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.