Jenei István

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István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration To classify experience accumulated on the lean transformation of hospital processes, I then collected from the relevant (and accessible) databases the articles which described the lean efforts of hospitals and the related experiences with sufficient detail and a scientific exactitude. This produced 20 hospital case descriptions. The information provided by these cases was structured and summarised according the codification framework elaborated before. Chapter 4 introduces this work. Since these provided information based on secondary sources and there was no Hungarian case among them, to remedy the deficiencies, I carried out a case-study research at Zala County Hospital (ZMK), Hungary. The information gathered during the research was structured also according the previously elaborated framework. Chapter 5 gives a short overview of the Hungarian health care environment in which hospitals function. Chapter 6 details the case of the Zala County Hospital (ZMK). Chapter 7 presents the results of the dissertation in detail. It contains the synthesised review of information from the four basic literature items, the 20 foreign and 1 Hungarian case studies – supplemented with the experiences of other sources related to the topic –, structured according to the analytical framework, in a systematic way. Chapter 8 summarises the whole study, describes the practical and scientific contribution made by the author and also phrases the possible further research directions The introductory part cannot be complete without the discussion of a highly important issue, viz. the theoretical relevance of the research. Over and beyond its practical relevance, the ideal of lean health care and the possibilities and pitfalls of its implementation is also key to scientific understanding. Hines et al. (2004), while condemning a major part of researcher society for identifying the lean principles with production, also hint at what could be the main areas of research in regard of this topic: “Further research is called for to see how this (introduction of value systems based on the lean philosophy) can be achieved in under-researched sectors, such as lowvolume manufacturing and service contexts like health care, which are still in early stages of their lean evolution” (2004, p.1007.). What is proposed by Hines et al. matches the target defined as commendable by the representative organisations of the - 15 -
István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences, PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration researchers of operations management 4 (Pannirselvam et al., 1999), i.e. basically that the growth of the services sector ought to be concurrent with a corresponding growth of the number of research projects there. In reality, however, the latter figure has always been much lower than the number of research projects in the production sector (Matchuca et al., 2007). The review carried out by Smith et al. (2007) of articles published in 1990–2006 in five leading (production and services) operations management periodicals demonstrated that researcher society responded with a significant delay to this increasingly definite directive. The same tendency has demonstrably been present, even more forcefully, in the research of Lean options in health care. Radnor et al. (2006) note the small number of descriptions or assessments of Lean in the public sector. It is typical that, of the 463 articles identified by Smith et al. (2007) as a being related to the services (based on their title), only 35 actually treated a health care issue of some kind, and none referred to research on the application of lean principles there. In discussing the lean approach, one must not forget the many other development approaches which target patient care development at the level of the organisation. Their forms are many, e.g. objective medicine, accreditation, total quality management, risk management and error prevention, organisational development etc. These approaches are partly competing and partly complementary ones (Grol et al. (2002). Their implementation raises many open questions: “We simply do not know which to apply and when, or what to expect” (Grol et al, 2002, p.110.). Although this dissertation is limited to the description of the steps and effects of Lean, many of its findings are probably equally true of other development approaches and it will obviously contribute also to the clarification of the relative positions of the various alternative solutions. 4 Production and Operations Management Society – POMS; European Operations Management Association – EurOMA - 16 -
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Jenei István

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