Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context

Abstract Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, re...

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Autores principales:	Elina Reponen, Ritva Jokela, Janet C. Blodgett, Thomas G. Rundall, Stephen M. Shortell, Mikko Nuutinen, Noora Skants, Markku Mäkijärvi, Paulus Torkki
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Lean healthcare Lean management Lean implementation Self-assessment instrument Lean maturity assessment Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/5dcb396894b84a8495b2aac10779eca2
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spelling	oai:doaj.org-article:5dcb396894b84a8495b2aac10779eca22021-12-05T12:06:54ZValidation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context10.1186/s12913-021-07322-21472-6963https://doaj.org/article/5dcb396894b84a8495b2aac10779eca22021-12-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07322-2https://doaj.org/toc/1472-6963Abstract Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Methods The original HISI survey was sent over a secure organizational email system to the over 26,000 employees of the Hospital District of Helsinki and Uusimaa in March 2020. The data were randomly split with one part used to carry out an exploratory factor analysis (EFA), and the other for testing the resulting model using confirmatory factor analysis (CFA). Results A total of 6073 employees responded to the LHISI survey, for an overall response rate of 23%. The results indicated that the 43 items used in the original LHISI can be reduced to 25 items, and these items measure a five-dimensional model of the progress of Lean implementation: leadership, commitment, standard work, communication, and daily management system. In comparison with a single-factor model, the fit measures for the 5-factor model were better: smaller X2, larger comparative fit index (CFI), smaller root mean square error of approximation (RMSEA), and smaller standardized root mean square residual (SRMR). Conclusions The 25 item LHISI is valid and feasible to use in the context of Finnish healthcare. The LHISI allows the organization to self-monitor the progress of its Lean implementation and provides the leadership with actionable knowledge to guide the path towards Lean maturity across the organization. Our findings encourage further studies on the adoption and validation of the LHISI in healthcare organizations worldwide.Elina ReponenRitva JokelaJanet C. BlodgettThomas G. RundallStephen M. ShortellMikko NuutinenNoora SkantsMarkku MäkijärviPaulus TorkkiBMCarticleLean healthcareLean managementLean implementationSelf-assessment instrumentLean maturity assessmentPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Lean healthcare Lean management Lean implementation Self-assessment instrument Lean maturity assessment Public aspects of medicine RA1-1270
spellingShingle	Lean healthcare Lean management Lean implementation Self-assessment instrument Lean maturity assessment Public aspects of medicine RA1-1270 Elina Reponen Ritva Jokela Janet C. Blodgett Thomas G. Rundall Stephen M. Shortell Mikko Nuutinen Noora Skants Markku Mäkijärvi Paulus Torkki Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
description	Abstract Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Methods The original HISI survey was sent over a secure organizational email system to the over 26,000 employees of the Hospital District of Helsinki and Uusimaa in March 2020. The data were randomly split with one part used to carry out an exploratory factor analysis (EFA), and the other for testing the resulting model using confirmatory factor analysis (CFA). Results A total of 6073 employees responded to the LHISI survey, for an overall response rate of 23%. The results indicated that the 43 items used in the original LHISI can be reduced to 25 items, and these items measure a five-dimensional model of the progress of Lean implementation: leadership, commitment, standard work, communication, and daily management system. In comparison with a single-factor model, the fit measures for the 5-factor model were better: smaller X2, larger comparative fit index (CFI), smaller root mean square error of approximation (RMSEA), and smaller standardized root mean square residual (SRMR). Conclusions The 25 item LHISI is valid and feasible to use in the context of Finnish healthcare. The LHISI allows the organization to self-monitor the progress of its Lean implementation and provides the leadership with actionable knowledge to guide the path towards Lean maturity across the organization. Our findings encourage further studies on the adoption and validation of the LHISI in healthcare organizations worldwide.
format	article
author	Elina Reponen Ritva Jokela Janet C. Blodgett Thomas G. Rundall Stephen M. Shortell Mikko Nuutinen Noora Skants Markku Mäkijärvi Paulus Torkki
author_facet	Elina Reponen Ritva Jokela Janet C. Blodgett Thomas G. Rundall Stephen M. Shortell Mikko Nuutinen Noora Skants Markku Mäkijärvi Paulus Torkki
author_sort	Elina Reponen
title	Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
title_short	Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
title_full	Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
title_fullStr	Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
title_full_unstemmed	Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
title_sort	validation of the lean healthcare implementation self-assessment instrument (lhisi) in the finnish healthcare context
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5dcb396894b84a8495b2aac10779eca2
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Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context

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