Publications

2026

Lean Management of Crisis Response and Post-Pandemic Outcomes in US Primary Care Practices

Dorothy Hung, PhD, MA, MPH; Stephen Shortell, PhD, MBA, MPH; Elicica Morris, MPH; Catalina Y. Quach; Elina Reponen MD, PhD; Thomas Rotter PhD; Agustin Perez-Araos, PhD; and Karen E. Schifferdecker PhD, MPH;

2025

Advancing Equity: Lean Leader Practices and a Path Forward

Dorothy Hung, PhD, MA, MPH; Lillian C. Levy, MS; Thomas G. Rundall, PhD; Elina Reponen, MD, PhD; William Huen, MD; Stephen Shortell, PhD, MBA, MPH;

Improving the US Healthcare System: The Case for Practical Wisdom

Stephen Shortell, PhD, MPH, MBA; Jodi Halpern, MD, PhD; Barry Schwartz, PhD;

Organizational Characteristics Associated with Sustained Participation in Internal Quality Improvement: Findings from Two Waves of a National Sample of Physician Practices in the United States

Vanessa B. Hurley, PhD; Amanda L. Brewster, PhD, MS; Matthew J. DePuccio, PhD, MS; Dorothy Y. Hung, PhD, MA, MPH; A. James O’Malley, PhD, MS; Karen E. Schifferdecker, PhD, MPH;

2024

Associations Between Lean IT Management and Financial Performance in US Hospitals

Justin Lee, BA; Dorothy Hung, PhD, MA, MPH; Elina Reponen, MD, PhD; Thomas G. Rundall, PhD; Aaron A Tierney, BA; Pierre-Luc Fournier, PhD, MS; Stephen M. Shortell, PhD, MBA, MPH;

The Maturity of Lean Management in a Large Academic Medical Center in Finland: A Qualitative Study

Irmeli Hirvelä, PaulusTorkki, PhD; Mervi Javanainen, MD; Elina Reponen, MD, PhD;

Primary Care Practice Characteristics Associated with Medical Assistant Staffing Ratios

Hector P. Rodriguez, PhD, MPH; Alena D. Berube, MS; Dorothy Y. Hung, PhD, MA, MPH; Stephen M. Shortell, PhD, MBA, MPH; Elliott S. Fisher, MD;

Lean Leadership to Advance Strategic Goals - Legacy Health

Lean Action Research Learning Collaborative (LARLC)

Lean Leadership to Advance Strategic Goals - Zuckerberg SF General Hospital and Trauma Center 

Lean Action Research Learning Collaborative (LARLC)

Lean Leadership to Advance Strategic Goals - John Muir Health

Lean Action Research Learning Collaborative (LARLC)

Lean Leadership to Advance Strategic Goals - Indiana University Health

Lean Action Research Learning Collaborative (LARLC)

Lean Leadership to Advance Strategic Goals - UCSF

Lean Action Research Learning Collaborative (LARLC)

2023

Sustainability of Performance Improvements After 26 Kaizen Events in a Large Academic Hospital System: A Mixed Methods Study

Erik Haapatalo, Elina Reponen, MD, PhD; Paulus Torkki, PhD;

Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals

Tyler Roey, Dorothy Y. Hung, PhD, MA, MPH; Thomas G. Rundall, PhD, Pierre-Luc Fournier, PhD, Athena Zhong, and Stephen M. Shortell, PhD;

The Better Care Plan: A Blueprint for Improving America’s Healthcare System
Stephen M. Shortell, PhD, MBA, MPH; John T. Toussaint, MD; George C. Halvorson; Jon M. Kingsdale, SPH; Richard M. Scheffler, PhD; Allyson Y. Schwartz, MS; Peter A. Wadsworth, MBA; Gail Wilensky, PhD;

Let’s Talk About It: The Impact of Nurses’ Implicit Voice Theories on Individual Agility and Quality of Care

Pierre-Luc Fournier, PhD, MS; Lionel Bahl, DBA, MBA, BAA; Desiree H. van Dun, PhD; Kevin J. Johnson, MS, PhD; Jean Cadieux, PhD;

2022

Transformational Performance Improvement: Why is Progress Slow?

Dorothy Y. Hung, PhD, MA, MPH; Justin Lee, BA; Thomas G. Rundall, PhD;

Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery

Dorothy Y. Hung, PhD, MA, MPH; Thomas G. Rundall, PhD; Justin Lee, BA; Negeen Khandel; Stephen M. Shortell, PhD;

Lean Practices for Resource Use, Timeliness, and Coordination of Care in Breast Cancer Navigation

Dorothy Y. Hung, PhD, MA, MPH: Paul Kim, MS; Martina Li, MPH; Qiwen Huang, MS; Cynthia Cantril, MPH, RN, OCN®, CBCN®; Natalia Colocci, MD, PhD; Ellis C. Dillon, PhD;

Expert-Identified Practices for Achieving Measurable Performance Improvements With Lean Implementation

Elina Reponen, MD, PhD; Thomas G. Rundall, PhD; Stephen M. Shortell, PhD, MBA, MPH; Janet C. Blodgett; Ritva Jokela; Markku Mäkijärvi; Paulus Torkki;

Breast Cancer Navigation: Using Physician and Patient Surveys to Explore Nurse Navigator Program Experiences

Ellis C. Dillon, PhD; Paul Kim, MS; Martina Li, MPH; Qiwen Huang, MS; Natalia Colocci, MD, PhD; Cynthia Cantril, RN, MPH, OCN, CBCN; Dorothy Y. Hung, PhD, MA, MPH;

Seizing the Opportunity: The Emergence of Shared Leadership During the Deployment of an Integrated Performance Management System

Pierre‐Luc Fournier, PhD; Line Moisan; Denis Lagacé;

Lean Adoption, Implementation, and Outcomes in Public Hospitals: Benchmarking the US and Italy Health Systems

Marta Marsilio, PhD; Martina Pisarra, MS; Karl Rubio, MS; Stephen Shortell, PhD, MBA, MPH; 

2021

Adoption of Lean Management and Hospital Performance: Results from a National Survey

Thomas G. Rundall, PhD; Stephen M. Shortell, PhD, MBA, MPH; Janet C. Blodgett, MSc; Rachel Mosher Henke, PhD; David Foster, PhD;

Examining the Relationship Between the Lean Management System and Quality Improvement Care Management Processes

Aaron A. Tierney, BA; Stephen M. Shortell, PhD, MPH, MBA; Thomas G. Rundall, PhD; Janet C. Blodgett, MSc; Elina Reponen, MD, PhD;

Assessing the Relationship of the Human Resource, Finance, and Information Technology Functions on Reported Performance in Hospitals Using the Lean Management System

Stephen M. Shortell, PhD, MBA, MPH; Thomas G. Rundall, PhD; Janet C. Blodgett, MS;

Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians

Dorothy Y. Hung, PhD, MA, MPH; Gabriela Mujal, MHA; Anqi Jin, PhD; Su‐Ying Liang, PhD;

Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the Finnish Healthcare Context

Elina Reponen, MD, PhD; Ritva Jokela; Janet C. Blodgett, MS; Thomas G. Rundall, PhD; Stephen M. Shortell, PhD, MBA, MPH; Mikko Nuutinen PhD; Noora Skants, MD; Markku Mäkijärvi MD; Paulus Torkki PhD;

The Cross-National Applicability of Lean Implementation Measures and Hospital Performance Measures: A Case Study of Finland and the USA

Elina Reponen, MD, PhD; Thomas G. Rundall, PhD; Stephen M. Shortell, PhD, MBA, MPH; Janet C. Blodgett, MSc; Ritva Jokela, PhD; Markku Mäkijärvi, MD; Paulus Torkki, PhD;

Implementing Lean QI in PC: Impact on Efficiency in Performing Common Clinical Tasks 

Pierre-Luc Fournier, PhD; Denis Chênevert MSc; Marie-Hélène Jobin, PhD, MBA; 

Lean Implementation in Healthcare: Offsetting Physicians’ Resistance to Change

Pierre-Luc Fournier, PhD; Marie-Hélène Jobin, PhD, MBA; Liette Lapointe, PhD, MSc; Lionel Bahl, MBA;

Lean, Shingo, and the Baldrige Framework: A Comprehensive Method to Achieve a Continuous-Improvement Management System

John S. Toussaint, MD; John R. Griffith, MBA, FACHE; Stephen M. Shortell, PhD, MBA, MPH;

Lean Management and Hospital Performance: Adoption vs. Implementation

Stephen M. Shortell, PhD, MBA, MPH; Janet C. Blodgett, MSc; Thomas G. Rundall, PhD; Rachel Mosher Henke, PhD; Elina Reponen, MD, PhD;

2020 

Lean Management and Breakthrough Performance Improvement in Health Care

Christie Ahn, MPH; Thomas G. Rundall, PhD; Stephen M. Shortell, PhD, MPH, MBA; Janet C. Blodgett, MSc; Elina Reponen, MD, PhD;

Patient Experiences After Implementing Lean Primary Care Redesigns

Dorothy Y. Hung, PhD, MA, MPH; Gabriela Mujal, MPH; Anqi Jin, PhD; 
Su-Ying Liang, PhD;

“Better Care Plan”: A Public Option Choice

George C. Halvorson; Stephen M. Shortell, PhD, MBA, MPH; Laurence Kotlikoff, PhD; Elizabeth Mitchell, PhD; Richard M. Scheffler, PhD; John Toussaint, MD; Peter A. Wadsworth, MBA; Gail R. Wilensky, PhD;

COVID-19: A Catalyst for Innovative Hybrid Teledermatology Workflows to Increase Access and Improve Patient Care at a Large Group Practice

Olga Afanasiev, MD, PhD; Dorothy Y. Hung, PhD, MA, MPH; Sherry Yan PhD; Bryan K. Cho, MD, PhD; Susan Huang, MD;

2019

Lean Management and U.S. Public Hospital Performance: Results from a National Survey

Justine Po; Thomas G. Rundall, PhD; Stephen Shortell, PhD, MBA, MPH; Janet C. Blodgett, MS;

Contextual Conditions and Performance Improvement in Primary Care

Dorothy Y. Hung, PhD, MA, MPH; Michael I. Harrison, PhD; Su-Ying Liang, PhD; Quan A. Truong, MPH;

Sustainment of Lean Redesigns for Primary Care Teams

Dorothy Y. Hung, PhD, MA, MPH; Caroline P. Gray, PhD; Quan A. Truong, MPH; Michael I. Harrison, PhD;

2018

Use of Lean and Related Transformational Performance Improvement Systems in Hospitals in the United States: Results From a National Survey

Stephen M. Shortell, PhD, MPH, MBA; Janet C. Blodgett, MS; Thomas G. Rundall, PhD; Peter Kralovec, PhD;

Experiences of Primary Care Physicians and Staff Following Lean Workflow Redesign

Dorothy Y. Hung, PhD, MA, MPH; Michael I. Harrison, PhD; Quan A. Truong, MPH; Xue Du;

Nurses’ Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency

Francesca M. Nicosia, PhD; Linda G. Park, NP, PhD; Caroline P. Gray PhD; Maayan J. Yakir, MD; Dorothy Y. Hung, PhD, MA, MPH;

Physician Engagement with Metrics in Lean Primary Care Transformation

Caroline P Gray PhD, MA; Maayan Yakir MD; Dorothy Hung PhD, MPH, MA;

Development and Use of a Comprehensive Contextual Framework for Evaluation of Process Redesign

Mahima Ashok, PhD, MS; Dorothy Hung, PhD, MA, MPH; Lucia Rojas-Smith, DrPH; Michael Halpern, MD, PhD, MPH; Michael Harrison, PhD;

2017

Scaling Lean in Primary Care: Impacts on System Performance

Dorothy Y. Hung, PhD, MA, MPH; Michael I. Harrison, PhD; Meghan C. Martinez, MPH; and Harold S. Luft, PhD;

Acceptance of lean redesigns in primary care: A contextual analysis

Dorothy Y. Hung, PhD, MA, MPH; Michael I. Harrison, PhD; Caroline Gray, PhD; Meghan Martinez, MPH; Julie Schmittdiel, PhD;

Ready for Change? The Role of Physician and Staff Engagement, Burnout, and
Workplace Attributes

Dorothy Hung, PhD, MA, MPH; Po-Han Chen, ScM;

2016

Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations 

Caroline P Gray, PhD, MA; Michael I Harrison, PhD; Dorothy Hung, PhD, MA, MPH;

Becoming Lean: What Will It Take to Sustain Lean Redesigns?

Dorothy Hung, PhD, MA, MPH; Carrie Gray, PhD, MBA; Michael Conroy, MD; Terrigal Burn, MD;

2015

Implementing a Lean Management System in Primary Care: Facilitators and Barriers from the Front Lines
Dorothy Hung, PhD, MA, MPH; Meghan Martinez, MPH; Maayan Yakir, BS; Caroline Gray, PhD, MA;