Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

Organizational issues for the lean success in China: exploring a change strategy for lean success

Authors: Tian Gao, Bruce Gurd

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

The purpose of this paper is to explore a change strategy for lean success in hospitals based on a comprehensive review of the Chinese literature.

Methods

The methodology is a systematic review of the Chinese literature which identified 212 case study papers about lean implementation. We did a thematic content analysis of the 212 papers.

Results

Lean applications in Chinese hospitals show significant increases and are mainly used in the fields of outpatient services, operating rooms, pharmacy and logistics. Most hospitals applied lean as a single project but some were beginning to use lean as a systemic path for improvement with an emphasis on lean and strategy. The main goals were to increase the operating efficiency and reduce operating costs. Patients were not central to lean applications. Chinese hospitals appear to lack a full understanding of lean. Four factors appear to be critical for lean success - organizational leadership, adequate technology, stakeholder involvement and individual and organizational benefits. The relationship of these factors changes over time.

Conclusions

This is the first paper to provide a comprehensive view of lean application in Chinese hospitals. The findings presented in this paper provide a systemic evidence to the application of lean in healthcare.
Footnotes
1
One hospital did not provide specific information on the lean application.
 
Literature
1.
Womak J, Jones D. Lean thinking. New York: Simon and Shuster; 1996.
2.
Houchens N, Kim CS. The Application of Lean in the Healthcare Sector: Theory and Practical Examples. In: Wickramasinghe N, Al-Hakim L, Gonzalez C, Tan J, editors. Lean Thinking for Healthcare. New York Heidelberg Dordrecht London: Springer; 2013. p. 43–54.
3.
Maijala R, Eloranta S, Reunanen T, Ikonen TS. Successful implementation of lean as a managerial principle in health care: a conceptual analysis from systematic literature review. Int J Technol Assess Health Care. 2018;34(2):134–46.PubMedCrossRef
4.
Su Y, Soar J, Shen N, Al-Hakim L. Adapted Lean Thinking for Healthcare Services: An Empirical Study in the Traditional Chinese Hospital. In: Wickramasinghe N, Al-Hakim L, Gonzalez C, Tan J, editors. Lean Thinking for Healthcare. New York Heidelberg Dordrecht London: Springer; 2013. p. 115–42.
5.
Zwicker M, Seitz J, Wickramasinghe N. Identifying Critical Issues for Developing Successful e-Health Solutions. In: Wickramasinghe N, Al-Hakim L, Gonzalez C, Tan J, editors. Lean Thinking for Healthcare. New York Heidelberg Dordrecht London: Springer; 2013. p. 207–24.
6.
Burgess NJ. Evaluating Lean in Healthcare. In: University of Warwick, Warwick Business School; 2012.
7.
Krafcik JF. Triumph of the lean production system. Sloan Manag Rev. 1988;30(1):1566–74.
8.
Deara A, Deara M, Bamber C, Elezi E. A comparative analysis of lean implementations in NHS England hospitals. International Journal of Lean Enterprise Research. 2018;2(3):218–39.CrossRef
9.
Cusumano MA. Manufacturing Innovation: Lessons from the Japanese Auto Industry Sloan Management Review. 1988;30(1, Fall):29–39.
10.
Holweg M. The genealogy of lean production. J Oper Manag. 2007;25(2):420–37.CrossRef
11.
Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform. 2013;82(5):73–86.CrossRef
12.
13.
Joosten T, Bongers I, Janssen R. 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. 2009;21(5):341–7.CrossRef
14.
Mazzocato P, Savage C, Brommels M, Aronsson H, Thor J. Lean thinking in healthcare: a realist review of the literature. Quality and Safety in Health Care. 2010;19(5):376–82.PubMed
15.
Radnor ZJ, Holweg M, Waring J. Lean in healthcare: the unfilled promise? Soc Sci Med. 2012;74(3):364–71.PubMedCrossRef
16.
Andersen H, Røvik KA, Ingebrigtsen T. Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews. BMJ Open. 2014;4(1):e003873.PubMedPubMedCentralCrossRef
17.
Burgess N, Radnor Z. Evaluating lean in healthcare. International Journal of Health Care Quality Assurance. 2013;26(3):220–35.PubMedCrossRef
18.
Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM. Quality and lean health care: a system for assessing and improving the health of healthcare organisations. Total Qual Manag Bus Excell. 2011;22(6):673–89.CrossRef
19.
Costa LBM, Godinho Filho M. Lean healthcare: review, classification and analysis of literature. Production Planning & Control. 2016;27(10):823–36.CrossRef
20.
Brännmark M, Lindskog P, Halvarsson A. Patient quality effects from lean healthcare: an empirical investigation. In: NES2012 proceedings.: ergonomics for sustainability and growth, Stockholm: KTH Royal Institute of Technology; 2012.
21.
Shazali NA, Habidin NF, Ali N, Khaidir NA, Jamaludin NH. Lean healthcare practice and healthcare performance in Malaysian healthcare industry. International Journal of Scientific and Research Publications. 2013;3(1):1–5.
22.
Al-Balushi S, et al. Readiness factors for lean implementation in healthcare settings–a literature review. Journal of health organization and management. 2014;28(2):135–53.PubMedCrossRef
23.
Poksinska B. The current state of lean implementation in health care: literature review. Quality Management in Health Care. 2010;19(4):319–29.PubMedCrossRef
24.
Holden RJ. Lean thinking in emergency departments: a critical review. Ann Emerg Med. 2011;57(3):265–78.PubMedCrossRef
25.
Morrow E, et al. Implementing large-scale quality improvement: lessons from the productive Ward:releasing time to care. International Journal of Health Care Quality Assurance. 2012;25(4):237–53.PubMedCrossRef
26.
Niemeijer, G., et al.. Generic project definitions for improvement of health care deliv-ery: a case-based approach Quality Management in Health Care. 2011;. 20(2): 152–164.
27.
Jin M, Switzer M, Agirbas G. Six Sigma and Lean in healthcare logistics centre design and operation: a case at North Mississippi Health Services International. Journal of Six Sigma and Competitive Advantage. 2008;4(3):270–88.CrossRef
28.
National Health and Family Planning Commission of the People's Repubic of China. China Health and Family Planning Statistics Yearbook 2016. Beijing: Peking Union Medical College press; 2016.
29.
Deng Y. Focus on patient and improve healthcare quality - overview of hospital management year working conference. Chinese Hospitals. 2005;9(5):4–6.
30.
31.
Wang H. A dilemma of Chinese healthcare reform: how to re-define government roles? China Econ Rev. 2009;20(4):598–604.CrossRef
32.
Dong K. Medical insurance system evolution in China. China Econ Rev. 2009;20(4):591–7.CrossRef
33.
34.
Liu XZ, Liu YL, Chen NS. The Chinese experience of hospital Price regulation. Health Policy Plan. 2000;15(2):157–63.PubMedCrossRef
35.
Wang S. The tradition of Confucian moral cultivation and the cultivation of modern personality. Journal of Chongqing University of Science and Technology (Social Sciences Edition). 2009;7:157–8.
36.
Hsiao W. The Chinese health care system: lessons for other nations. Soc Sci Med. 1995;41(8):1047–55.PubMedCrossRef
37.
Wong V, Chiu S. Health-care reforms in the People’s republic of China. Journal of Management in Medicine. 1998;12(4/5):270–86.PubMedCrossRef
38.
Liu X, Mills A. The effect of performance-related pay of hospital doctors on hospital behaviour: A case study from Shandong, China. Human Resources for Health. 2005;3:11.PubMedPubMedCentralCrossRef
39.
Dib HH, Hong SY, Bin Z, Hongliang S. Health care costs in China: need for intervention. J Health Manag. 2007;9(1):85–103.CrossRef
40.
Braam G, Benders J, Heusinkveld S. The balanced scorecard in the Netherlands. Journal of Organization Change Management. 2007;20(6):866–79.CrossRef
41.
Lin JK, Zhao MJ. A trial on the hospital practice of“consummate service”. Chinese Journal of Hospital Administration. 1997;6:363–4.
42.
Ren Z. To Promote High Quality Nursing Services with Lean Management. Journal of Capital Medical University (Social Science Edition). 2013;4:20–3.
43.
Yi LH, Zhao Y, Hu MM, Xing M. Delicacy management chain and its role in improvement of hospital management and service. Chinese Journal of Hospital Administration. 2014;30(3):174–7.
44.
Luo J, Xu DG, Luo F, Jiang F, Shang XK, Tu ZL, Feng XM. Practice and experience of applying lean management in our hospital. Chinese Hospital Management. 2011;31(9):22–3.
45.
Zhao YM, Zhang WY, Chen X, Li FM, Hu RY, Xu FX, Ma DM, Zhang JF. Exploration of improved hospital creation by all workers with the introduction of Toyota production system. Modern Hospital Management. 2014;12(2):41–4.
46.
Liu H, Li YM. An explore of innovation leading propaganda work to boost the construction of lean hospital. Capital Medicine. 2013;6:14–6.
47.
Ye CQ, Zhao DH, Qu HY, Zhang LP, Hu Z, Li QY. Practice and thinking of application of lean in the physical examination center. Journal of Military Surgeon in Southwest China. 2015;17(3):352–3.
48.
Fan KH. Experience of the implementation lean Management in Drugstores in our hospital. China Pharmacy. 2011;22(25):2355–7.
49.
Xia ZM. The effect of lean management on the punctual start rate in operating room. Chinese Journal of Rural Medicine. 2015;22(4):102–3.
50.
Xiang YJ, Li LZ. Optimizing outpatient procedure by lean management. China Hospital CEO. 2012;17:76–7.
51.
Wang XL, Wang Q, Li HC. Attempts to lean management in optimizing the nursing work process. Hospital Directors' Forum. 2012;3:54–6.
52.
Liu M, Zhao DH, Qu HY, Li QY. Use lean management to improve the efficiency of hospital financial management. For all Health (Academic Edition). 2014;8(2):383.
53.
Zhou YJ, Zhu ZM. Promotion of lean management of hospital human resource by the thinking of people oriented. China Medical Herald. 2011;35:140–2.
54.
Zeng DM, Zhang ZJ. Build a new hospital culture with lean management as the guide. Economist. 2012;10:282–3.
55.
Lin H, Wang YH, Qu BX, Xia P. Applying lean management in process optimization of outpatient pharmacy. Chinese Journal of Hospital Administration. 2009;25(2):83–4.
56.
Zhang J, Tan JM. Optimization of a surgery scheduling system based on lean management. J Nurs Sci. 2014;29(10):45–7.
57.
Li Y, Hu MM. On hospital culture construction from the perspective of lean management. Value Engineering. 2014;31:200–1.
58.
Geng RW, Lin JX, Zhu H, Wang JY. Introduction of lean management and innovation of hospital culture. Chinese Journal of Hospital Administrati. 2008;24(5):289–91,97.
59.
Christopher SK, David AS, Jeanne MK, John EB, Yuan J. Inspirations of Toyota's perfection management on the medical industry. Chinese Journal of Hospital Administration. 2009;25(2):77–80.
60.
Fillingham D. Can lean saves lives? Leadersh Health Serv. 2007;20(4):231–41.CrossRef
61.
Gao T. Analysis on the diffusion of the balanced scorecard in Chinese hospitals based on PMI method. Chinese Hospitals. 2015;2:33–4.
62.
Speckbacher G, Bischof J, Pefeiffer T. A descriptive analysis on the implementation of balanced scorecard in German-speaking countries. Manag Account Res. 2003;14(4):361–87.CrossRef
63.
Young TP, Mcclean SI. A critical look at lean thinking in healthcare. Quality & Safety in Health Care. 2008;17(5):382–6.CrossRef
64.
Ballé M, Régnier A. Lean as a learning system in a hospital ward. Leadersh Health Serv. 2007;20(1):33–41.CrossRef
65.
Radnor Z, Boaden R. Editorial: Lean in public services-panacea or paradox? Public Money & Management. 2008;28(1):3–7.
66.
Goossens A, Bossuyt PMM, De Haan RJ. Physicians and nurses focus on different aspects of guidelines when deciding whether to adopt them: an application of conjoint analysis. Med Decis Mak. 2008;28(1):138–45.CrossRef
67.
Emiliani B. Real. In: Lean: Understanding the lean management system. The Center for Lean Business Management. Wethersfield, CT: LLC; 2007.
68.
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: releasing time to care initiative. The International Journal of Leadership in Public Services. 2013;9(3/4):90–108.CrossRef
Metadata
Title
Organizational issues for the lean success in China: exploring a change strategy for lean success
Authors
Tian Gao
Bruce Gurd
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-3907-6

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

Relationships between dental hygienists’ work environment and patient safety culture

Research article

Unlawful dispensing practice of diazepam: a simulated client approach in community pharmacies in the north-west of Dar-es-Salaam region, Tanzania

Research article

Preferences for HIV testing services among young people in Nigeria

Research article

Evaluation of facility and community-based active household tuberculosis contact investigation in Ethiopia: a cross-sectional study

Research article

Patient safety culture among nurses working in Palestinian governmental hospital: a pathway to a new policy

Research article

What happened and why? A programme theory-based qualitative evaluation of a healthcare-academia partnership reform in primary care