Jenei István

István Jenei: Lean transformation of hospital processes – Structuring foreign and Hungarian experiences,
PhD Dissertation, Corvinus University of Budapest, Doctoral School in Business Administration
Table of contents
TABLE OF CONTENTS ................................................................................................................................1
TABLE OF FIGURES.....................................................................................................................................4
TABLE OF TABLES.......................................................................................................................................5
ACKNOWLEDGEMENTS...............................................................................................................................6
ACKNOWLEDGEMENTS...............................................................................................................................6
INTRODUCTION ...........................................................................................................................................8
1. DESCRIPTION OF LEAN MANAGEMENT AND A VISION OF LEAN HEALTH CARE...........17
1.1. THE ORIGINS OF LEAN MANAGEMENT ............................................................................................. 17
1.2. THE BASES OF LEAN THINKING........................................................................................................ 19
1.3. LEAN MANAGEMENT TOOLS............................................................................................................ 22
1.4. THE RELATIONSHIP OF TQM AND LEAN.......................................................................................... 24
1.5. THE VISION OF LEAN HEALTHCARE ................................................................................................. 28
2. THE HEALTH CARE CONTEXT..........................................................................................................31
2.1. ACTUALITY OF THE TRANSFORMATION OF HEALTH CARE: MACRO-LEVEL CHALLENGES................. 31
2.2. ACTUALITY OF THE TRANSFORMATION OF HEALTH CARE: MICRO-LEVEL CHALLENGES .................. 33
2.3. EFFECTS OF THE SPECIAL FEATURES OF HEALTH CARE ON LEAN TRANSFORMATION ....................... 39
2.3.1. Hospital care as service ......................................................................................................... 40
2.3.2. The difficulties defining the “customer” ................................................................................ 41
2.3.3. Health care institutions as professional service provider organisations ............................... 43
3. METHODOLOGICAL TOOLS AND THE FRAMEWORK OF THE RESEARCH ........................45
3.1. DEFINITION OF THE RESEARCH OBJECTIVE AND METHODOLOGY ..................................................... 45
3.1.1. Definition of the research objective........................................................................................ 45
3.1.2. Research methodology ........................................................................................................... 48
3.2. THE BASIC LITERATURE ON THE TOPIC ............................................................................................ 51
3.2.1. Application of Lean in hospitals in the US (Spear, 2005) ...................................................... 52
3.2.2. Lean in the public sector (Radnor et al., 2006)...................................................................... 54
3.2.3. Lessons of six sigma applications to prospective applicants of the Lean (Proudlove et al.,
2008) ................................................................................................................................................ 57
3.2.4. Lean transformation of hospital processes: General experiences and propositions (Young -
McClean, 2008)................................................................................................................................60
3.3. THE CODE SYSTEM OF THE RESEARCH ............................................................................................. 61
3.3.1. Organisational objectives....................................................................................................... 65
3.3.2. External stakeholders............................................................................................................. 67
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