Background
Liker’s description of Lean and Lean in healthcare
Instruments measuring Lean
Method
Theoretical development of the questionnaire
Contextualization and assessment of the questionnaires face validity
Construct validity, internal consistency and stability of the LiHcQ questionnaire
Responders to LiHcQ | Non-responders to LiHcQ | Subsample for analysis of test-retest reliability | |
---|---|---|---|
Total number of participants, n | 386 | 95 | 43 |
Participants at public non-profit//private for-profit provider healthcare units, n | 320//66 | 71//24 | 36//7 |
Women//Men, n | 333//49 | 85//8 | 35//8 |
Age; | |||
Md (Q1−Q3) | 51 (43–58) | 55 (47–59) | 53 (41–57) |
Mean (SD) | 50 (10) | 52 (10) | 48 (11) |
Profession, n | |||
- Nurses | 150 | 31 | 20 |
- Licensed Practical Nurse (LPN) | 25 | 18 | 2 |
- Manager | 24 | 1 | 1 |
- Physiotherapist | 41 | 3 | 8 |
- Occupational therapist | 12 | 6 | 1 |
- Physician | 66 | 4 | 5 |
- Administrator/secretary | 39 | 24 | 1 |
- Dietician | 2 | 1 | 2 |
- Social welfare officer/psychologist | 35 | 6 | 2 |
Years worked at the present unit; | |||
Md (Q1−Q3) | 5 (2–13) | 7 (2–20) | 5 (2–12) |
Mean (SD) | 9 (9) | 12 (11) | 7 (7) |
Years worked in the profession; | |||
Md (Q1−Q3) | 20 (10–30) | 26 (15–35) | 20 (11–28) |
Mean (SD) | 21 (12) | 25 (12) | 18 (11) |
Results
Contextual adjustments and face validity of the preliminary questionnaire
One participant in the first TA round expressed the need for contextualizing the questionnaire: “It feels like difficult language that I don’t really understand. And also it feels like a literal translation from English, a little stilted and strange, …”Another participant in the first round expressed the need for a shorter and contextualized questionnaire, however the participant stated that the questionnaire was relevant: “It’s comprehensive and sort of difficult to respond to sometimes, to think about care and not factory production on some of them. I thought others were very good.”
One participant in the second round expressed an overall feeling about the 31-item questionnaire; “It feels a bit long. It can be hard to maintain your focus on each question all the way through. But otherwise there’s a lot that makes you think, we should deal with this or I’d like to do that, or be there. Lots of feelings like that, a lot, we have a long way to go.”
Testing the construct validity, internal consistency and stability of the questionnaire
n = 386 | test –retest n = 43 | |||
---|---|---|---|---|
Factors Item no in LiHcQ). (Liker’s principle) | Missing n (%) | Mean (SD) | Md (Q1− Q3) | ICC (95% CI) |
Philosophy α = 0.75 | 0.80 (0.63;0.89) | |||
1). Employees participation in Lean (Long-term thinking. Plan ahead and do investments even if they costs more at present) | 17 (4) | 3 (1) | 3 (2–4) | 0.75 (0.53;0.86) |
2). Ward manager participation in Lean (Long-term thinking. Plan ahead and do investments even if they costs more at present) | 67 (17) | 3 (1) | 3 (3–4) | 0.79 (0.59;0.89) |
3). Allocated time for continuous improvements (Long-term thinking. Plan ahead and do investments even if they costs more at present) | 6 (1) | 3 (1) | 2 (2–3) | 0.64 (0.33;0.81) |
Processes α = 0.86 | 0.77 (0.57;0.87) | |||
6). Value stream mapping (Create flow in the processes which makes problem visible) | 34 (9) | 3 (1) | 3 (2–3) | 0.50 (0.06;0.73) |
7). Standardization (Have standardized work to achieve flow and continuous improvements. Encourage employee involvement) | 9 (2) | 4 (1) | 4 (3–4) | 0.76 (0.56;0.87) |
8). Plan with the patient in focus (Level out the workload) | 18 (5) | 3 (1) | 3 (2–4) | 0.55 (0.16;0.76) |
9). Automatically quality controls (Good quality from the beginning is achieved by teaching everyone to stop the process if quality problem occurs) | 39 (10) | 3 (1) | 3 (1–3) | 0.65 (0.33;0.81) |
10). Patient need control the work flow (Avoid overproduction by producing only on customer demand) | 24 (6) | 3 (1) | 3 (2–4) | 0.37 (0.19;0.66) |
11). Visual improvements to guide the employees (Use visualized signs in the process, to reduce errors) | 21 (6) | 3 (1) | 3 (2–4) | 0.80 (0.62;0.89) |
15). Technique and involve employees (Use only techniques that are reliable; it shall support the employee and the processes) | 8 (2) | 3 (1) | 3 (3–4) | 0.67 (0.38;0.82) |
People and partners α = 0.60 | 0.88 (0.77;0.93) | |||
4). A person who support Lean adoption at the unit (Develop leaders from the organization that know the processes, know and can spread the Lean philosophy) | 21 (5) | 2 (1) | 1 (1–2) | 0.94 (0.88;0.97) |
5). Quality of given care (Develop a culture where everyone share the organizations core values and want to improve the organization) | 17 (4) | 3 (1) | 4 (2–4) | 0.75 (0.55;0.87 |
16). Employee collaboration with partners and suppliers (Show respect to partners and suppliers and set up challenging goals for theme and help them to achieve it) | 14 (4) | 3 (1) | 2 (2–3) | 0.66 (0.37;0.82) |
Problem-solving α = 0.81 | 0.79 (0.61;0.89) | |||
12). Evaluate each work task (Be a learning organization through reflections and continuous improvements) | 20 (5) | 3 (1) | 2 (1–4) | 0.80 (0.64;0.89) |
13). Problem-solving (To develop processes and to solve problems; go and see for yourself instead of trusting secondary information) | 14 (4) | 3 (1) | 3 (2–4) | 0.68 (0.39;0.83) |
14). Participation in decisions (Decision making is a slow process and solutions are made in consensus) | 8 (2) | 3 (1) | 3 (3–4) | 0.72 (0.47;0.85) |