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The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.

The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.

The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.

Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations’ working environment, staff development, and organizational performance.

In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Data were collected using a survey based on Liker’s four principles, divided into 16 items (n=298 staff in 45 units). Complementary observations (n=28 staff) were carried out at four units.

Lean maturity varied both between and within units. The highest Lean maturity was found for “adhering to routines” and the lowest for “having a change agent at the unit.” Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.

Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

The purpose of this paper is to examine the impact of lean management (LM) on operational performance (OP) in the context of health care in Jordanian private hospitals. LM is measured using four bundles: total quality management (TQM), human resource management (HRM), just-in-time system (JIT) and total productive maintenance (TPM). The study also investigates the effects of OP dimensions on hospitals’ business performance (BP).

The study is based on survey data collected from 260 respondents from 25 private hospitals in Jordan. Validity and reliability analyses were performed using SPSS and Amos, and the study hypotheses were tested using structural equation modeling.

The study found that the TQM bundle affects quality performance positively, but does not affect efficiency and accessibility performances, while the HRM bundle positively affects all OP dimensions. Furthermore, the JIT bundle positively contributes to both efficiency and accessibility performances, while the TPM bundle positively influences quality and accessibility performances. Moreover, the results have demonstrated that OP dimensions of quality and accessibility significantly and positively affect hospitals’ BP.

This study is one of the first to adapt the four lean bundles popularized in the manufacturing sector and apply them in a health-care context. It examines the effects of the four lean bundles on hospitals’ OP in terms of efficiency, quality and accessibility. In addition, the study demonstrates the role of OP dimensions in improving private hospitals’ BP.

The purpose of this paper is to review original research on lean management (LM) in health care to identify potential research gaps and present recommendations for future research. The paper also discusses the current state of implementing LM practices in health care. In addition, it presents and highlights “lean bundles” imported from manufacturing, namely, total quality management (TQM), human resource management, just-in-time and total productive maintenance, as a potential implementation strategy of LM in hospitals to optimize overall health care performance.

The scoping review was conducted based on the guidelines specified by Arksey and O’Malley (2005). Relevant included studies were retrieved by searching various electronic databases. The PRISMA guidelines were applied to identify and select eligible studies.

The majority of previous studies used selected practices to measure LM in health care. In most cases, these practices reflected a narrow and biased view of LM. Lean bundles which comprehensively view LM and reflect all its aspects have rarely been discussed in the health care literature. Evidence about the contribution of lean bundles to hospital performance needs to be addressed in future studies.

This paper demonstrates the implementation of the four lean bundles in hospitals. It argues that, instead of adopting one dimension or selected practices of LM, hospitals viewing LM as a comprehensive multi-dimensional approach through the adoption of the four lean bundles are expected to maximize their performances.

This is one of the first works to comprehensively review and discuss lean bundles in the context of health care. It argues that the adoption of the four lean bundles by hospitals will enable them to yield the maximum LM performance benefits. In addition, a proposed survey questionnaire based on the literature review is provided to assist researchers in conducting future empirical studies.

The purpose of this paper is to study the effect of the implementation of Lean bundles on hospital performance in private hospitals in Jordan and evaluate how much the size of organization can affect the relationship between Lean bundles implementation and hospital performance.

The research is considered as quantitative method (descriptive and hypothesis testing). Three statistical techniques were adopted to analyse the data. Structural equation modeling techniques and multi-group analysis were used to examine the research’s hypothesis, and to perform the required statistical analysis of the data from the survey. Reliability analysis and confirmatory factor analysis were used to test the construct validity, reliability and measurement loadings that were performed.

Lean bundles have been identified as an effective approach that can dramatically improve the organizational performance of private hospitals in Jordan. Main Lean bundles – just in time, human resource management, and total quality management are applicable to large, small and medium hospitals without significant differences in advantages that depend on size.

According to the researchers’ best knowledge, this is the first research that studies the impact of Lean bundles implementation in healthcare sector in Jordan. This research also makes a significant contribution for decision makers in healthcare to increase their awareness of Lean bundles.

The purpose of this study is to empirically test how problem-solving lean practices, along with leaders as learning facilitators in an action learning approach, can be transferred from a production context to a knowledge work context for the purpose of becoming a learning organization while enhancing performance. This is important to study because many organizations struggle to enhance efficiency in the short term while still trying to be long-term learning oriented (i.e. learning organization development).

The authors draw on theory on learning interventions to show how lean practices for problem-solving can foster learning and help an organization to become adaptive. This study’s subject is a non-production department of 100 employees at the LEGO corporation. The authors applied survey results from a natural experiment lasting 18 months between a pre-measurement survey and a post-measurement survey. The results were compared to a control department of 50 employees who were not exposed to the lean practices intervention. The authors’ focus was on the individual level as individuals have different perceptions of lean practices, performance, and learning.

Using repeated-measures tests, difference-in-difference regressions analyses, and structural equation models, the authors find that a package of contemporary lean practices for problem-solving, along with leaders who function as learning facilitators, significantly improved learning organization dimensions while also enhancing efficiency and quality and that learning organizations positively mediate the relationship between the lean intervention and quality-related performance, while efficiency is directly affected by the lean interventions. Data from LEGO's key performance indicators (KPIs), benefit trackers, on-site observations and more than 40 interviews with managers provided results that were consistent with the survey data. A detailed description of the lean practices implemented is provided to inspire future implementations in non-operations environments and to assist educators.

The authors contribute to the learning literature by showing that a learning-to-learn approach to lean management can serve as an active and deliberate intervention in helping an organization becoming a learning organization as perceived by the individual organizational members. The authors also add to the lean literature by showing how a learning approach to lean, as used by LEGO, can positively affect short-term efficiency and quality and create a foundation for a longer-term competitive advantage (i.e. a learning organization) in a non-production context. By contrast, most of the lean literature streams treat efficiency separately from a learning organization and mainly examine lean in a production context.

The extant literature shows three research streams on lean, learning, and performance. The authors built on these streams by trying to emphasize both learning and efficiency. Prior research has not empirically tested whether and how the application of problem-solving lean practices combined with leaders as learning facilitators helps to create a comprehensive learning organization while enhancing performance in a non-production context.