Sustaining lean thinking in healthcare: case studies
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFSCAR |
Texto Completo: | https://repositorio.ufscar.br/handle/ufscar/9801 |
Resumo: | Many hospitals have achieved high levels of lean performance only to lose it later on. These hospitals, which often achieved excellent results, neglected some specific aspects of sustaining lean improvements in their environments, and failed to maintain what was implemented. This research develops a theoretical understanding of how organizations can sustain lean in healthcare. Through the analysis of the literature, it was possible to compile 22 main critical success factors of lean sustainability in hospitals through three main pillars: people, method and tools. A comparative case study provides evidence to confirm these 22 theoretical propositions, and also to add other 5 new propositions to the framework. The proposed framework allows hospitals to conduct a structured process of change, with all the foundation needed to succeed and sustain the lean journey in the long-term. It differs from previous studies by integrating literature streams that have been previously disconnected and by specifying the components of lean healthcare sustainability. These new insights are revealed by studying hospitals after minimum 18 months of lean implementation and comparing the ones that have achieved a high level of lean sustainability with those that do not. To the best of our knowledge, this dissertation is the first to attempt to bring together the key factors that influence hospitals to sustain lean improvements in the long term. This research found evidence that external factors to the three pillars may also interfere to facilitate or difficult hospitals to achieve sustainability in their lean implementations. They are called “success variables moderators” and they are intrinsically linked to the organizational characteristics of each hospital. The variables “type of administration and financial objective” and “accreditation” have proved to influence the hospital to achieve success in its lean implementations in the long term. Another interesting conclusion that can be drawn is that although it is notorious knowledge, several points brought by the theoretical framework proved to be difficult to implement and the hospitals are failing to implement the basics. |
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Henrique, Daniel BarberatoGodinho Filho, Moacirhttp://lattes.cnpq.br/6136685270563354http://lattes.cnpq.br/9069896528184461514d2510-e635-447e-9821-ad80c5d54e852018-04-24T11:16:05Z2018-04-24T11:16:05Z2018-03-01HENRIQUE, Daniel Barberato. Sustaining lean thinking in healthcare: case studies. 2018. Tese (Doutorado em Engenharia de Produção) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/9801.https://repositorio.ufscar.br/handle/ufscar/9801Many hospitals have achieved high levels of lean performance only to lose it later on. These hospitals, which often achieved excellent results, neglected some specific aspects of sustaining lean improvements in their environments, and failed to maintain what was implemented. This research develops a theoretical understanding of how organizations can sustain lean in healthcare. Through the analysis of the literature, it was possible to compile 22 main critical success factors of lean sustainability in hospitals through three main pillars: people, method and tools. A comparative case study provides evidence to confirm these 22 theoretical propositions, and also to add other 5 new propositions to the framework. The proposed framework allows hospitals to conduct a structured process of change, with all the foundation needed to succeed and sustain the lean journey in the long-term. It differs from previous studies by integrating literature streams that have been previously disconnected and by specifying the components of lean healthcare sustainability. These new insights are revealed by studying hospitals after minimum 18 months of lean implementation and comparing the ones that have achieved a high level of lean sustainability with those that do not. To the best of our knowledge, this dissertation is the first to attempt to bring together the key factors that influence hospitals to sustain lean improvements in the long term. This research found evidence that external factors to the three pillars may also interfere to facilitate or difficult hospitals to achieve sustainability in their lean implementations. They are called “success variables moderators” and they are intrinsically linked to the organizational characteristics of each hospital. The variables “type of administration and financial objective” and “accreditation” have proved to influence the hospital to achieve success in its lean implementations in the long term. Another interesting conclusion that can be drawn is that although it is notorious knowledge, several points brought by the theoretical framework proved to be difficult to implement and the hospitals are failing to implement the basics.Muitos hospitais atingiram altos níveis de desempenho lean e o perderam mais tarde. Esses hospitais, que muitas vezes alcançaram excelentes resultados, negligenciaram alguns aspectos específicos da sustentabilidade das melhorias implementadas e não conseguiram manter o que foi implementado no longo prazo. Esta pesquisa desenvolve um modelo teórico de como as organizações podem sustentar o lean em ambientes hospitalares. Através da análise da literatura, foi possível compilar 22 principais fatores críticos de sucesso da sustentabilidade lean em hospitais por meio de três pilares principais: pessoas, método e ferramentas. Após esse levantamento, um estudo de caso comparativo é realizado e fornece evidências para confirmar essas 22 proposições teóricas, e também para adicionar outras 5 novas proposições ao modelo final. O modelo final proposto visa ajudar os hospitais a conduzirem um processo estruturado de mudança, com toda a base necessária para alcançar sucesso e sustentar a jornada lean no longo prazo. A tese se difere de estudos anteriores por integrar teorias desconectadas e por especificar os componentes da sustentabilidade lean para ambientes hospitalares. Os fatores críticos que compões o modelo final proposto foi consolidado por meio do estudo de hospitais após um mínimo de 18 meses de implementação lean e da comparação daqueles que alcançaram um alto nível de sustentabilidade com aqueles que não o fizeram. Até onde sabemos, esta tese é a primeira a tentar reunir os principais fatores que influenciam os hospitais a sustentar melhorias lean a longo prazo. Esta pesquisa encontrou evidências de que fatores externos aos três pilares (pessoas, método e ferramentas) também podem interferir para facilitar ou dificultar os hospitais a alcançarem a sustentabilidade em suas implementações de lean healthcare. Eles são chamados de “variáveis moderadoras de sucesso” e estão intrinsecamente ligados às características organizacionais de cada hospital. As variáveis “tipo de administração e objetivo financeiro” e “acreditação” provaram influenciar o hospital para alcançar sucesso em suas implementações lean no longo prazo. Outra conclusão interessante é que, embora seja de conhecimento notório, vários pontos levantados na literatura atual sobre o tema mostraram-se difíceis de se implementar e os hospitais estão falhando ao implementar o básico.Não recebi financiamentoengUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Engenharia de Produção - PPGEPUFSCarHospitaisSustentabilidadeEstudo de casoMelhoria contínuaLean healthcareLean sustainabilityLean hospitalCase studyContinuous improvementENGENHARIAS::ENGENHARIA DE PRODUCAO::GERENCIA DE PRODUCAOSustaining lean thinking in healthcare: case studiesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisOnline6006009e5a83c6-728c-4e41-946f-fd7a8431b1d6info:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARLICENSElicense.txtlicense.txttext/plain; charset=utf-81957https://repositorio.ufscar.br/bitstream/ufscar/9801/4/license.txtae0398b6f8b235e40ad82cba6c50031dMD54ORIGINALHENRIQUE_Daniel_2018.pdfHENRIQUE_Daniel_2018.pdfapplication/pdf4762976https://repositorio.ufscar.br/bitstream/ufscar/9801/5/HENRIQUE_Daniel_2018.pdfdc5df077993c35e569a9f63f06b4cffcMD55TEXTHENRIQUE_Daniel_2018.pdf.txtHENRIQUE_Daniel_2018.pdf.txtExtracted texttext/plain315481https://repositorio.ufscar.br/bitstream/ufscar/9801/6/HENRIQUE_Daniel_2018.pdf.txt02d4a3cad83908f59dee597ef5610a02MD56THUMBNAILHENRIQUE_Daniel_2018.pdf.jpgHENRIQUE_Daniel_2018.pdf.jpgIM Thumbnailimage/jpeg6700https://repositorio.ufscar.br/bitstream/ufscar/9801/7/HENRIQUE_Daniel_2018.pdf.jpgf6992fdeec9567f9107ef92101c1db6dMD57ufscar/98012023-09-18 18:31:42.786oai:repositorio.ufscar.br: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Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:31:42Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false |
dc.title.eng.fl_str_mv |
Sustaining lean thinking in healthcare: case studies |
title |
Sustaining lean thinking in healthcare: case studies |
spellingShingle |
Sustaining lean thinking in healthcare: case studies Henrique, Daniel Barberato Hospitais Sustentabilidade Estudo de caso Melhoria contínua Lean healthcare Lean sustainability Lean hospital Case study Continuous improvement ENGENHARIAS::ENGENHARIA DE PRODUCAO::GERENCIA DE PRODUCAO |
title_short |
Sustaining lean thinking in healthcare: case studies |
title_full |
Sustaining lean thinking in healthcare: case studies |
title_fullStr |
Sustaining lean thinking in healthcare: case studies |
title_full_unstemmed |
Sustaining lean thinking in healthcare: case studies |
title_sort |
Sustaining lean thinking in healthcare: case studies |
author |
Henrique, Daniel Barberato |
author_facet |
Henrique, Daniel Barberato |
author_role |
author |
dc.contributor.authorlattes.por.fl_str_mv |
http://lattes.cnpq.br/9069896528184461 |
dc.contributor.author.fl_str_mv |
Henrique, Daniel Barberato |
dc.contributor.advisor1.fl_str_mv |
Godinho Filho, Moacir |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/6136685270563354 |
dc.contributor.authorID.fl_str_mv |
514d2510-e635-447e-9821-ad80c5d54e85 |
contributor_str_mv |
Godinho Filho, Moacir |
dc.subject.por.fl_str_mv |
Hospitais Sustentabilidade Estudo de caso Melhoria contínua |
topic |
Hospitais Sustentabilidade Estudo de caso Melhoria contínua Lean healthcare Lean sustainability Lean hospital Case study Continuous improvement ENGENHARIAS::ENGENHARIA DE PRODUCAO::GERENCIA DE PRODUCAO |
dc.subject.eng.fl_str_mv |
Lean healthcare Lean sustainability Lean hospital Case study Continuous improvement |
dc.subject.cnpq.fl_str_mv |
ENGENHARIAS::ENGENHARIA DE PRODUCAO::GERENCIA DE PRODUCAO |
description |
Many hospitals have achieved high levels of lean performance only to lose it later on. These hospitals, which often achieved excellent results, neglected some specific aspects of sustaining lean improvements in their environments, and failed to maintain what was implemented. This research develops a theoretical understanding of how organizations can sustain lean in healthcare. Through the analysis of the literature, it was possible to compile 22 main critical success factors of lean sustainability in hospitals through three main pillars: people, method and tools. A comparative case study provides evidence to confirm these 22 theoretical propositions, and also to add other 5 new propositions to the framework. The proposed framework allows hospitals to conduct a structured process of change, with all the foundation needed to succeed and sustain the lean journey in the long-term. It differs from previous studies by integrating literature streams that have been previously disconnected and by specifying the components of lean healthcare sustainability. These new insights are revealed by studying hospitals after minimum 18 months of lean implementation and comparing the ones that have achieved a high level of lean sustainability with those that do not. To the best of our knowledge, this dissertation is the first to attempt to bring together the key factors that influence hospitals to sustain lean improvements in the long term. This research found evidence that external factors to the three pillars may also interfere to facilitate or difficult hospitals to achieve sustainability in their lean implementations. They are called “success variables moderators” and they are intrinsically linked to the organizational characteristics of each hospital. The variables “type of administration and financial objective” and “accreditation” have proved to influence the hospital to achieve success in its lean implementations in the long term. Another interesting conclusion that can be drawn is that although it is notorious knowledge, several points brought by the theoretical framework proved to be difficult to implement and the hospitals are failing to implement the basics. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-04-24T11:16:05Z |
dc.date.available.fl_str_mv |
2018-04-24T11:16:05Z |
dc.date.issued.fl_str_mv |
2018-03-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
HENRIQUE, Daniel Barberato. Sustaining lean thinking in healthcare: case studies. 2018. Tese (Doutorado em Engenharia de Produção) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/9801. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufscar.br/handle/ufscar/9801 |
identifier_str_mv |
HENRIQUE, Daniel Barberato. Sustaining lean thinking in healthcare: case studies. 2018. Tese (Doutorado em Engenharia de Produção) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/9801. |
url |
https://repositorio.ufscar.br/handle/ufscar/9801 |
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eng |
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eng |
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openAccess |
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Universidade Federal de São Carlos Câmpus São Carlos |
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Programa de Pós-Graduação em Engenharia de Produção - PPGEP |
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UFSCar |
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Universidade Federal de São Carlos Câmpus São Carlos |
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