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Towards the sustainable implementation of lean in hospitals
Thesis (PhD)--Stellenbosch University, 2023.
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| Format: | Thesis |
| Language: | en_ZA en_ZA |
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Stellenbosch : Stellenbosch University
2023
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| _version_ | 1867614022882295808 |
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| access_status_str | Open Access |
| author | Joubert, Bronwyn |
| author2 | Bam, Wouter Gideon |
| author_browse | Bam, Wouter Gideon Joubert, Bronwyn |
| author_facet | Bam, Wouter Gideon Joubert, Bronwyn |
| author_sort | Joubert, Bronwyn |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2023. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/126949 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA en_ZA |
| last_indexed | 2026-06-10T12:45:26.037Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/126949 Towards the sustainable implementation of lean in hospitals Joubert, Bronwyn Bam, Wouter Gideon Louw, Louis Stellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering. Lean manufacturing Health care reform Hospitals -- Administration Thesis (PhD)--Stellenbosch University, 2023. ENGLISH ABSTRACT: To meet increasing demands for delivering care with fewer resources, leaders of healthcare organisations are continually looking for ways to optimise healthcare operations and processes. Following significant success in improving quality while reducing costs in the manufacturing industry, healthcare facility managers started implementing “lean thinking”, a management philosophy focused on continuous improvement. While lean success in healthcare has been widely reported, there are also frequent cases where healthcare facilities revert to the pre-implementation state after some time. An initial investigation into the application of lean in hospitals revealed a lack of holistic lean implementation and correctly targeted assessments as contributing factors to unsustainable implementation. However, there is a lack of knowledge of the supporting organisational factors required to support a holistic implementation long-term, and thus the factors that need to be assessed for implementation. Therefore, to foster sustained improvement outcomes, the primary aim of the research was to contribute toward an improved theoretical understanding of how to ensure lean’s implementation in hospitals is sustained. The secondary aim to guide the practical application of these findings was to develop an artefact that encapsulates the improved understanding and supports its implementation in hospitals. A narrative literature review of lean and its application in hospitals was executed to explore the problem and develop objectives for a solution. It motivated the problem of incomplete and unsustainable implementations of lean and the lack of knowledge on how it can be achieved. Additionally, it identified the need for an assessment tool to determine the extent to which activities that would support this are being implemented. Systematic literature reviews were executed to answer the research questions. The factors that have been found to impact lean sustainability in hospitals were gathered, analysed, and synthesised to realise a collection of practices that aid the sustainability of lean in hospitals. Thereafter, a second systematic review of existing approaches to leanness assessment was executed to gather the practices required to implement lean holistically and to consider the possible approaches to structuring the assessment tool being developed. The findings from the two reviews were then considered to develop a preliminary sustainable lean assessment tool (SLAT). A Delphi study was executed on the preliminary tool to verify and validate it. The tool was iteratively refined until the evaluation criteria were all satisfied, resulting in the final version of the tool. The resulting SLAT presents a tool consisting of all the practices required to sustainably transform into a lean hospital that hospitals can use to prioritise those needing improvement. AFRIKAANS OPSOMMING: Die leiers van gesondheidsorg-organisasies is voortdurend op soek na maniere om gesondheidsorgwerksaamhede en -prosesse te optimaliseer, om aan die steeds toenemende vraag na die lewering van sorg met minder hulpbronne te voldoen. Ná die sukses van ‘soepel denke’ se implementering met gehalteverbetering terwyl koste verlaag word in die vervaardiginsbedryf, het bestuurders van gesondheidsorggeriewe dit ook begin implementeer. Dit is ʼn bestuursfilosofie wat op deurlopende verbetering gerig is. Hoewel daar wyd oor die sukses van soepel denke in gesondheidsorg verslag gedoen is, was daar ook dikwels gevalle waar die gesondheidsorgfasiliteit ná ʼn ruk na die status voor implementering teruggeval het. ʼn Aanvanklike ondersoek na die toepassing van soepel denke in hospitale het onthul dat bydraende faktore tot onvolhoubare implementering die feit is dat soepel-implementering nie holisties geskied nie en assesserings nie op die regte teikens gemik word nie. Daar is egter te min bekend oor die organisatoriese steunfaktore wat nodig is om ʼn holistiese implementering oor die lang termyn te steun, en dus oor die faktore wat vir implementering geassesseer moet word. Die primêre doel van die navorsing was dus om by te dra tot ʼn verbeterde begrip van hoe om seker te maak dat soepel denke se implementering in hospitale deurgevoer word, om sodoende volhoubare verbeteringsuitkomste aan te moedig. Die sekondêre doel en om die praktiese toepassing van hierdie bevindings te rig, was om ʼn artefak te ontwikkel wat die verbeterde begrip saamvat en die implementering daarvan in hospitale ondersteun. ʼn Narratiewe literatuuroorsig van soepel denke en die toepassing daarvan in hospitale is gedoen om die probleem te verken en oogmerke vir ʼn oplossing te ontwikkel. Dit het gelei tot die uitlig van die probleem van onvolledige en onvolhoubare implementerings van soepel denke en die gebrek aan kennis oor hoe dit bereik kan word. Dit het ook die behoefte aan ʼn assesseringshulpmiddel geïdentifiseer om vas te stel tot watter mate die werksaamhede wat dit sou ondersteun, geïmplementeer word. Stelselmatige literatuuroorsigte is gedoen om die navorsingsvrae te beantwoord. Die faktore wat die volhoubaarheid van soepel denke in hospitale beïnvloed, is uitgeken, ontleed en gesintetiseer om ʼn versameling praktyke ter ondersteuning van die volhoubaarheid van soepel denke in hospitale op te lewer. Daarna is ʼn tweede stelselmatige oorsig van bestaande benaderings tot die assessering van soepelheid uitgevoer, om die praktyke wat nodig is om soepelheid holisties te implementeer, te identifiseer en om die moontlike benaderings tot die strukturering van die assesseringshulpmiddel wat ontwikkel moes word, in oënskou te neem. Die bevindings uit die twee oorsigte is bestudeer om ʼn voorlopige volhoubaresoepelheidsassesseringshulpmiddel (VSAH) te ontwikkel. ʼn Delphi-studie is op die voorlopige hulpmiddel gedoen om dit te bevestig en te staaf. Die hulpmiddel is herhaaldelik verfyn totdat daar aan al die evalueringskriteria voldoen is, wat die finale weergawe van die hulpmiddel opgelewer het. Die gevolglike VSAH is ʼn hulpmiddel wat bestaan uit al die praktyke wat nodig is om volhoubaar na ʼn soepel hospitaal te transformeer en wat deur hospitale gebruik kan word om daardie aspekte wat verbetering vereis, te prioritiseer. Doctorate 2023-02-06T07:23:07Z 2023-05-18T06:57:08Z 2023-02-06T07:23:07Z 2023-05-18T06:57:08Z 2023-03 Thesis http://hdl.handle.net/10019.1/126949 en_ZA en_ZA Stellenbosch University xxi, 292 pages : illustrations. application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Lean manufacturing Health care reform Hospitals -- Administration Joubert, Bronwyn Towards the sustainable implementation of lean in hospitals |
| title | Towards the sustainable implementation of lean in hospitals |
| title_full | Towards the sustainable implementation of lean in hospitals |
| title_fullStr | Towards the sustainable implementation of lean in hospitals |
| title_full_unstemmed | Towards the sustainable implementation of lean in hospitals |
| title_short | Towards the sustainable implementation of lean in hospitals |
| title_sort | towards the sustainable implementation of lean in hospitals |
| topic | Lean manufacturing Health care reform Hospitals -- Administration |
| url | http://hdl.handle.net/10019.1/126949 |
| work_keys_str_mv | AT joubertbronwyn towardsthesustainableimplementationofleaninhospitals |