MEASURING THE LEVEL OF LEAN HEALTHCARE IMPLEMENTATION OF PRIVATE HOSPITALS TOWARDS ORGANISATIONAL PERFORMANCE
DOI:
https://doi.org/10.32890/jtom2019.14.1.7Keywords:
Operational aspects, sociotechnical aspects, lean healthcare, Rasch Measurement ModelAbstract
Private healthcare in Malaysia is one of the industries that contributes toward National GDP. However, increasing costs and waste has led to the issue of sustainability. Numerous studies examined the impact of lean healthcare practices on organisational performance. However, there is limited research examining the level of lean healthcare practices among private hospitals. Hence, this study attempted to investigate the level of lean healthcare implementation that lead to enhanced operational performance. The sociotechnical and operational aspects are variables adopted to measure the level of implementation of lean healthcare practices on operational performance. The questionnaire was developed based on previous literature, comprising three aspects, namely operational (24 items), sociotechnical (8 items), and operational performance (10 items). Out of 184 private hospitals in Malaysia, 118 were randomly selected, and 54 questionnaires were returned and used for analysis. Rasch quality control was applied to ensure that the instrument was valid, reliable, and able to measure what it is supposed to measure. It was found that sociotechnical aspect is difficult to implement as compared to operational aspect. Motivation factor dimensions contribute the highest mean value, which is indicative that if an organisation is able to improve this dimension, it is then able to further improve the organisational performance.
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References
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Al-Hyari, K., Abu Hammour, S., Abu Zaid, M. K. S., & Haffar, M. (2016). The impact of Lean bundles on hospital performance: does size matter? International Journal of Health Care Quality Assurance, 29(8), 877–894. https://doi.org/10.1108/IJHCQA-07-2015-0083
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Azrilah Abdul Aziz, Mohamad, A., Arshad, N., Zakaria, S., Ghulman, H. A., Masodi, M., & Aziz, A. A. (2008). Application of Rasch Model in validating the construct of measurement instrument. International Journal of Education and Information Technologies, Vol.2(2), 105–112.
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Burgess, N., & Radnor, Z. (2013). Evaluating Lean in healthcare. International Journal of Health Care Quality Assurance, 26(3), 220–235. https://doi.org/10.1108/09526861311311418
Caballer-Tarazona, M., Moya-Clemente, I., Vivas-Consuelo, D., & Barrachina-MartÃnez, I. (2010). A model to measure the efficiency of hospital performance. Mathematical and Computer Modelling, 52(7–8), 1095–1102. https://doi.org/10.1016/j.mcm.2010.03.006
Capkun, V., Messner, M., & Rissbacher, C. (2012). Service specialization and operational performance in hospitals. International Journal of Operations & Production Management, 32(4), 468–495. https://doi.org/10.1108/01443571211223103
Chavez, R., Gimenez, C., Fynes, B., Wiengarten, F., & Yu, W. (2013). Internal lean practices and operational performance. International Journal of Operations & Production Management, 33(5), 562–588. https://doi.org/10.1108/01443571311322724
Chen, H.-C. (2013). Effects of Institutional Pressure and Dynamic Capabilities on Operational Performance of U.S Long-Term Healthcare Providers. May. https://doi.org/10.1017/CBO9781107415324.004
Chiarini, A. (2013). Waste savings in patient transportation inside large hospitals using lean thinking tools and logistic solutions. Leadership in Health Services, 26(4), 356–367. https://doi.org/10.1108/LHS-05-2012-0013
Cho, J. (2014). The Sequential Relationships among Operational Capabilities and Performance in Service Industry: An Empirical Study*. Seoul Journal of Business, 20(2), 23–47.
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Economic Planning Unit. (2015a). Rancangan Malaysia Kesebelas (Eleventh Malaysia Plan).
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Elg, M., Palmberg Broryd, K., & Kollberg, B. (2013). Performance measurement to drive improvements in healthcare practice. International Journal of Operations & Production Management (Vol. 33). https://doi.org/10.1108/IJOPM-07-2010-0208
Elshennawy, A. K., Bahaitham, H., & Furterer, S. (2012). Assessing Sustainability of Lean Implementation in Healthcare : A Case Study Using the Lean Sustainability Assessment Framework ( LSAF ), 5(2).
Fisher, W. P. J. (2008). The Cash Value of Reliability. Rasch Measurement Transactions. Retrieved from http://www.rasch.org/rmt/rmt221i.htm
Gares, D. (2011). The Relationship of Acute Inpatient Hospital Length of Stay and Patient Satisfaction. Medical University of South California.
Gomes, C. F., Yasin, M. M., & Yasin, Y. (2010). Assessing operational effectiveness in healthcare organisations: a systematic approach. International Journal of Health Care Quality Assurance, 23(2), 127–140. https://doi.org/10.1108/09526861011017067
Gowen III, C. R., McFadden, K. L., & Settaluri, S. (2014). Contrasting continuous quality improvement, Six Sigma, and lean management for enhanced outcomes in US hospitals. American Journal of Business, 27(2), 133–153.
Gupta, S., & Jain, S. K. (2015). An Application of 5s concept to organise the workplace at a scientific instruments manufacturing company. International Journal of Lean Six Sigma, 6(1), 73–88. https://doi.org/10.1108/EL-01-2017-0019
Hadid, W., Mansouri, S. A., & Galler, D. (2016). Is lean service promising? A socio-technical perspective. International Journal of Operations & Production Management, 36(6), 618–642. https://doi.org/https://doi.org/10.1108/IJOPM-01-2015-0008
Hajmohammad, S., Vachon, S., Klassen, R. D., & Gavronski, I. (2013). Lean management and supply management: Their role in green practices and performance. Journal of Cleaner Production, 39, 312–320. https://doi.org/10.1016/j.jclepro.2012.07.028
Jamaludin, N. H., Habidin, N. F., Shazali, N. A., Ali, N., & Khaidir, N. A. (2012). Exploring Sustainable Healthcare Service and Sustainable Healthcare Performance: Based on Malaysian Healthcare Industry. Journal of Sustainable Development Studies, 33(1), 3–8. https://doi.org/10.1073/pnas.0703993104
Joosten, T., Bongers, I., & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / ISQua, 21(5), 341–347. https://doi.org/10.1093/intqhc/mzp036
Jorma, T., Tiirinki, H., Bloigu, R., & Turkki, L. (2016). LEAN thinking in Finnish healthcare. Leadership in Health Services, 29(1), 9–36. https://doi.org/10.1108/LHS-08-2015-0021
Jr., J. L. W. (2006). Integrating Lean Manufacturing with Technology: Analyzing the Effects on Organisational Performance in tern of Quality, Cost and Response time. Capella University.
Krejcie, R., & Morgan, D. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30, 607–610.
Li, L. X., & Benton, W. C. (1996). Performance measurement criteria in health care organisations: Review and future research directions. European Journal of Operational Research, 93(3), 449–468. https://doi.org/10.1016/0377-2217(95)00375-4
Liaropoulos, L., & Goranitis, I. (2015). Health care financing and the sustainability of health system. International Journal for Equity in Health, 14(80), 1–4. https://doi.org/10.1016/B978-012373960-5.00167-2
Linacre, J. M. (2004). Test Validity and Rasch Measurement: Construct, Content, etc. Rasch Measurement Transaction.
Machado, C. M. L., Scavarda, A., & Vaccaro, G. (2014). Lean Healthcare Supply Chain Management: Minimizing Waste and Costs. Independent Journal of Management & Production, 5(4), 1071–1089. https://doi.org/10.14807/ijmp.v5i4.245
Malmbrandt, M., & Åhlström, P. (2013). An instrument for assessing lean service adoption. International Journal of Operations and Production Management, 33(9), 1131–1165. https://doi.org/10.1108/IJOPM-05-2011-0175
Mark, W., John, W., & Tony, B. (2013). Leadership, a key element of quality improvement in healthcare. Results from a literature review of “Lean Healthcare†and the Productive Ward Releasing time to care initiative. The International Journal of Leadership in Public Services, 9(3/4), 90–108.
Miller, R., & Chalapati, N. (2015). Utilizing Lean Tools to improve value and reduce outatient wait times in an iidan hospital. Leadership in Health Services, 28(1), 57–69. https://doi.org/10.1108/LHS-01-2014-0001
Ministry of Health Malaysia. (2011). Country Health Plan 2011 - 2015.
Nawanir, G., Teong, L. K., & Othman, S. N. (2013). Impact of lean practices on operations performance and business performance: Some evidence from Indonesian manufacturing companies. Journal of Manufacturing Technology Management (Vol. 24). https://doi.org/10.1108/JMTM-03-2012-0027
Nerminathan, V., Adlan, W. N. A. B. W. F., & Nerminathan, A. A. (2014). Hospital at home: Sustainable healthcare in developing countries through reducing average length of stay in hospitals. International Journal of Management and Sustainability, 3(2), 51–61.
Pillay, D. I. M. S., Dato Mohd Ghazali, R. J., Manaf, N. H. A., Abdullah, A. H. A., Bakar, A. A., Salikin, F., … Ismail, W. I. W. (2011). Hospital waiting time: the forgotten premise of healthcare service delivery? International Journal of Health Care Quality Assurance, 24(7), 506–522.
Plytiuk, C. F., da Costa, S. E. G., & de Lima, E. P. (2013). Practices and Performance gains of Lean Healthcare: An analysis of empirical papers. IIE Annual Conference. Proceedings, 651–660.
Purbey, S., Mukherjee, K., & Bhar, C. (2007). Performance measurement system for healthcare processes. Production Planning & Control, 56(3), 241–251. https://doi.org/10.1080/09537280701599772
Radnor, Z. (2011). Implementing Lean in Health Care: Making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management (IJIEM), 2(1), 1–12.
Rahman, S., Laosirihongthong, T., & Sohal, A. S. (2010). Impact of lean strategy on operational performance : a study of Thai manufacturing companies. Journal of Manufacturing Technology Management, 21(7), 839–852. https://doi.org/10.1108/17410381011077946
Ramlan, R., & Ahmad, K. (2014). Business Improvement and Sustainable Service Quality in Healthcare - A Review and Research Agenda, (2003), 3038–3041.
Roszell, S. S. (2013). Measuring Lean Management Penetration on The Hospital Nursing frontline: Instrument Development. University of North Carolina. https://doi.org/10.1073/pnas.0703993104
Sekaran, U. (2003). Research Methods for Business: a Skill Building Approach. New York: John Wiley.
Suryadevara, K. M. (2015). Assessing Climate for Systems Improvement Initiatives in Healthcare. University of Rhode Island.
Ulhassan, W., Westerlund, H., Thor, J., Sandahl, C., & von Thiele Schwarz, U. (2014). Does Lean implementation interact with group functioning? Journal of Health, Organisation and Management, 28(2), 196–213. https://doi.org/10.1108/JHOM-03-2013-0065
Waterson, P. E., Gray, M. T. O., & Clegg, C. W. (2002). A Sociotechnical Method for Designing Work Systems. Human Factors: The Journal of the Human Factors and Ergonomics Society, 44(3), 376–391. https://doi.org/10.1518/0018720024497628
Wiengarten, F., & Longoni, A. (2015). A nuanced view on supply chain integration: a coordinative and collaborative approach to operational and sustainability performance improvement. Supply Chain Management: An International Journal, 20(2), 139–150. https://doi.org/10.1108/SCM-04-2014-0120
Woehl, J. H. (2011). How leadership styles reflect on lean manufacturing practices and culture. ProQuest Dissertations and Theses, (August), 149–n/a.
Wright, B. D. (1977). Solving Measurement Problems with the Rasch Model. Journal of Educational Measurement, Vol 14(2).
Yasin, M. M., & Gomes, C. F. (2008). Performance management in service operational settings : a selective literature examination. Benchmarking: An International Journal, 17(2), 214–231. https://doi.org/10.1108/14635771011036311
Yu, C. H., Popp, S. O., Digangi, S., & Jannasch-Pennell, A. (2007). Assessing unidimensionality : A comparison of Rasch Modeling , Parallel Analysis , and TETRAD. Practical Assessment, Research, and Evaluation, 12(14), 1–19. https://doi.org/10.4236/ojs.2014.46044
Al-Hyari, K., Abu Hammour, S., Abu Zaid, M. K. S., & Haffar, M. (2016). The impact of Lean bundles on hospital performance: does size matter? International Journal of Health Care Quality Assurance, 29(8), 877–894. https://doi.org/10.1108/IJHCQA-07-2015-0083
Aoun, M. (2015). The Mediating effect of Soft TQM on The Relationship Between Lean Practices and Innovation skills in Labanese Hospitals. Universiti Utara Mmalaysia.
Azrilah Abdul Aziz, Mohamad, A., Arshad, N., Zakaria, S., Ghulman, H. A., Masodi, M., & Aziz, A. A. (2008). Application of Rasch Model in validating the construct of measurement instrument. International Journal of Education and Information Technologies, Vol.2(2), 105–112.
Balok, D. V. (2012). Critical Team Success Factors and Lean Manufacturing: An Empirical Study David Vincent Balok Cypress , California.
Bond, T. G., & Fox, C. M. (2015). Applying the Rasch Model Fundamental Measurement in the Human Sciences (3rd Editio). Taylor & Francis Group.
Burgess, N., & Radnor, Z. (2013). Evaluating Lean in healthcare. International Journal of Health Care Quality Assurance, 26(3), 220–235. https://doi.org/10.1108/09526861311311418
Caballer-Tarazona, M., Moya-Clemente, I., Vivas-Consuelo, D., & Barrachina-MartÃnez, I. (2010). A model to measure the efficiency of hospital performance. Mathematical and Computer Modelling, 52(7–8), 1095–1102. https://doi.org/10.1016/j.mcm.2010.03.006
Capkun, V., Messner, M., & Rissbacher, C. (2012). Service specialization and operational performance in hospitals. International Journal of Operations & Production Management, 32(4), 468–495. https://doi.org/10.1108/01443571211223103
Chavez, R., Gimenez, C., Fynes, B., Wiengarten, F., & Yu, W. (2013). Internal lean practices and operational performance. International Journal of Operations & Production Management, 33(5), 562–588. https://doi.org/10.1108/01443571311322724
Chen, H.-C. (2013). Effects of Institutional Pressure and Dynamic Capabilities on Operational Performance of U.S Long-Term Healthcare Providers. May. https://doi.org/10.1017/CBO9781107415324.004
Chiarini, A. (2013). Waste savings in patient transportation inside large hospitals using lean thinking tools and logistic solutions. Leadership in Health Services, 26(4), 356–367. https://doi.org/10.1108/LHS-05-2012-0013
Cho, J. (2014). The Sequential Relationships among Operational Capabilities and Performance in Service Industry: An Empirical Study*. Seoul Journal of Business, 20(2), 23–47.
Conrad, K. J., Conrad, K. M., Dennis, M. L., Riley, B. B., & Funk, R. (2011). Validation of the Crime and Violence Scale (CVS) to the Rasch Measurement Model, GAIN Methods Report 1 .2, (January), 1–35.
Davis, P., Milne, B., Parker, K., Hider, P., Lay-Yee, R., Cumming, J., & Graham, P. (2013). Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions. Health Policy, 112(1–2), 19–27. https://doi.org/10.1016/j.healthpol.2013.02.008
Department of Statistics Malaysia. (2016). Press Release: Index of Services Fourth Quarter.
Economic Planning Unit. (2015a). Rancangan Malaysia Kesebelas (Eleventh Malaysia Plan).
Economic Planning Unit. (2015b). Transforming Services Sector.
Elg, M., Palmberg Broryd, K., & Kollberg, B. (2013). Performance measurement to drive improvements in healthcare practice. International Journal of Operations & Production Management (Vol. 33). https://doi.org/10.1108/IJOPM-07-2010-0208
Elshennawy, A. K., Bahaitham, H., & Furterer, S. (2012). Assessing Sustainability of Lean Implementation in Healthcare : A Case Study Using the Lean Sustainability Assessment Framework ( LSAF ), 5(2).
Fisher, W. P. J. (2008). The Cash Value of Reliability. Rasch Measurement Transactions. Retrieved from http://www.rasch.org/rmt/rmt221i.htm
Gares, D. (2011). The Relationship of Acute Inpatient Hospital Length of Stay and Patient Satisfaction. Medical University of South California.
Gomes, C. F., Yasin, M. M., & Yasin, Y. (2010). Assessing operational effectiveness in healthcare organisations: a systematic approach. International Journal of Health Care Quality Assurance, 23(2), 127–140. https://doi.org/10.1108/09526861011017067
Gowen III, C. R., McFadden, K. L., & Settaluri, S. (2014). Contrasting continuous quality improvement, Six Sigma, and lean management for enhanced outcomes in US hospitals. American Journal of Business, 27(2), 133–153.
Gupta, S., & Jain, S. K. (2015). An Application of 5s concept to organise the workplace at a scientific instruments manufacturing company. International Journal of Lean Six Sigma, 6(1), 73–88. https://doi.org/10.1108/EL-01-2017-0019
Hadid, W., Mansouri, S. A., & Galler, D. (2016). Is lean service promising? A socio-technical perspective. International Journal of Operations & Production Management, 36(6), 618–642. https://doi.org/https://doi.org/10.1108/IJOPM-01-2015-0008
Hajmohammad, S., Vachon, S., Klassen, R. D., & Gavronski, I. (2013). Lean management and supply management: Their role in green practices and performance. Journal of Cleaner Production, 39, 312–320. https://doi.org/10.1016/j.jclepro.2012.07.028
Jamaludin, N. H., Habidin, N. F., Shazali, N. A., Ali, N., & Khaidir, N. A. (2012). Exploring Sustainable Healthcare Service and Sustainable Healthcare Performance: Based on Malaysian Healthcare Industry. Journal of Sustainable Development Studies, 33(1), 3–8. https://doi.org/10.1073/pnas.0703993104
Joosten, T., Bongers, I., & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / ISQua, 21(5), 341–347. https://doi.org/10.1093/intqhc/mzp036
Jorma, T., Tiirinki, H., Bloigu, R., & Turkki, L. (2016). LEAN thinking in Finnish healthcare. Leadership in Health Services, 29(1), 9–36. https://doi.org/10.1108/LHS-08-2015-0021
Jr., J. L. W. (2006). Integrating Lean Manufacturing with Technology: Analyzing the Effects on Organisational Performance in tern of Quality, Cost and Response time. Capella University.
Krejcie, R., & Morgan, D. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30, 607–610.
Li, L. X., & Benton, W. C. (1996). Performance measurement criteria in health care organisations: Review and future research directions. European Journal of Operational Research, 93(3), 449–468. https://doi.org/10.1016/0377-2217(95)00375-4
Liaropoulos, L., & Goranitis, I. (2015). Health care financing and the sustainability of health system. International Journal for Equity in Health, 14(80), 1–4. https://doi.org/10.1016/B978-012373960-5.00167-2
Linacre, J. M. (2004). Test Validity and Rasch Measurement: Construct, Content, etc. Rasch Measurement Transaction.
Machado, C. M. L., Scavarda, A., & Vaccaro, G. (2014). Lean Healthcare Supply Chain Management: Minimizing Waste and Costs. Independent Journal of Management & Production, 5(4), 1071–1089. https://doi.org/10.14807/ijmp.v5i4.245
Malmbrandt, M., & Åhlström, P. (2013). An instrument for assessing lean service adoption. International Journal of Operations and Production Management, 33(9), 1131–1165. https://doi.org/10.1108/IJOPM-05-2011-0175
Mark, W., John, W., & Tony, B. (2013). Leadership, a key element of quality improvement in healthcare. Results from a literature review of “Lean Healthcare†and the Productive Ward Releasing time to care initiative. The International Journal of Leadership in Public Services, 9(3/4), 90–108.
Miller, R., & Chalapati, N. (2015). Utilizing Lean Tools to improve value and reduce outatient wait times in an iidan hospital. Leadership in Health Services, 28(1), 57–69. https://doi.org/10.1108/LHS-01-2014-0001
Ministry of Health Malaysia. (2011). Country Health Plan 2011 - 2015.
Nawanir, G., Teong, L. K., & Othman, S. N. (2013). Impact of lean practices on operations performance and business performance: Some evidence from Indonesian manufacturing companies. Journal of Manufacturing Technology Management (Vol. 24). https://doi.org/10.1108/JMTM-03-2012-0027
Nerminathan, V., Adlan, W. N. A. B. W. F., & Nerminathan, A. A. (2014). Hospital at home: Sustainable healthcare in developing countries through reducing average length of stay in hospitals. International Journal of Management and Sustainability, 3(2), 51–61.
Pillay, D. I. M. S., Dato Mohd Ghazali, R. J., Manaf, N. H. A., Abdullah, A. H. A., Bakar, A. A., Salikin, F., … Ismail, W. I. W. (2011). Hospital waiting time: the forgotten premise of healthcare service delivery? International Journal of Health Care Quality Assurance, 24(7), 506–522.
Plytiuk, C. F., da Costa, S. E. G., & de Lima, E. P. (2013). Practices and Performance gains of Lean Healthcare: An analysis of empirical papers. IIE Annual Conference. Proceedings, 651–660.
Purbey, S., Mukherjee, K., & Bhar, C. (2007). Performance measurement system for healthcare processes. Production Planning & Control, 56(3), 241–251. https://doi.org/10.1080/09537280701599772
Radnor, Z. (2011). Implementing Lean in Health Care: Making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management (IJIEM), 2(1), 1–12.
Rahman, S., Laosirihongthong, T., & Sohal, A. S. (2010). Impact of lean strategy on operational performance : a study of Thai manufacturing companies. Journal of Manufacturing Technology Management, 21(7), 839–852. https://doi.org/10.1108/17410381011077946
Ramlan, R., & Ahmad, K. (2014). Business Improvement and Sustainable Service Quality in Healthcare - A Review and Research Agenda, (2003), 3038–3041.
Roszell, S. S. (2013). Measuring Lean Management Penetration on The Hospital Nursing frontline: Instrument Development. University of North Carolina. https://doi.org/10.1073/pnas.0703993104
Sekaran, U. (2003). Research Methods for Business: a Skill Building Approach. New York: John Wiley.
Suryadevara, K. M. (2015). Assessing Climate for Systems Improvement Initiatives in Healthcare. University of Rhode Island.
Ulhassan, W., Westerlund, H., Thor, J., Sandahl, C., & von Thiele Schwarz, U. (2014). Does Lean implementation interact with group functioning? Journal of Health, Organisation and Management, 28(2), 196–213. https://doi.org/10.1108/JHOM-03-2013-0065
Waterson, P. E., Gray, M. T. O., & Clegg, C. W. (2002). A Sociotechnical Method for Designing Work Systems. Human Factors: The Journal of the Human Factors and Ergonomics Society, 44(3), 376–391. https://doi.org/10.1518/0018720024497628
Wiengarten, F., & Longoni, A. (2015). A nuanced view on supply chain integration: a coordinative and collaborative approach to operational and sustainability performance improvement. Supply Chain Management: An International Journal, 20(2), 139–150. https://doi.org/10.1108/SCM-04-2014-0120
Woehl, J. H. (2011). How leadership styles reflect on lean manufacturing practices and culture. ProQuest Dissertations and Theses, (August), 149–n/a.
Wright, B. D. (1977). Solving Measurement Problems with the Rasch Model. Journal of Educational Measurement, Vol 14(2).
Yasin, M. M., & Gomes, C. F. (2008). Performance management in service operational settings : a selective literature examination. Benchmarking: An International Journal, 17(2), 214–231. https://doi.org/10.1108/14635771011036311
Yu, C. H., Popp, S. O., Digangi, S., & Jannasch-Pennell, A. (2007). Assessing unidimensionality : A comparison of Rasch Modeling , Parallel Analysis , and TETRAD. Practical Assessment, Research, and Evaluation, 12(14), 1–19. https://doi.org/10.4236/ojs.2014.46044
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27-06-2019
How to Cite
Saad, R., Iteng, R., & Mohd Asaad, M. N. (2019). MEASURING THE LEVEL OF LEAN HEALTHCARE IMPLEMENTATION OF PRIVATE HOSPITALS TOWARDS ORGANISATIONAL PERFORMANCE. Journal of Technology and Operations Management, 14(1), 64–79. https://doi.org/10.32890/jtom2019.14.1.7
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