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Assessing the relationship of the human resource, finance, and information technology functions on reported performance in hospitals using the Lean management system

Shortell, Stephen M.; Rundall, Thomas G.; Blodgett, Janet C.

doi: 10.1097/HMR.0000000000000253
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Background Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown.

Purpose The aim of this study was to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean.

Methodology/Approach Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16).

Results There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects.

Conclusion HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation.

Practice Implications Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals.

Stephen M. Shortell, PhD, MPH, MBA, is Co-director, Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley. E-mail: shortell@berkeley.edu.

Thomas G. Rundall, PhD, is Co-director, Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley.

Janet C. Blodgett, MSc, is Senior Analyst/Research Director, Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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