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Modelling of the factors affecting lean implementation in healthcare using structural equation modelling

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Abstract

Lean is a quality enhancement process which has been implemented by several industries including healthcare to get leverage in this era of globalization and liberalization. The objective of present work is to identify the variables affecting implementation of lean principles in healthcare industry. To achieve this objective, a survey was conducted by using a structured questionnaire which was distributed among 460 health professionals in different hospitals in India to collect their responses about lean applications in healthcare. EFA was applied to identify the factor structure with the help of the SPSS software version 20 and dimensions were extracted from the variables. After that, CFA was carried out by SEM statistical approach to verify these dimensions in the factor analysis by AMOS software. Fifteen variables were explored and three factors i.e. organizational factors, management commitment and communication and human resource factors were extracted which affect lean application in healthcare. SEM was used to identify first order three factor structure. The managers and healthcare professionals can acquire information about the strength of various factors in advance which would help them to thoroughly understand the relative importance, interdependencies and relationships among these factors so that lean principles can be applied successfully in the organization.

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References

  • Achanga P, Shehab E, Roy R, Nelder G (2006) Critical success factors for lean implementation within SMEs. J Manuf Technol Manag 17:460–471

    Article  Google Scholar 

  • Ajmera P (2017) Ranking the strategies for Indian medical tourism sector through the integration of SWOT analysis and TOPSIS method. Int J Health Care Qual Assur 30:668–679

    Article  Google Scholar 

  • Bañuelas R, Antony J (2001) A strategy for survival. Manuf Eng 80:119–121

    Article  Google Scholar 

  • Banuelas Coronado R, Antony J (2002) Critical success factors for the successful implementation of six sigma projects in organisations. TQM Mag 14(2):92–99

    Article  Google Scholar 

  • Baumgartner H, Homburg C (1996) Applications of structural equation modeling in marketing and consumer research: a review. Int J Res Mark 13:139–161

    Article  Google Scholar 

  • Bentler PM (1990) Comparative fit indexes in structural models. Psychol Bull 107:238–246

    Article  Google Scholar 

  • Bentler PM, Bonett DG (1980) Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 88:588

    Article  Google Scholar 

  • Bercaw R (2016) Lean leadership for healthcare: approaches to lean transformation. Productivity Press, New York

    Google Scholar 

  • Bhatia N, Drew J (2006) Applying lean production to the public sector. McKinsey Q 3:97–98

    Google Scholar 

  • Bowen DE, Youngdahl WE (1998) “Lean” service: in defense of a production-line approach. Int J Serv Ind Manag 9:207–225

    Article  Google Scholar 

  • Brandao de Souza L (2009) Trends and approaches in lean healthcare. Leadersh Health Serv 22:121–139

    Article  Google Scholar 

  • Burgess N, Radnor Z (2013) Evaluating lean in healthcare. Int J Health Care Qual Assur 26:220–235

    Article  Google Scholar 

  • Byrne BM (1998) Structural equation modeling with LISREL, PRELIS, and SIMPLIS: basic concepts, application, and programming. Lawrence Erlabum, Mathwah

    MATH  Google Scholar 

  • Byrne BM (2013) Structural equation modeling with LISREL, PRELIS, and SIMPLIS: basic concepts, applications, and programming. Psychology Press, New York

    Book  Google Scholar 

  • Camuffo A, Gerli F (2018) Modeling management behaviors in lean production environments. Int J Oper Prod Manag 38:403–423

    Article  Google Scholar 

  • Cattell RB (1966) The scree test for the number of factors. Multivar Behav Res 1:245–276

    Article  Google Scholar 

  • Chavez R, Yu W, Jacobs M, Fynes B, Wiengarten F, Lecuna A (2015) Internal lean practices and performance: the role of technological turbulence. Int J Prod Econ 160:157–171. https://doi.org/10.1016/j.ijpe.2014.10.005

    Article  Google Scholar 

  • Chen K, Hsu C, Ouyang L (2007) Applied product capability analysis chart in measure step of Six Sigma. Qual Quant 41:387–400

    Article  Google Scholar 

  • D’Andreamatteo A, Ianni L, Lega F, Sargiacomo M (2015) Lean in healthcare: a comprehensive review. Health Policy 119:1197–1209

    Article  Google Scholar 

  • Dahlgaard JJ, Østergaard P (2000) TQM and lean thinking in higher education. Best Qual Targets Improv Syst 11:203–226

    Google Scholar 

  • Dahlgaard-Park SM (2011) The quality movement: where are you going? Total Qual Manag Bus Excell 22:493–516

    Article  Google Scholar 

  • De Jonge J, Schaufeli WB (1998) Job characteristics and employee well-being: a test of Warr’s Vitamin Model in health care workers using structural equation modelling. J Organ Behav 19:387–407

    Article  Google Scholar 

  • de Souza LB, Pidd M (2011) Exploring the barriers to lean health care implementation. Public Money Manag 31:59–66

    Article  Google Scholar 

  • Diamantopoulos A, Siguaw JA (2000) Introducing LISREL: a guide for the uninitiated. Sage Publication Ltd, London

    Book  Google Scholar 

  • Diamantopoulos A, Siguaw JA, Siguaw JA (2000) Introducing LISREL: a guide for the uninitiated. Sage Publication Ltd., London

    Book  Google Scholar 

  • Drotz E, Poksinska B (2014) Lean in healthcare from employees’ perspectives. J Health Organ Manag 28:177–195

    Article  Google Scholar 

  • Fabrigar LR, Wegener DT (2011) Exploratory factor analysis. Oxford University Press, Oxford

    Book  Google Scholar 

  • Fadly Habidin N, Mohd Yusof S (2013) Critical success factors of Lean Six Sigma for the Malaysian automotive industry. Int J Lean Six Sigma 4:60–82

    Article  Google Scholar 

  • Fan X, Thompson B, Wang L (1999) Effects of sample size, estimation methods, and model specification on structural equation modeling fit indexes. Struct Equ Model A Multidiscip J 6:56–83

    Article  Google Scholar 

  • Fitch D (2007) Structural equation modeling the use of a risk assessment instrument in child protective services. Decis Support Syst 42:2137–2152

    Article  Google Scholar 

  • Francis DJ (1988) An introduction to structural equation models. J Clin Exp Neuropsychol 10:623–639

    Article  Google Scholar 

  • Golob TF (2003) Structural equation modeling for travel behavior research. Transp Res Part B: Methodol 37:1–25

    Article  Google Scholar 

  • Hair JF, Sarstedt M, Ringle CM, Mena JA (2012) An assessment of the use of partial least squares structural equation modeling in marketing research. J Acad Mark Sci 40:414–433

    Article  Google Scholar 

  • Halling B, Wijk K (2013) Experienced barriers to lean in Swedish manufacturing and health care. Int J Lean Think 4:43–63

    Google Scholar 

  • Hihnala S, Kettunen L, Suhonen M, Tiirinki H (2018) The Finnish healthcare services lean management: health services managers’ experiences in a special health care unit. Leadersh Health Serv 31:17–32

    Article  Google Scholar 

  • Hines P, Holweg M, Rich N (2004) Learning to evolve: a review of contemporary lean thinking. Int J Oper Prod Manag 24:994–1011

    Article  Google Scholar 

  • Hooper D, Coughlan J, Mullen MR (2008) Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods 6:53–60

    Google Scholar 

  • Hu Lt, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J 6:1–55

    Article  Google Scholar 

  • Hutchins K (2006) United Airlines says goodbye to “the Big B”. Ground Support Mag 14:14–17

    Google Scholar 

  • Jain V, Ajmera P (2018a) Modelling the factors affecting Indian medical tourism sector using interpretive structural modeling. Benchmark Int J 25:1461–1479

    Article  Google Scholar 

  • Jain V, Ajmera P (2018b) Quantifying the variables affecting Indian medical tourism sector by graph theory and matrix approach. Manag Sci Lett 8:225–240

    Article  Google Scholar 

  • Jain V, Raj T (2013) Evaluating the variables affecting flexibility in FMS by exploratory and confirmatory factor analysis. Global J Flex Syst Manag 14:181–193. https://doi.org/10.1007/s40171-013-0042-9

    Article  Google Scholar 

  • Jain V, Raj T (2014) Modelling and analysis of FMS productivity variables by ISM, SEM and GTMA approach. Front of Mech Eng 9:218–232. https://doi.org/10.1007/s11465-014-0309-7

    Article  Google Scholar 

  • Jain V, Raj T (2016) Modeling and analysis of FMS performance variables by ISM, SEM and GTMA approach. Int J Prod Econ 171:84–96. https://doi.org/10.1016/j.ijpe.2015.10.024

    Article  Google Scholar 

  • Jöreskog KG, Sörbom D (1993) LISREL 8: structural equation modeling with the SIMPLIS command language. Scientific Software International, Chicago

    Google Scholar 

  • Kim CS, Spahlinger DA, Kin JM, Billi JE (2006) Lean health care: what can hospitals learn from a world-class automaker? J Hosp Med 1:191–199

    Article  Google Scholar 

  • Kline R (2011) Principles and practice of structural equation modeling, 3rd edn. Guilford Press, New York

    MATH  Google Scholar 

  • Lander E, Liker JK (2007) The Toyota Production System and art: making highly customized and creative products the Toyota way. Int J Prod Res 45:3681–3698

    Article  Google Scholar 

  • Langabeer JR, DelliFraine JL, Heineke J, Abbass I (2009) Implementation of Lean and Six Sigma quality initiatives in hospitals: a goal theoretic perspective. Oper Manag Res 2:13–27

    Article  Google Scholar 

  • Lau AK, Yam RC, Tang EP (2010) Supply chain integration and product modularity: an empirical study of product performance for selected Hong Kong manufacturing industries. Int J Oper Prod Manag 30:20–56

    Article  Google Scholar 

  • Lawal AK et al (2014) Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Syst Rev 3:103

    Article  Google Scholar 

  • Lee D, Rho B-H, Yoon SN (2015) Effect of investments in manufacturing practices on process efficiency and organizational performance. Int J Prod Econ 162:45–54

    Article  Google Scholar 

  • Liker JK (2004) The Toyota Way: 14 management principles from the World’s greatest automaker. McGraw-Hill, New York

    Google Scholar 

  • Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP (2007) Transformational change in health care systems: an organizational model. Health Care Manag Rev 32:309–320

    Article  Google Scholar 

  • MacCallum RC, Browne MW, Sugawara HM (1996) Power analysis and determination of sample size for covariance structure modeling. Psychol Methods 1:130–149

    Article  Google Scholar 

  • Magd HA (2008) ISO 9001: 2000 in the Egyptian manufacturing sector: perceptions and perspectives. Int J Qual Reliab Manag 25:173–200

    Article  Google Scholar 

  • Maiga AS, Nilsson A, Ax C (2015) Relationships between internal and external information systems integration, cost and quality performance, and firm profitability. Int J Prod Econ 169:422–434

    Article  Google Scholar 

  • Mazzocato P, Holden RJ, Brommels M, Aronsson H, Bäckman U, Elg M, Thor J (2012) How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Serv Res 12:28

    Article  Google Scholar 

  • McDonald RP, Ho M-HR (2002) Principles and practice in reporting structural equation analyses. Psychol Methods 7:64

    Article  Google Scholar 

  • Miles J, Shevlin M (2007) A time and a place for incremental fit indices. Personal Individ Differ 42:869–874

    Article  Google Scholar 

  • Mittal VK, Sindhwani R, Kapur P (2016) Two-way assessment of barriers to lean–green manufacturing system: insights from India. Int J Syst Assur Eng Manag 7:400–407

    Article  Google Scholar 

  • Mulaik SA, James LR, Van Alstine J, Bennett N, Lind S, Stilwell CD (1989) Evaluation of goodness-of-fit indices for structural equation models. Psychol Bull 105:430

    Article  Google Scholar 

  • Naik T, Duroseau Y, Zehtabchi S, Rinnert S, Payne R, McKenzie M, Legome E (2012) A structured approach to transforming a large public hospital emergency department via lean methodologies. J Healthc Qual 34:86–97

    Article  Google Scholar 

  • Nunnally JC (1978) Psychometric theory, 2nd edn. Tata McGraw-Hill Education, New York

    Google Scholar 

  • Park HS, Dailey R, Lemus D (2002) The use of exploratory factor analysis and principal components analysis in communication research. Hum Commun Res 28:562–577

    Article  Google Scholar 

  • Patidar L, Soni VK, Soni PK (2017) Manufacturing wastes analysis in lean environment: an integrated ISM-fuzzy MICMAC approach. Int J Syst Assur Eng Manag 8:1783–1809. https://doi.org/10.1007/s13198-017-0669-6

    Article  Google Scholar 

  • Patri R, Suresh M (2018) Factors influencing lean implementation in healthcare organizations: AN ISM approach. Int J Healthc Manag 11:25–37. https://doi.org/10.1080/20479700.2017.1300380

    Article  Google Scholar 

  • Pettersen J (2009) Defining lean production: some conceptual and practical issues. TQM J 21:127–142

    Article  Google Scholar 

  • Punnakitikashem P, Buavaraporn N, Chen L (2013) An investigation of factors affecting Lean implementation success of Thai logistics companies. In: 24th POMS annual conference

  • Radnor ZJ, Holweg M, Waring J (2012) Lean in healthcare: the unfilled promise? Soc Sci Med 74:364–371

    Article  Google Scholar 

  • Reinhardt K (2007) Kaizen: a change for the better. Ground Support Worldw 15:14–17

    Google Scholar 

  • Rother M, Shook J (1999) Learning to see. Lean Enterprise Institute, Cambridge

    Google Scholar 

  • Ryman TK, Austin MA, Hopkins S, Philip J, O’Brien D, Thummel K, Boyer BB (2014) Using exploratory factor analysis of FFQ data to identify dietary patterns among Yup’ik people. Public Health Nutr 17:510–518

    Article  Google Scholar 

  • Schoenherr T, Narayanan S, Narasimhan R (2015) Trust formation in outsourcing relationships: a social exchange theoretic perspective. Int J Prod Econ 169:401–412

    Article  Google Scholar 

  • Schonberger RJ (2018) Reconstituting lean in healthcare: from waste elimination toward ‘queue-less’ patient-focused care. Bus Horiz 61:13–22

    Article  Google Scholar 

  • Schumacker RE, Lomax RG (2012) A beginner’s guide to structural equation modeling. Routledge, New York

    Book  Google Scholar 

  • Shah R, Goldstein SM (2006) Use of structural equation modeling in operations management research: looking back and forward. J Oper Manag 24:148–169

    Article  Google Scholar 

  • Shazali NA, Habidin NF, Ali N, Khaidir NA, Jamaludin NH (2013) Lean healthcare practice and healthcare performance in Malaysian healthcare industry. Int J Sci Res Publ 3:1–5

    Google Scholar 

  • Stevens JP (2012) Exploratory and confirmatory factor analysis. In: Stevens JP (ed) Applied multivariate statistics for the social sciences. Routledge, New York, pp 337–406

    Google Scholar 

  • Su Y-f, Yang C (2010) A structural equation model for analyzing the impact of ERP on SCM. Expert Syst Appl 37:456–469

    Article  Google Scholar 

  • Suárez-Barraza MF, Ramis-Pujol J (2008) Process standardisation and sustainable continuous improvement: a closer look at the application of ISO 9000 to Logroño City Council (Spain). Int J Qual Stand 1:1–35

    Google Scholar 

  • Suhr DD (2006) Exploratory or confirmatory factor analysis. SAS Institute, Cary

    Google Scholar 

  • Swank CK (2003) The lean service machine. Harvard Bus Rev 81:123–130

    Google Scholar 

  • Tabachnick BG, Fidell LS (2007) Using multivariate statistics. Allyn and Bacon, New York

    Google Scholar 

  • Toussaint J, Gerard R (2010) On the mend: revolutionizing healthcare to save lives and transform the industry. Lean Enterprise Institute, Cambridge

    Google Scholar 

  • Valmohammadi C, Roshanzamir S (2015) The guidelines of improvement: relations among organizational culture, TQM and performance. Int J Prod Econ 164:167–178. https://doi.org/10.1016/j.ijpe.2014.12.028

    Article  Google Scholar 

  • Womack JP, Jones DT (1997) Lean thinking—banish waste and create wealth in your corporation. J Oper Res Soc 48:1148

    Article  Google Scholar 

  • Zeng J, Phan CA, Matsui Y (2015) The impact of hard and soft quality management on quality and innovation performance: an empirical study. Int J Prod Econ 162:216–226

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Mechanical Engineering, Amity University Haryana, Gurgaon, India

    Vineet Jain

  2. Department of Hospital Administration, Amity Medical School, Amity University Haryana, Gurgaon, India

    Puneeta Ajmera

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  1. Vineet Jain
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Jain, V., Ajmera, P. Modelling of the factors affecting lean implementation in healthcare using structural equation modelling. Int J Syst Assur Eng Manag 10, 563–575 (2019). https://doi.org/10.1007/s13198-019-00770-4

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