A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing

Abstract

BackgroundDuring the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff’s perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker’s description of Lean, by adapting an existing instrument developed for the service sector.MethodsA mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker’s 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker’s principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire’s psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care.ResultsThe think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker’s description of Lean. Internal consistency, measured using Cronbach’s alpha, for the factors in Liker’s description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors.ConclusionsWe designed a questionnaire capturing staff’s perceptions of Lean adoption in healthcare on the basis of Liker’s description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2163-x) contains supplementary material, which is available to authorized users.

Implementation outcome instruments for use in physical healthcare settings: a systematic review

“…Acceptability: consumer = 10 [23,37,39,41,42,44,51,52,57,59], provider = 27 [24-36, 38, 40, 43, 45-50, 53-56, 58] Appropriateness: consumer = 3 [61][62][63], provider = 3 [46,60,64], both consumer and provider = 1 [65] Adoption: consumer = 1 [66], provider = 3 [67][68][69] Feasibility: provider = 4 [46,70,71,80] Penetration: organisation = 4 [72][73][74][75] Sustainability: provider = 2 [76,77], organisation = 2 [78,79] Methodological quality Table 1 presents the global COSMIN scores for reliability, validity and responsiveness, and rank orders the instruments by descending reliability scores. Detailed COSMIN scores for individual measurement properties are presented in Additional file 3.…”

“…Twelve (12/65) scales scored 7 or more (of the maximum possible score = 22), indicating greater psychometric strength on the ConPsy checklist [23,45,46,61,69,[76][77][78]. Detailed ConPsy scores for each scale are presented in Additional file 4.…”

“…Most studies only reported the internal consistency of the scales and only calculated Cronbach's alpha, hence generally receiving low ConPsy scores. Only 5 scales reported evidence on the stability (or test-retest reliability) of the scale [35,37,69]. Forty-six publications did not assess the reliability of the reported instrument, yet they did assess structural or criterion related validity.…”

Process Evaluation of a Participative Organizational Intervention as a Stress Preventive Intervention for Employees in Swedish Primary Health Care

“…If integrated with other organizational processes, ProMES can give employees some control over assessment and monitoring, thereby possibly mitigating some of the negative effects of new public management and achieving less stress and more “dignity” [ 42 ]. However, the Swedish health care system has, during the past decade, implemented lean thinking with the aim to improve quality of care and increase efficiency [ 43 ]. In other words, a lot of measuring besides that initiated through working with ProMES was taking place during the study and it is unclear how these two processes interacted with each other.…”

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“…[17] Studies on the implementation of Lean principles in healthcare have been limited and there are few studies that considered the consequences of Lean on healthcare workers' perceptions of Lean. [18] Also, there is a lack of in-depth research on Lean readiness. Researchers and practitioners have shown that, despite the benefits that Lean can offer to organizations, there have been a large number of failed implementations of it.…”