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SUCCESSFUL IMPLEMENTATION OF LEAN AS A MANAGERIAL PRINCIPLE IN HEALTH CARE: A CONCEPTUAL ANALYSIS FROM SYSTEMATIC LITERATURE REVIEW

Part of: Special Collection - Methods

Published online by Cambridge University Press:  12 April 2018

Riikka Maijala ,
Sini Eloranta ,
Tero Reunanen  and
Tuija S. Ikonen
Riikka Maijala
Affiliation:
Turku University Hospital, Department of Public Health, University of Turkuriimai@utu.fi
Sini Eloranta
Affiliation:
Turku University of Applied Sciences, Health and Well-being Department of Nursing Science, University of Turku
Tero Reunanen
Affiliation:
Turku University of Applied Sciences Tampere University of Technology
Tuija S. Ikonen
Affiliation:
Turku University Hospital, Department of Public Health, University of Turku
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Abstract

Purpose: The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare.

Design: A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period.

Findings: Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities.

Practical Implications: A conceptual analysis of systematically reviewed studies of Lean leadership and management point to certain traits as being typical when adapting Lean thinking to health care. The concept of a managerial windshield is useful when categorizing and analyzing essential managerial skills and capabilities for Lean implementation. Findings are beneficial when learning and educating the skills required for Lean transformation in healthcare organizations.

Keywords

Lean leadershipLean managementHealth careConcept of managerial windshield
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 2 , 2018 , pp. 134 - 146
Copyright
Copyright © Cambridge University Press 2018 

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References

REFERENCES

1.Viitanen, E, Kokkinen, L, Konu, A, Simonen, O, Virtanen, JV, Lehto, J. terveydenhuollossa, Johtajana. 2007. Kunnallisalan kehittämissäätiön tutkimusjulkaisut, nro 59. Pole-Kuntatieto Oy ja tekijät. Vammalan Kirjapaino Oy, Vammala.Google Scholar
2.Antwi, M, Kale, M. Change management in healthcare. Ottawa, Ontario: The Monieson Centre for Business Research in Healthcare; 2014.Google Scholar
3.Al-Abri, R. Managing chance in healthcare. Oman Med J. 2007;22:9–10.Google Scholar
4.Drotz, E, Poksinska, B. Lean in healthcare from employees’ perspectives. J Health Organ Manag. 2014;28:177–195.Google Scholar
5.Kimsey, DB. Lean methodology in health care. AORN J. 2010;92:53–60.Google Scholar
6.Lawal, AK, Rotter, T, Kinsman, L, et al. Lean management in health care: Definition, concepts, methodology and effects reported. (systematic review protocol). Syst Rev. 2014;3:103.Google Scholar
7.Maijala, R, Eloranta, S, Saloniemi, A, Ikonen, T. 2015. Hukan arviointi ja poistaminen Hukkatunnistimella. Suom Lääkäril. 2016;26-32:65–71.Google Scholar
8.Dahlgaard, J, Jostein, P, Dahlgaard-Park, S. Quality and Lean health care: A system for assessing and improving the health of healthcare organisations. Total Qual Manag. 2011;22:673–689.Google Scholar
9.OECD. Health Expenditure. 2017. http://www.oecd.org/els/health-systems/health-expenditure.htm (accessed March 15, 2018).Google Scholar
10.Joosten, T, Bongers, I, Janssen, R. Application of Lean thinking to health care: Issues and observations. Int J Qual Health Care. 2009;21:341–347.Google Scholar
11.Kim, C, Spahlinger, DS, Kin J, M, Billi, JE. Lean health care: What can hospitals learn from a world‐class automaker? J Hosp Med. 2006;1:191–199.Google Scholar
12.Kowalski, K, Bradley, K, Pappas, S. Nurse retention, leadership, and the Toyota System Model: Building leaders and problem solvers for better patient care. Nurse Lead. 2006;46–51.Google Scholar
13.Radnor, ZJ, Holweg, M, Waring, J. Lean in healthcare: The unfilled promise? Soc Sci Med. 2012;74:364–371.Google Scholar
14.Simon, RW, Canacari, EG. A practical guide to applying Lean tools and management principles to health care improvement projects. AORN J. 2012;95:85–100; quiz 101–103.Google Scholar
15.Toussaint, J, Berry, L. The promise of Lean in health care. Mayo Clin Proc. 2013;88:74–82.Google Scholar
16.Wackerbarth, S, Strawser-Srinath, JR, Conigliaro, JC. The human side of Lean teams. Am J Med Qual. 2015;30:248–254.Google Scholar
17.Waring, JJ, Bishop, S. Lean healthcare: Rhetoric, ritual and resistance. Soc Sci Med. 2010;71:1332–1340.Google Scholar
18.Savage, C, Parke, L, Von Konrring, M, Mazzocato, P. Does Lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement. 2016. BMC Health Serv Res. 2016;16:588.Google Scholar
19.Huskins, M, Van Kuiken, S, Velamoor, S. Applying Lean IT to healthcare. 2018. https://www.mckinsey.com/business-functions/digital-mckinsey/our-insights/applying-lean-it-to-healthcare (accessed March 15, 2018).Google Scholar
20.Aij, K, Rapsaniotis, S. Leadership requirements for Lean versus servant leadership in health care: A systematic review of the literature. J Healthc Leadersh. 2017;9:1–14.Google Scholar
21.Andersen, H, Rovik, KA, Ingebritsen, T. Lean thinking in hospitals: Is there a cure for the absence of evidence? BMJ Open. 2014;4: e003873.CrossRefGoogle Scholar
22.Lorden, AL, Zhang, Y, Lin, SH, Cote, MJ. Measures of success: The role of human factors in Lean implementation in healthcare. Qual Manag J. 2014;21:3.Google Scholar
23.Mann, D. The missing link: Lean leadership. Front Health Serv Manag. 2009;26:15–26.Google Scholar
24.Aij, H, Aernoudts, K, Joosten, G. Manager traits and quality-of-care performance in hospitals. Leadersh Health Serv. 2015;28:200–215.Google Scholar
25.Aij, K, Visse, M, Widdershoven, G. Lean leadership: An ethnographic study. Leadersh Health Serv. 2015;28:119–134.Google Scholar
26.Ljungblom, M. Ethics and Lean management – A paradox? Int J Qual Serv Sci. 2014;6:191–202.Google Scholar
27.Chiodo, A, Wilke, R, Bakshi, R, Craig, A, Duew, D, Hurwitz, E. Using Lean principles to manage throughput on an inpatient rehabilitation unit source reference. Am J Phys Med Rehabil. 2012;91:977–983.Google Scholar
28.Thomas, DA. The Lean librarian. J Hosp Librariansh. 2015;15: 23–30.Google Scholar
29.Aij, K, Simons, F, Widdershoven, G, Visse, M. Experiences of leaders in the implementation of Lean in a teaching hospital–Barriers and facilitators in clinical practices: A qualitative study. BMJ Open. 2013;3:e003605.CrossRefGoogle Scholar
30.Steed, A. An Exploration of the leadership attributes and methods associated with successful Lean system deployments in acute care hospitals. Qual Manag Health Care. 2012;21:48–58.Google Scholar
31.Vanharanta, H. The management windshield, an effective metaphore for management and leadership. AHFE International Conference, July 14–17, 2008, Las Vegas, Nevada.Google Scholar
32.Reunanen, T. ScienceDirect human factor in time management. Procedia Manuf. 2015;3:709–716.Google Scholar
33.Reunanen, T, Junno, M. Leadership focus in modern expert organization. Adv Intell Syst Comput. 2017;498:979–991.Google Scholar
34.Reunanen, T, Kaitonen, J. Different roles in leadership styles in modern organization. Adv Intell Syst Comput. 2017;251–262.Google Scholar
35.Burns, N, Grove, SK. Practice of nursing research: Conduct, critique & utilization. Philadelphia, PA: Saunders; 1997.Google Scholar
36.Frankfort-Nachmia, C, Nachmias, D. Research methods in social sciences. London: Worth Publisher; 1996.Google Scholar
37.D'Andreamatteo, A, Ianni, L, Lega, F, Sargiacomo, M. Lean in healthcare: A comprehensive review. Health Policy. 2015;119:1197–2013.Google Scholar
38.White, M, Wells, J, Butterworth, T. Leadership, a key element of quality improvement in healthcare. Results from a literature review of ‘Lean Healthcare’ and the productive ward. Int J Leadersh Public Serv. 2013;9:90–108.Google Scholar
39.Al-Balushi, S, Sohal, AS, Singh, PJ, et al. Readiness factors for lean implementation in healthcare settings–A literature review. J Health Organ Manag. 2014;28:135–153.Google Scholar
40.Hung, D, Martinez, M, Yakir, M, Gray, C. Implementing a Lean management system in primary care: Facilitators and barriers from the front lines. Qual Manag Health Care. 2015;24: 103–108.Google Scholar
41.Johnson, J, Smith, AL, Mastro, KA. From Toyota to the bedside: Nurses can lead the lean way in health care reform. Nurs Admin Q. 2012;36:234–242.Google Scholar
42.Goodridge, D, Westhorp, G, Rotter, T, Dobson, R, Bath, B. Lean and leadership practices: Development of an initial realist program theory. BMC Health Serv Res. 2015;16:362.Google Scholar
43.Hwang, P, Hwang, D, Hong, P. Lean practices for quality results: A case illustration. Int J Health Care Qual Assur. 2014;27:729–741.Google Scholar
44.Bass, BM. From transactional to transformational leadership: Learning to share the vision. Organ Dyn. 1990;18:19–31.Google Scholar
45.Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Open Med. 2009;3:123–130.Google Scholar
46.Tong, A, Sainsbury, P, Craig, J. Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-itemchecklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–357.Google Scholar