سنجش سطح آمادگی بیمارستان‌های دولتی برای استقرار سیستم ناب (مطالعه موردی: بیمارستان‌های دولتی شهر همدان)
محورهای موضوعی : -مدارک پزشکیروح اله سهرابی 1 , هدیه مبشری 2 , عباس صمدی 3
1 - عضو هیات علمی دانشگاه بوعلی سینا
2 - دانش آموخته دانشگاه بوعلی سینا
3 - عضو هیات علمی دانشگاه بوعلی سینا
کلید واژه: سنجش, سیستم ناب, بیمارستان‌های دولتی, سطح آمادگی,
چکیده مقاله :
مقدمه: در راستای سیاست‌های نظام بهداشت و درمان بسیاری از کشورها، مبنی بر بهبود مراقبت‌های بهداشتی و درمانی، پیاده‌سازی ناب به‌عنوان راه دست‌یابی به این مهم موردتوجه قرارگرفته است اما یک سازمان یک‌شبه نمی‌تواند ناب شود و نیازمند فراهم کردن پیش‌شرط‌های ساختاری است؛ لذا درک عوامل زمینه‌ای در پیاده‌سازی سیستم ناب در موفقیت و اثربخشی این سیستم نقش بسزایی دارد. روش پژوهش: پژوهش حاضر، پژوهشی توصیفی است که به روش مقطعی در نیمه اول سال 1394 در بیمارستان‌های دولتی شهر همدان انجام گرفت. در این پژوهش، پرسشنامه محقق ساخته در دو مرحله، جهت گردآوری داده‌ها استفاده شد. در مرحله اول، جامعه آماری 179 نفر متشکل از؛ سرپرستاران، روسا و مدیران واحدهای بالینی و پشتیبانی بودند که به روش تصادفی ساده با استفاده از فرمول کوکران، تعداد 122 نفر به عنوان نمونه پژوهش انتخاب گردید. در مرحله دوم، پاسخ‌گویان 10 نفر از خبرگان دارای تحصیلات فوق‌لیسانس و یا دکتری باسابقه اجرایی حداقل 5 سال در زمینه مدیریت بیمارستان بودند. در مرحله اول تجزیه و تحلیل اطلاعات با استفاده از نرم‌افزار آماری SPSS22 و در مرحله دوم رتبه‌بندی عوامل مؤثر بر ناب‌سازی بیمارستانی به روش AHP نرم‌افزار Expert Choice صورت گرفت. یافته‌ها: بیمارستان‌های شهر همدان از بعد آموزش و مشارکت کارکنان و همسویی سیستم پاداش و عملکرد با اهداف ناب، در سطح مطلوبی قرار ندارند. هم‌چنین شناسایی و از بین بردن اتلافات با وزن نسبی 234/0 دارای بیشترین وزن و سیستم پاداش و ارزیابی عملکرد با وزن 032/0، دارای کمترین وزن در میان هفت عامل آمادگی ناب‌سازی است. نتیجه‌گیری: پیاده‌سازی ناب بدون در نظر گرفتن بستر مناسب، در درازمدت منجر به عدم کارایی و اتلاف منابع می‌شود. هم‌چنین توجه به عوامل آمادگی با توجه به حساسیت و نقش بسزای شناسایی و از بین بردن اتلافات در دست‌یابی به بهبود عملکرد، از ضروریات است.
Introduction: In the way of the policies of the healthcare system of many countries, based on the improvement of the healthcare services, the lean implementation has been taken into consideration as the way of achieving it but no organization can become lean overnight so it needs providing some precondition structures. Therfore, understanding the fundamental factors plays a profound role in successfully and effectively implementing the lean system. Mothods: This research is a descriptive survey which has been done in cross-sectional way in the state hospitals of the Hamedan city in the first half of the year 2015. In this study, a questionnaire in two stages, was used for data collection. The population of the first stage 179 members of supervisors, managers and support clinical units were used to randomly sample, 122 subjects were selected randomly. In the second stage of the respondents, 10 master's degree or doctorate senior executive experts in the field of hospital management were at least 5 years. In the first phase analysis using statistical software SPSS22 and secondly ranking factors affecting the purity of the hospital AHP method took Expert Choice software. Results: The hospitals of the Hamadan city are not in a desirable situation in accordance with educational issues, employee participant, and the alignment of the performance and reward system with the lean goals. Also, identifying and eliminating wastes has the greatest weight by the relative weight of 0.234 and the system of evaluating performance and reward has the least weight by the relative weight of 0.032 among the seven readiness factors of lean implementation. Conclusion: Implementing lean without considering the sufficient fundamental conditions will lead to non-performance and wastage of resources. Moreover, considering the readiness factors is essential due to the important role of identifying and eliminating the wastes in lean implementation to achieve performance improvement.
1- Ruiz U, Simon J. Quality management in health care: A 20-year journey. Int J Health Care Qual Assur, 2004; 17(6): 323-333.
2- Kollberg B, Dahlgaard JJ, Brehmer PO. Measuring lean initiatives in health careservices: Issues and findings. International Journal of Productivity and Performance Management, 2007; 56(1): 7-24.
3- Brandao de Souza L. Trends and approaches in lean healthcare. Leadersh Health Serv (Bradf Engl), 2009; 22(2): 121-139.
4- Radnor ZJ, and Walley P. Learning to walk before we try to run: Adapting lean for the public sector. Public Money & Management, 2008; 28(1): 13-20.
5- Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM. Quality and lean health care: A system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence, 2011; 22(6): 673-689.
6- Yang M, Hong P, Modi S. Impact of lean manufacturing and environmental management on business performance: an international study of manufacturing firms. International Journal of Production Economics, 2011; 129(2): 251-261.
7- Guimara˜es CM, Carvalho JC. Assessing lean deployment in healthcare-A critical review and framework. Journal of Enterprise Transformation, 2014; 4(1): 3-27.
8- Anvari AR, Norzima Z, Rosnay MY, Hojjati MSH, Ismail Y. A comparative study on journey of lean manufacturing implementation. AIJSTPME, 2010; 3: 77-85.
9- Radnor Z. Implementing lean in health care: making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management, 2011; 2(1): 1-12.
10- Balushi AlS, Sohal AS, Singh PJ, Hijri A, Farsi YM, Abri R. Readiness factors for lean implementation in healthcare setting. Journal of health Organization and Management, 2014; 28(2): 135-153.
11- Ben-Tovim DI, Dougherty ML, O’Connell TJ, McGrath KM. Patient journeys: the process of clinical redesign. Med J Aust, 2008; 188(6): 14-17.
12- Armenakis AA, Harris SG, Mossholder KW. Creating readiness for organizational change. Human Relations, 1993; 46(6): 681-703.
13- Butler TW, Leong GK, Everett LN. The operationsmanagement role in hospital strategic planning. Journal of Operations Management, 1996; 14(2): 137-156.
14- Womack JP, Jones DT, Ross D. The Machine that Changed the World. Macmillan. New York. NY; 1990.
15- Vest JR, Gamm LD. A critical review of the research literature on six sigma, lean and studergroup’s hardwiring excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare. Implementation Science, 2009; 35(4): 1-9.
16- Waring JJ, Bishop S. Lean healthcare: rhetoric, ritual and resistance. Soc Sci Med, 2010; 71(7): 1332-1340.
17- Dick R, Ullrich J, Tissington PA. Working under a black cloud: how to sustain organizational identification after a merger. British Journal of Management, 2006; 17(1): 69-79.
18- Rich N, Bateman N. Companies’ perceptions of inhibitors and enablers for process improvement activities. International Journal of Operations & Production Management, 2003; 23(2): 185-199.
19- Andersson R, Eriksson H, Torstensson H. Similarities and differences between TQM, six sigma and lean. The TQM Magazine, 2006; 18(3): 282-296.
20- Bercaw GR. Lean Leadership for Healthcare: Approaches to Lean Transformation. Productivity Press Reference; 2013: 254.
21- Papadopoulos T, Radnor Z, Merali Y. The role of actor associations in understanding the implementation of lean thinking in healthcare. International Journal of Operations & Production Management, 2011; 31(2): 167-191.
22- MacDufile, J.P. and Helper, S. Creating lean suppliers: diffusing lean production through the supply chain. Paper presented at International Motor Vehicle Program (IMVP), FY’97 IMVP working paper; 1997.
23- Folinas D, Faruna T. Implementing lean thinking paradigm practices in medical set up. Business Management Dynamics 2011; 1(2): 61-78.
24- Fillingham D. Can lean save lives? Leadersh Health Serv (Bradf Engl), 2007; 20(4): 231-241.
25- Joosten T, Bongers I, Janssen R. Application of lean thinking to health care: issues and observations. Int J Qual Health Care, 2009; 21(5): 341-347.
26- Saurin T, Marodin G, Ribeiro J. A framework for assessing the use of leanproduction practices in manufacturing cells. International Journal of Production Research, 2011; 49(11): 32-51.
27- Steed AD. Exploration of the leadership attributes and methods found to be associated with successful lean system deployments in acute care hospitals. Unpublished EdD, Olivet Nazarene University, Chicago, IL; 2011.
28- Hines P, Lethbridge S. New development: creating a lean university. Public Money and Management, 2008; 28(1): 53-56.
29- Graber DR, Kilpatrick AO. Establishing values-based leadership and value systems in healthcare organizations. Journal of Health and Human Services Administration, 2008; 31(2): 179-197.
30- Setijono D, Naraghi AM, Ravipati UP. Decision support system and the adoption of lean in a Swedish emergency ward: balancing supply and demand towards improved value stream. International Journal of Lean Six Sigma, 2010; 1(3): 234-248.
31- Naderimagham Sh, Niknami Sh, Abolhassani F, Hajizadeh E. Development and psychometric properties of perceived self-efficacy scale (SES) for self-care in middle-aged patients with diabetes mellitus type 2. Payesh, 2013; 12: 679-690. [Persian]
32- Mohamadi Zanjirani D, Salimifard K, yousefi Dehbidi SH. Performance avaluation the most common technique to multi-criteria decision making approach based on approach to optimization. Journal of operational research and its applications (journal of applied mathematics), 2014; 11(1); 65-84. [Persian]
33- Mazur L, McCreery J, Rothenberg L. Facilitating lean learning and behaviors in hospitals during the early stages of lean implementation. Engineering Management Journal, 2012; 24(1): 11-22.
34- Radnor Z, Walley P, Stephens A, et al. Evaluation of the leanapproach to business management and its use in the public sector. Edinburgh: The Scottish Government; 2006.
35- Kazazi A, Sarukhani D. Identify key factors in the effective implementation of Six Sigma programs in different organizations, Third International Conference on Management; 2005.
36- Peterson DN, Leppa C. Creating an environment for caringusing lean principles of the Virginia Mason Production System. J Nurs Adm; 2007; 37(6): 287-93.
37- Albliwi S, Antony J, Abdul Halim S, Wiele L. Critical failure factors of Lean Six Sigma: a systematic literature review. International Journal of Quality & Reliability Management, 2014; 31(9): 1012-1030.
38- Mann D. The missing link: lean leadership. Frontiers of Health Services Management, 2009; 26(1): 15-26.
39- Ballatt J, Campling P. Intelligent Kindness Reforming the Culture of Healthcare, RCPsych Publications, London; 2011.
40- Radnor ZJ, Holweg M, Waring J. Lean in healthcare: the unfilled promise?. Soc Sci Med, 2012; 74(3): 364-371.
41- Antony J, Krishan N, Cullen D, Kumar M. Lean Six Sigma for higher education institutions (HEIs): challenges, barriers, success factors, tools/techniques. International Journal of Productivity and Performance Management, 2012; 61(8): 940-948.
42- Martinez-Jurado PJ, Moyano-Fuentes J. Key determinants of lean production adoption: evidence from the aerospace sector. Production Planning & Control: TheManagement of Operations, 2012; 25(4): 332-345.
43- Revital G, et al. Implementing QA programs in managed care health plans: factors contributing to success. Int J Health Care Qual Assur, 2008; 21(3): 308-324.
44- Mosadegh Rad AM. The impact of organizational culture on the successful implementation of total quality management. The TQM Magazine, 2006; 18(6): 606-625.
45- Golden B. Transforming healthcare organizations. Healthc Q, 2006; 10: 10-19.
46- Dalal A. Keep it simple for lean success, focus on the fundamentals. Quality Progress, 2006; 43(9): 24-32.
47- Rich N, Bateman N. Companies’ perceptions of inhibitors and enablers for process improvement activities. International Journal of Operations & Production Management, 2003; 23(2): 185-199.
48- Harald AK, Simons FE, Widdershoven AM, Visse M. Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study. BMJ Open, 2013; 3(10).
49- Lee TH. Turning doctors into leaders. Harvard Business Review, 2010; 88: 50-58.
50- Snee RD. Lean Six Sigma – getting better all the time. International Journal of Lean Six Sigma, 2010; 1(1): 9-29.
51- Poksinska B. The current state of lean implementation in health care: literature review. Qual Manag Health Care, 2010; 19(4): 319-329.
52- Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of lean manufacturing techniques in the emergency department. J Emerg Med, 2009; 37(2): 177-182.
53- Ahlstrom P. Lean service operations: translating lean production principles to service Operations. International Journal of Services Technology and Management, 2004; 5(5-6): 545-564.
54- Balle´ M, Re´gnier A. Lean as a learning system in a hospital ward. Leadersh Health Serv (Bradf Engl), 2007; 20(1): 33-41.
55- Cinite I, Duxbury LE, Higgins C. Measurement of perceived organizational readiness for change in the public sector. British Journal of Management, 2009; 20(2): 265-277.
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1- Ruiz U, Simon J. Quality management in health care: A 20-year journey. Int J Health Care Qual Assur, 2004; 17(6): 323-333.
2- Kollberg B, Dahlgaard JJ, Brehmer PO. Measuring lean initiatives in health careservices: Issues and findings. International Journal of Productivity and Performance Management, 2007; 56(1): 7-24.
3- Brandao de Souza L. Trends and approaches in lean healthcare. Leadersh Health Serv (Bradf Engl), 2009; 22(2): 121-139.
4- Radnor ZJ, and Walley P. Learning to walk before we try to run: Adapting lean for the public sector. Public Money & Management, 2008; 28(1): 13-20.
5- Dahlgaard JJ, Pettersen J, Dahlgaard-Park SM. Quality and lean health care: A system for assessing and improving the health of healthcare organisations. Total Quality Management & Business Excellence, 2011; 22(6): 673-689.
6- Yang M, Hong P, Modi S. Impact of lean manufacturing and environmental management on business performance: an international study of manufacturing firms. International Journal of Production Economics, 2011; 129(2): 251-261.
7- Guimara˜es CM, Carvalho JC. Assessing lean deployment in healthcare-A critical review and framework. Journal of Enterprise Transformation, 2014; 4(1): 3-27.
8- Anvari AR, Norzima Z, Rosnay MY, Hojjati MSH, Ismail Y. A comparative study on journey of lean manufacturing implementation. AIJSTPME, 2010; 3: 77-85.
9- Radnor Z. Implementing lean in health care: making the link between the approach, readiness and sustainability. International Journal of Industrial Engineering and Management, 2011; 2(1): 1-12.
10- Balushi AlS, Sohal AS, Singh PJ, Hijri A, Farsi YM, Abri R. Readiness factors for lean implementation in healthcare setting. Journal of health Organization and Management, 2014; 28(2): 135-153.
11- Ben-Tovim DI, Dougherty ML, O’Connell TJ, McGrath KM. Patient journeys: the process of clinical redesign. Med J Aust, 2008; 188(6): 14-17.
12- Armenakis AA, Harris SG, Mossholder KW. Creating readiness for organizational change. Human Relations, 1993; 46(6): 681-703.
13- Butler TW, Leong GK, Everett LN. The operationsmanagement role in hospital strategic planning. Journal of Operations Management, 1996; 14(2): 137-156.
14- Womack JP, Jones DT, Ross D. The Machine that Changed the World. Macmillan. New York. NY; 1990.
15- Vest JR, Gamm LD. A critical review of the research literature on six sigma, lean and studergroup’s hardwiring excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare. Implementation Science, 2009; 35(4): 1-9.
16- Waring JJ, Bishop S. Lean healthcare: rhetoric, ritual and resistance. Soc Sci Med, 2010; 71(7): 1332-1340.
17- Dick R, Ullrich J, Tissington PA. Working under a black cloud: how to sustain organizational identification after a merger. British Journal of Management, 2006; 17(1): 69-79.
18- Rich N, Bateman N. Companies’ perceptions of inhibitors and enablers for process improvement activities. International Journal of Operations & Production Management, 2003; 23(2): 185-199.
19- Andersson R, Eriksson H, Torstensson H. Similarities and differences between TQM, six sigma and lean. The TQM Magazine, 2006; 18(3): 282-296.
20- Bercaw GR. Lean Leadership for Healthcare: Approaches to Lean Transformation. Productivity Press Reference; 2013: 254.
21- Papadopoulos T, Radnor Z, Merali Y. The role of actor associations in understanding the implementation of lean thinking in healthcare. International Journal of Operations & Production Management, 2011; 31(2): 167-191.
22- MacDufile, J.P. and Helper, S. Creating lean suppliers: diffusing lean production through the supply chain. Paper presented at International Motor Vehicle Program (IMVP), FY’97 IMVP working paper; 1997.
23- Folinas D, Faruna T. Implementing lean thinking paradigm practices in medical set up. Business Management Dynamics 2011; 1(2): 61-78.
24- Fillingham D. Can lean save lives? Leadersh Health Serv (Bradf Engl), 2007; 20(4): 231-241.
25- Joosten T, Bongers I, Janssen R. Application of lean thinking to health care: issues and observations. Int J Qual Health Care, 2009; 21(5): 341-347.
26- Saurin T, Marodin G, Ribeiro J. A framework for assessing the use of leanproduction practices in manufacturing cells. International Journal of Production Research, 2011; 49(11): 32-51.
27- Steed AD. Exploration of the leadership attributes and methods found to be associated with successful lean system deployments in acute care hospitals. Unpublished EdD, Olivet Nazarene University, Chicago, IL; 2011.
28- Hines P, Lethbridge S. New development: creating a lean university. Public Money and Management, 2008; 28(1): 53-56.
29- Graber DR, Kilpatrick AO. Establishing values-based leadership and value systems in healthcare organizations. Journal of Health and Human Services Administration, 2008; 31(2): 179-197.
30- Setijono D, Naraghi AM, Ravipati UP. Decision support system and the adoption of lean in a Swedish emergency ward: balancing supply and demand towards improved value stream. International Journal of Lean Six Sigma, 2010; 1(3): 234-248.
31- Naderimagham Sh, Niknami Sh, Abolhassani F, Hajizadeh E. Development and psychometric properties of perceived self-efficacy scale (SES) for self-care in middle-aged patients with diabetes mellitus type 2. Payesh, 2013; 12: 679-690. [Persian]
32- Mohamadi Zanjirani D, Salimifard K, yousefi Dehbidi SH. Performance avaluation the most common technique to multi-criteria decision making approach based on approach to optimization. Journal of operational research and its applications (journal of applied mathematics), 2014; 11(1); 65-84. [Persian]
33- Mazur L, McCreery J, Rothenberg L. Facilitating lean learning and behaviors in hospitals during the early stages of lean implementation. Engineering Management Journal, 2012; 24(1): 11-22.
34- Radnor Z, Walley P, Stephens A, et al. Evaluation of the leanapproach to business management and its use in the public sector. Edinburgh: The Scottish Government; 2006.
35- Kazazi A, Sarukhani D. Identify key factors in the effective implementation of Six Sigma programs in different organizations, Third International Conference on Management; 2005.
36- Peterson DN, Leppa C. Creating an environment for caringusing lean principles of the Virginia Mason Production System. J Nurs Adm; 2007; 37(6): 287-93.
37- Albliwi S, Antony J, Abdul Halim S, Wiele L. Critical failure factors of Lean Six Sigma: a systematic literature review. International Journal of Quality & Reliability Management, 2014; 31(9): 1012-1030.
38- Mann D. The missing link: lean leadership. Frontiers of Health Services Management, 2009; 26(1): 15-26.
39- Ballatt J, Campling P. Intelligent Kindness Reforming the Culture of Healthcare, RCPsych Publications, London; 2011.
40- Radnor ZJ, Holweg M, Waring J. Lean in healthcare: the unfilled promise?. Soc Sci Med, 2012; 74(3): 364-371.
41- Antony J, Krishan N, Cullen D, Kumar M. Lean Six Sigma for higher education institutions (HEIs): challenges, barriers, success factors, tools/techniques. International Journal of Productivity and Performance Management, 2012; 61(8): 940-948.
42- Martinez-Jurado PJ, Moyano-Fuentes J. Key determinants of lean production adoption: evidence from the aerospace sector. Production Planning & Control: TheManagement of Operations, 2012; 25(4): 332-345.
43- Revital G, et al. Implementing QA programs in managed care health plans: factors contributing to success. Int J Health Care Qual Assur, 2008; 21(3): 308-324.
44- Mosadegh Rad AM. The impact of organizational culture on the successful implementation of total quality management. The TQM Magazine, 2006; 18(6): 606-625.
45- Golden B. Transforming healthcare organizations. Healthc Q, 2006; 10: 10-19.
46- Dalal A. Keep it simple for lean success, focus on the fundamentals. Quality Progress, 2006; 43(9): 24-32.
47- Rich N, Bateman N. Companies’ perceptions of inhibitors and enablers for process improvement activities. International Journal of Operations & Production Management, 2003; 23(2): 185-199.
48- Harald AK, Simons FE, Widdershoven AM, Visse M. Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study. BMJ Open, 2013; 3(10).
49- Lee TH. Turning doctors into leaders. Harvard Business Review, 2010; 88: 50-58.
50- Snee RD. Lean Six Sigma – getting better all the time. International Journal of Lean Six Sigma, 2010; 1(1): 9-29.
51- Poksinska B. The current state of lean implementation in health care: literature review. Qual Manag Health Care, 2010; 19(4): 319-329.
52- Dickson EW, Singh S, Cheung DS, Wyatt CC, Nugent AS. Application of lean manufacturing techniques in the emergency department. J Emerg Med, 2009; 37(2): 177-182.
53- Ahlstrom P. Lean service operations: translating lean production principles to service Operations. International Journal of Services Technology and Management, 2004; 5(5-6): 545-564.
54- Balle´ M, Re´gnier A. Lean as a learning system in a hospital ward. Leadersh Health Serv (Bradf Engl), 2007; 20(1): 33-41.
55- Cinite I, Duxbury LE, Higgins C. Measurement of perceived organizational readiness for change in the public sector. British Journal of Management, 2009; 20(2): 265-277.
