2022 Publications
Transformational Performance Improvement: Why is Progress Slow?
Dorothy Y. Hung MA, Ph.D., MPH; Justin Lee; Thomas G. Rundall Ph.D.
Abstract: In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also sum- marize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real-world practice settings.
Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery
Dorothy Y. Hung, Ph.D., ; Thomas G. Rundall, Ph.D., ; Justin Lee; Negeen Khandel; Stephen M. Shortell, Ph.D.;
Objectives: This study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems. Originally developed in manufacturing, Lean is an evidence-based approach to quality and process improvement in healthcare. Although Lean has been studied in individual hospital units and outpatient practices, it has not been examined as a whole system response to crisis events.
Lean Practices for Resource Use, Timeliness, and Coordination of Care in Breast Cancer Navigation
Dorothy Y. Hung, Ph.D., MA, MPH, Paul Kim, MS, Martina Li, MPH, Qiwen Huang, MS, Cynthia Cantril, MPH, RN, OCN®, CBCN®, Natalia Colocci, MD, Ph.D., and Ellis C. Dillon, Ph.D.
Background: Cancer care is described as insufficiently patient-centered, requiring improved accessibility and coordination. Breast oncology nurse navigators may help provide timely patient care by improving care coordination.
Elina Reponen, Thomas G. Rundall, Ph.D, Stephen M. Shortell, Ph.D., Janet C. Blodgett, Ritva Jokela, Markku Mäkijärvi, Paulus Torkki
Background and Objectives: Despite the rapid spread of Lean management in health care, few organizations have achieved measurable overall performance improvements with Lean. What differentiates these organizations from those that struggle with realizing the potential benefits of Lean management is unclear. In this qualitative study we explore measuring the impact of Lean and the recommended practices for achieving measurable performance improvements with Lean in healthcare organizations.
Ellis C. Dillon, Ph.D., Paul Kim, MS, Martina Li, MPH, Qiwen Huang, MS, Natalia Colocci, MD, Ph.D., Cynthia Cantril, RN, MPH, OCN, CBCN, and Dorothy Y. Hung, Ph.D., MA, MPH
Background: Patient navigators can improve patient experiences of care and outcomes, but
little is known about how navigation programs may affect physician workflows and experience.
Pierre‐Luc Fournier Ph.D., Line Moisan, and Denis Lagacé
Background: Performance management systems have been introduced in health and social services institutions to improve organizational performance, supporting the emergence of new management behaviors that are more rooted in collaborative management practices. This study aims to understand how different leadership styles emerge through the implementation of a performance management system and its related tools, and how these can foster distributed leadership.
Marta Marsilio Ph.D, Martina Pisarra M.S. , Karl Rubio M.S. and Stephen Shortell, Ph.D.
Background: 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.