Towards the development of a system-wide quality improvement maturity model: a synthesis using systematic review and expert opinion

Abstract

Purpose The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes. Design/methodology/approach A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs). Findings The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited. Practical implications The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality. Originality/value This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.

Does organizational readiness matter in lean thinking practices? An agency perspective

“…LT's sustainability is associated with an incremental growth in its scope from being a single value-stream or a departmental improvement program, to a system-wide improvement philosophy (Akmal et al, 2021b). LT also emphasizes continuous improvement as a central modus operandi (Costa et al, 2019), and amplification of lean tools and techniques (from simplistic to complex) to support organizational double-loop learning (Hopp and Spearman, 2020;Hu et al, 2016;Akmal et al, 2021b). Failure to achieve lean sustainability is often attributed to the lack of organizational lean readiness (McCann et al, 2015;Narayanamurthy et al, 2018;Al-Balushi et al, 2014;Leite et al, 2020).…”

“…, 2020). LT's sustainability is associated with an incremental growth in its scope from being a single value-stream or a departmental improvement program, to a system-wide improvement philosophy (Akmal et al. , 2021b).…”

“…, 2019), and amplification of lean tools and techniques (from simplistic to complex) to support organizational double-loop learning (Hopp and Spearman, 2020; Hu et al. , 2016; Akmal et al. , 2021b).…”

“…IJOPM 42,11 However, achieving lean success and sustainability is not an easy feat with some researchers pointing out failures in sustainable lean implementations (Secchi and Camuffo, 2019;Leite et al, 2020). LT's sustainability is associated with an incremental growth in its scope from being a single value-stream or a departmental improvement program, to a system-wide improvement philosophy (Akmal et al, 2021b). LT also emphasizes continuous improvement as a central modus operandi (Costa et al, 2019), and amplification of lean tools and techniques (from simplistic to complex) to support organizational double-loop learning (Hopp and Spearman, 2020;Hu et al, 2016;Akmal et al, 2021b).…”

“…, Leite et al (2020), Ladinig et al (2020), Akmal et al (2021b) Communication Effective and transparent two-way communication Alpenberg and Scarbrough (2016), Holweg (2007), Achanga et al (2006), Losonci et al (2011), Ng et al (2006), Sim and Rogers (2008), van Dun and Wilderom (2021), Fournier et al (2021), Ladinig et al (2020) Training and development Continuous, development of hard and soft practices Bortolotti et al (2015), Liker (2021), Liker and Hoseus (2009), Spear and Bowen (1999), Mondoux et al (2017), Netland et al (2021), Fournier et al (2021), Gaiardelli et al (2019) Leadership Involved, supportive and dynamic Poksinska et al (2013), Liker and Convis (2012), Morrow et al (2014), Phillips et al (2016), van Dun and Wilderom (2016), Andrea and Emidia (2017), Leite et al (2020), Galeazzo and Furlan (2018) Structure Flat, integrated and team-based Bortolotti et al (2016), Dahlgaard et al (2011), Bhasin (2011), Boscari et al (2016), Kaplan et al (2014), Akmal et al (2021a), Leyer et al (2020), Gaiardelli et al (2019) Decision making Data-driven, decentralized Spear and Bowen (1999), Liker (2021), Liker and Hoseus (2008), Alves et al (2012), Bhasin and Burcher (2006), James and Jones (2014), Netland et al (2021), Leyer et al (2020) TeamworkIntensity of teamwork and cross functional workBoscari et al (2016),Hozak and Olsen (2015),Adler (1999),Holweg (2007), van Wilderom (2016, 2021), Sahoo (2020) Continuous improvementThe never-ending pursuit of excellence in all aspects of the organizational environmentWomack et al (1990),Liker (2021),Chen et al (2010),Liker and Morgan (2011),Henrique et al (2020),Fredriksson and Isaksson (2018),Yadav et al (2019a),Akmal et al (2021b) …”