Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, Via Conservatorio, 7, 20122, Milan, Italy.
Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley, Berkeley, California, USA.
BMC Health Serv Res. 2022 Jan 29;22(1):122. doi: 10.1186/s12913-022-07473-w.
Despite the growing interest in transformational performance improvement among nearly all countries, international benchmarking has rarely been used. Cross-comparative research could allow an appreciation of the extent of Lean's use in healthcare and a better evaluation of possible cultural influences on Lean implementation. This study provides a comparative international benchmarking of Lean adoption, implementation, and outcomes of hospitals in the US and Italy.
The National Survey of Lean, developed in 2017 in the US and adapted in Italy in 2019 was used to compare the two healthcare systems along three dimensions: the maturity of adoption, the implementation approach, identifying both strategic and operational activities and tools, and the Lean performance, investigated through patients, employed, and affiliated staff, costs, and service provision areas. Descriptive statistics including T-tests were used to examine differences between the two countries on the study variables.
Lean has been adopted less by Italian public hospitals (36%) than US public hospitals (53%). Each country averages 4 years of experience with Lean. Italian hospitals reported being at a higher maturity stage while the US implemented a more system-wide approach, developing Lean in more operational units. The daily management system, leadership commitment, education and training indexes were higher or the same in the US while in Italy, hospitals had a higher self-reported performance index.
This exploratory work is one of the first international benchmarking studies on Lean implementation in healthcare systems using a standardized survey with a common set of definitions and questions. The study identifies different forms of Lean implementation that can be adopted, both at strategic and operational levels, with related perceived outcomes. Despite the US public hospitals being more likely to report a higher number of units using Lean, a higher daily management system index and use of Lean tools, Italian hospitals report more achievements primarily due to Lean. Further research can build on these findings by examining the relationship between Lean adoption/implementation and independent, objective performance measures.
尽管几乎所有国家都对变革性绩效改进越来越感兴趣，但很少进行国际基准比较。跨国比较研究可以让人们了解精益在医疗保健中的应用程度，并更好地评估精益实施可能受到的文化影响。本研究对美国和意大利的医院进行了比较国际基准的精益采用、实施和成果评估。
使用 2017 年在美国开发并于 2019 年在意大利改编的国家精益调查，从三个维度比较两个医疗系统：采用的成熟度、实施方法、确定战略和运营活动以及工具，以及通过患者、员工和附属员工、成本和服务提供领域调查的精益绩效。使用描述性统计（包括 t 检验）检查两国在研究变量上的差异。
意大利公立医院（36%）采用精益的比例低于美国公立医院（53%）。两国平均有 4 年的精益经验。意大利医院报告处于更高的成熟阶段，而美国则采用了更全面的方法，在更多的运营单位中发展精益。日常管理系统、领导力承诺、教育和培训指数在美国较高或相同，而在意大利，医院的自我报告绩效指数较高。
这项探索性工作是使用标准化调查和共同定义和问题对医疗保健系统中的精益实施进行的首批国际基准研究之一。该研究确定了可以采用的不同形式的精益实施，包括战略和运营层面，并与相关感知结果相关。尽管美国公立医院更有可能报告更多使用精益的单位、更高的日常管理系统指数和使用精益工具，但意大利医院报告的成就更多，主要是因为精益。进一步的研究可以通过检查精益采用/实施与独立、客观绩效衡量之间的关系，在此基础上进行。
