ArticleBMC health services research2017
A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing.
Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Implementation outcome instruments for use in physical healthcare settings: a systematic review.Implementation science : IS · 2020Pooled it
- Operational inefficiency and perceived quality in a paediatric day hospital: a lean-informed study of patient flow, caregiver and staff perceptions.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Observational
- Thinking-aloud methodology applied to health questionnaire development and validation: a scoping review.BMC medical research methodology · 2026Article
- The maturity of lean management in a large academic medical center in Finland: a qualitative study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2024Article
- The Implementation Process Assessment Tool: translation, contextualization, and psychometric evaluation of a Swedish version in a municipal elderly care context.BMC health services research · 2024Article
- Achieving transformation to lean management systems in health care.Health services research · 2023Observational
- Associations between lean maturity in primary care and musculoskeletal complaints among staff: a longitudinal study.BMJ open · 2023Article
- Process Evaluation of a Participative Organizational Intervention as a Stress Preventive Intervention for Employees in Swedish Primary Health Care.International journal of environmental research and public health · 2020Article
- Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care.BMC health services research · 2019Article
- Role of lean leadership in the lean maturity-second-order problem-solving relationship: a mixed methods study.BMJ open · 2019Article
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4 authors.
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Abstract
backgroundDuring 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.
methodsA 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.
resultsThe 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.
conclusionsWe 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.
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