid:20698096.

Furman, C., & Caplan, R. (2007). Applying the Toyota Production System: using a patient safety alert system to reduce error. Joint Commission Journal on Quality and Patient Safety, 33(7), 376-386. http://dx.doi.org/10.1016/S1553-7250(07)33043-2. PMid:17711139.

Gijo, E., & Antony, J. (2014). Reducing patient waiting time in outpatient department using lean six sigma methodology. Quality and Reliability Engineering International , 30(8), 1481-1491. http://dx.doi.org/10.1002/qre.1552.

Giovinazzo, R. (2001). Modelo de aplicação de metodologia Delphi pela internet: vantagens e ressalvas. Administração On Line, 2(2), 1-11.

Graban, M. (2012). Lean hospitals: improving quality, patient safety, and employee satisfaction. New York: Productivity Press.

Grout, J., & Toussaint, J. (2010). Mistake-proofing healthcare: why stopping processes may be a good start. Business Horizons, 53(2), 149-156. http://dx.doi.org/10.1016/j.bushor.2009.10.007.

Jeyaraman, K., & Kee Teo, L. (2010). A conceptual framework for critical success factors of lean six sigma. International Journal of Lean Six Sigma, 1(3), 191-215. http://dx.doi.org/10.1108/20401461011075008.

Jones, D. (2006). Leaning healthcare. Management Services, 50(2), 16-17.

Kim, C., Hayman, J., Billi, J., Lash, K., & Lawrence, T. (2007). The application of lean thinking to the care of patients with bone and brain metastasis with radiation therapy. Journal of Oncology Practice, 3(4), 189-193. http://dx.doi.org/10.1200/JOP.0742002. PMid:20859409.

Kim, C., Spahlinger, D., Kin, J., & Billi, J. (2006). Lean health care: What can hospitals learn from a world-class automaker? Journal of Hospital Medicine, 1(3), 191-199. http://dx.doi.org/10.1002/jhm.68. PMid:17219493.

Kimsey, D. B. (2010). Lean methodology in health care. AORN Journal, 92(1), 53-60. http://dx.doi.org/10.1016/j.aorn.2010.01.015. PMid:20619772.

Kollberg, B., Dahlgaard, J., & Brehmer, P. (2006). Measuring lean initiatives in health care services: issues and findings. International Journal of Productivity and Performance Management, 56(1), 7-24. http://dx.doi.org/10.1108/17410400710717064.

Kothari, R. (2004). Research methodology: methods and techniques. New Delhi: New Age International.

Laganga, L. (2011). Lean service operations: reflections and new directions for capacity expansion in outpatient clinics. Journal of Operations Management, 29(5), 422-433. http://dx.doi.org/10.1016/j.jom.2010.12.005.

Laureani, A., Brady, M., & Antony, J. (2013). Applications of lean six sigma in an Irish hospital. Leadership in Health Services, 26(4), 322-337. http://dx.doi.org/10.1108/LHS-01-2012-0002.

Leslie, M., Hagood, C., Royer, A., Reece Junior, C., & Maloney, S. (2006). Using lean methods to improve OR turnover times. AORN Journal, 84(5), 849-855. http://dx.doi.org/10.1016/S0001-2092(06)63971-9. PMid:17144053.

Liker, J. (2004). The Toyota way: 14 principles of world’s greatest manufacturer . Madison: McGraw-Hill.

Lummus, R., Vokurka, R., & Rodeghiero, B. (2006). Improving quality through value stream mapping: a case study of a physician’s clinic. Total Quality Management , 17(8), 1063-1075. http://dx.doi.org/10.1080/14783360600748091.

Mann, D. (2005). Creating a lean culture: tools to sustain lean conversions . New York: Productivity Press. http://dx.doi.org/10.4324/9781420080971.

Mannon, M. (2014). Lean healthcare and quality management: the experience of ThedaCare. The Quality Management Journal, 21(1), 7-10. http://dx.doi.org/10.1080/10686967.2014.11918371.

Marodin, G., & Saurin, T. (2013). Implementing lean production systems: research areas and opportunities for future studies. International Journal of Production Research , 51(22), 6663-6680. http://dx.doi.org/10.1080/00207543.2013.826831.

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean Thinking in healthcare: a realist review of the literature. Quality & Safety in Health Care, 19(5), 376-382. PMid:20724397.

McConnell, K., Chang, A., Maddox, T., Wholey, D., & Lindrooth, R. (2014). An exploration of management practices in hospitals. Health Care, 2(2), 121-129. PMid:26250380.

Miller, D. (2005). Going lean in health care. Cambridge: Institute for Healthcare Improvement.

Pavnaskar, S., Gershenson, J., & Jambekar, A. (2003). Classification scheme for lean manufacturing tools. International Journal of Production Research , 41(13), 3075-3090. http://dx.doi.org/10.1080/0020754021000049817.

Persoon, T., Zaleski, S., & Frerichs, J. (2006). Improving preanalytic processes using the principles of lean production (Toyota Production System). American Journal of Clinical Pathology, 125(1), 16-25. http://dx.doi.org/10.1309/865V7UMFPUKGCF8D. PMid:16482987.

Poksinska, B. (2010). The current state of Lean implementation in health care: literature review. Quality Management in Health Care, 19(4), 319-329. http://dx.doi.org/10.1097/QMH.0b013e3181fa07bb. PMid:20924253.

Proudlove, N., Moxham, C., & Boaden, R. (2008). Lessons for lean in healthcare from using six sigma in the NHS. Public Money & Management, 28(1), 27-34.

Raab, S., Grzybicki, D., Condel, J., Stewart, W., Turcsanyi, B., Mahood, L., & Becich, M. (2008). Effect of lean method implementation in the histopathology section of an anatomical pathology laboratory. Journal of Clinical Pathology, 61(11), 1193-1199. http://dx.doi.org/10.1136/jcp.2007.051326. PMid:17675533.

Radnor, Z., Holweg, M., & Waring, J. (2012). Lean in healthcare: the unfilled promise? Social Science & Medicine, 74(3), 364-371. http://dx.doi.org/10.1016/j.socscimed.2011.02.011. PMid:21414703.

Rechel, B., Wright, S., Barlow, J., & McKee, M. (2010). Hospital capacity planning: from measuring stocks to modelling flows. Bulletin of the World Health Organization , 88(8), 632-636. http://dx.doi.org/10.2471/BLT.09.073361. PMid:20680129.

Righi, A., & Saurin, T. (2015). Complex socio-technical systems: characterization and management guidelines. Applied Ergonomics, 50, 19-30. http://dx.doi.org/10.1016/j.apergo.2015.02.003. PMid:25959314.

Ruiz, U., & Simon, J. (2004). Quality management in health care: a 20-year journey. International Journal of Health Care Quality Assurance, 17(6), 323-333. http://dx.doi.org/10.1108/09526860410557570. PMid:15552387.

Saurin, T., Rooke, J., & Koskela, L. (2013). A complex systems theory perspective of lean production. International Journal of Production Research, 51(19), 5824-5838. http://dx.doi.org/10.1080/00207543.2013.796420.

Shah, R., & Ward, P. (2007). Defining and developing measures of lean production. Journal of Operations Management, 25(4), 785-805. http://dx.doi.org/10.1016/j.jom.2007.01.019.

Shannon, R., Frndak, D., Grunden, N., Lloyd, J. C., Herbert, C., Patel, B., Cummins, D., Shannon, A. H., O’Neill, P. H., & Spear, S. J. (2006). Using real-time problem solving to eliminate central line infections. Joint Commission Journal on Quality and Patient Safety, 32(9), 479-487. http://dx.doi.org/10.1016/S1553-7250(06)32063-6. PMid:17987871.

Shingo Prize. (2014). The Shingo Prize for operational excellence: application guidelines. Utah. Retrieved in 2016, May 29, from http://www.shingoprize.org/

Silberstein, A. 2006. Um estudo de casos sobre a aplicação de princípios enxutos em serviços de saúde no Brasil (Dissertação de mestrado). Instituto de Pós-graduação e Pesquisa em Administração, Universidade Federal do Rio de Janeiro, Rio de Janeiro.

Society of Automotive Engineers – SAE. (1999). SAE J4000: identification and measurement of best practice in implementation of lean operation. Warrendale: SAE.

Souza, L. (2009). Trends and approaches in lean healthcare. Leadership in Health Services, 22(2), 121-139. http://dx.doi.org/10.1108/17511870910953788.

Souza, L., & Pidd, M. (2011). Exploring the barriers to lean health care implementation. Public Money & Management, 31(1), 59-66. http://dx.doi.org/10.1080/09540962.2011.545548.

Spear, S. (2004). Learning to lead at Toyota. Harvard Business Review , 82(5), 78-86. PMid:15146738.

Spear, S. (2005). Fixing health care from the inside today. Harvard Business Review , 83(9), 78-91, 158. PMid:16171213.

Spear, S. (2009). The high-velocity edge: how market leaders leverage operational excellence to beat the competition. New York, McGraw-Hill.

Tortorella, G., & Fogliatto, F. (2014). Method for assessing human resources management practices and organizational learning factors in a company under lean manufacturing implementation. International Journal of Production Research, 52(15), 4623-4645. http://dx.doi.org/10.1080/00207543.2014.881577.

Tortorella, G., Fogliatto, F., Anzanello, M., Marodin, G., Garcia, M., & Reis Esteves, R. (2017a). Making the value flow: application of value stream mapping in a Brazilian public healthcare organisation. Total Quality Management & Business Excellence , 28(13-14), 1544-1558. http://dx.doi.org/10.1080/14783363.2016.1150778.

Tortorella, G., Marodin, G., Miorando, R., & Seidel, A. (2015). The impact of contextual variables on learning organization in firms that are implementing lean: a study in Southern Brazil. International Journal of Advanced Manufacturing Technology , 78(9-12), 1879-1892. http://dx.doi.org/10.1007/s00170-015-6791-1.

Tortorella, G., Vergara, L., & Ferreira, E. (2017b). Lean manufacturing implementation: an assessment method with regards to socio-technical and ergonomics practices adoption. International Journal of Advanced Manufacturing Technology, 89(9-12), 3407-3418. http://dx.doi.org/10.1007/s00170-016-9227-7.

Tréville, S., & Antonakis, J. (2006). Could lean production job design be intrinsically motivating? Contextual, configurational, and levels-of-analysis issues. Journal of Operations Management, 24(2), 99-123. http://dx.doi.org/10.1016/j.jom.2005.04.001.

Vinodh, S., & Chintha, S. (2011). Leanness assessment using multi-grade fuzzy approach. International Journal of Production Research, 49(2), 431-445. http://dx.doi.org/10.1080/00207540903471494.

Vinodh, S., Shivraman, K., & Viswesh, S. (2011). AHP-based lean concept selection in a manufacturing organization. Journal of Manufacturing Technology Management , 23(1), 124-136. http://dx.doi.org/10.1108/17410381211196320.

Waldhausen, J., Avansino, J., Libby, A., & Sawin, R. (2010). Application of lean methods improves surgical clinic experience. Journal of Pediatric Surgery, 45(7), 1420-1425. http://dx.doi.org/10.1016/j.jpedsurg.2009.10.049. PMid:20638518.

Wan, H., & Chen, F. (2008). A leanness measure of manufacturing systems for quantifying impacts of Lean initiatives. International Journal of Production Research , 46(23), 6567-6584. http://dx.doi.org/10.1080/00207540802230058.

Yew Wong, K. (2005). Critical success factors for implementing knowledge management in small and medium enterprises. Industrial Management & Data Systems, 105(3), 261-279. http://dx.doi.org/10.1108/02635570510590101.

Young, T., & McClean, S. (2008). A critical look at lean thinking in healthcare. Quality & Safety in Health Care, 17(5), 382-386. http://dx.doi.org/10.1136/qshc.2006.020131. PMid:18842980.

Young, T., & McClean, S. (2009). Some challenges facing lean thinking in healthcare. International Journal for Quality in Health Care, 21(5), 309-310. http://dx.doi.org/10.1093/intqhc/mzp038. PMid:19749078.

Zarbo, R., & D’Angelo, R. (2007). The Henry ford production system: effective reduction of process defects and waste in surgical pathology. American Journal of Clinical Pathology, 128(6), 1015-1022. http://dx.doi.org/10.1309/RGF6JD1NAP2DU88Q. PMid:18024328.

Zarbo, R., Tuthill, J., D’Angelo, R., Varney, R., Mahar, B., Neuman, C., & Ormsby, A. (2009). The Henry Ford Production System reduction of surgical pathology in-process misidentification defects by bar code: specified work process standardization. American Journal of Clinical Pathology, 131(4), 468-477. http://dx.doi.org/10.1309/AJCPPTJ3XJY6ZXDB. PMid:19289582.
 

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