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dc.contributor.authorMin, Yong Taeken_US
dc.date.accessioned2015-04-27T16:57:33Z
dc.date.available2015-04-27T16:57:33Z
dc.date.issued2014
dc.date.submitted2014
dc.identifier.other
dc.identifier.urihttps://hdl.handle.net/2144/11148
dc.descriptionThesis (D.B.A.)--Boston Universityen_US
dc.description.abstractLean has been implemented in the health care sector for over a decade to address the challenges of lowering cost and improving quality. Its impact, however, has not been conclusive. Furthermore, the debate on its potential benefit has not been rigorous or systemic. This dissertation research fills this gap in literature. This dissertation is composed of three papers. In the first paper, I develop a reliable and valid instrument to measure the extent of lean implementation in hospitals. I theoretically derive a more robust set of lean principles for the hospital environment (patient focus, standardized care, seamless coordination, and continuous improvement) and use them as a primary platform for analyzing the use of lean in the health care environment. The results show that currently hospitals have implemented lean principles at relatively low level, compared to the possible maximum implementation level. Among the four principles, continuous improvement principle showed highest implementation level in hospitals. In the second paper, I assess the impact of lean principles implementation on quality and efficiency performance in hospitals by performing multivariate regression analysis with lean principles as independent variables and hospital performance as dependent variable. Multiple hospital performance indicators (adherence to evidence-based care processes, risk-adjusted mortality, patient satisfaction, and risk-adjusted cost) are used to measure process quality, outcome quality, perceived quality, and efficiency of each hospital. The results show that patient focus, standardized care, and continuous improvement principles are significantly associated with hospital quality, while seamless coordination principle is not. The result does not show any significant association between lean principles and hospital efficiency. In the last paper, I identify different lean implementation patterns in hospitals. Since lean is a multi-dimensional concept of four lean principles, which can be implemented individually or in combination , several lean implementation patterns are possible, depending on differing level of emphasis on lean principles. The results show that when lean is implemented holistically, lean is effective in improving quality performance in the health care environment, as in the manufacturing. The result does not show any significant association between lean implementation patterns and hospital efficiency.en_US
dc.language.isoen_US
dc.publisherBoston Universityen_US
dc.titleThe impact of lean implementation on quality and efficiency of U.S. hospitalsen_US
dc.typeThesis/Dissertationen_US
etd.degree.nameDoctor of Business Administrationen_US
etd.degree.leveldoctoralen_US
etd.degree.disciplineOperations and Technology Managementen_US
etd.degree.grantorBoston Universityen_US


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