Kaltenbrunner Monica, Bengtsson Lars, Mathiassen Svend Erik, Engström Maria
Faculty of Health and Occupational Studies, University of Gävle, 801 76, Gävle, Sweden.
Faculty of Engineering and Sustainable Development, University of Gävle, 801 76, Gävle, Sweden.
BMC Health Serv Res. 2017 Mar 24;17(1):235. doi: 10.1186/s12913-017-2163-x.
During 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.
A 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.
The 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.
We 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.
在过去十年中，精益理念在医疗保健领域迅速传播，但缺乏能够衡量员工对采用精益理念看法的工具。因此，本研究的目的是通过改编为服务业开发的现有工具，基于利克对精益的描述，开发一份衡量医疗保健领域精益程度的问卷。
采用混合方法设计。最初，根据利克描述的精益在四个领域（理念、流程、人员与合作伙伴以及问题解决）的14条原则，对服务业工具中的项目进行分类。利克的三条原则缺少相关项目，因此重新进行了开发。对12名来自不同专业的医护人员进行了出声思考访谈，以将问卷原型置于具体情境中并检验其表面效度。此后，基于对386名基层医疗工作人员的横断面调查，评估了调整后问卷的心理测量特性。
出声思考访谈促使对问卷进行调整，以更好地适应医疗保健环境，并减少了项目数量。对调整后问卷的验证性因素分析表明，与利克对精益的描述总体上具有可接受的一致性。使用克朗巴哈系数测量的内部一致性，在利克对精益的描述中，人员与合作伙伴因素为0.60，其他三个因素均超过0.70。通过组内相关系数测量的重测信度，四个因素的范围为0.77至0.88。
我们基于利克的描述设计了一份问卷，以了解员工对医疗保健领域采用精益理念的看法。这份医疗保健领域精益问卷（LiHcQ）显示出总体上可接受的心理测量特性，这支持了其在衡量医疗保健领域精益采用情况方面的可用性。我们建议进一步的研究集中在验证LiHcQ在其他医疗保健环境中的可用性，并在需要时对该工具进行调整。
