The social outcomes of kaizen initiatives in healthcare

This thesis presents results from of a field study that focuses on the social benefits of kaizen initiatives in healthcare context. Although human resources are recognised as the corner stone of kaizen initiatives, there has been few studies that address the social benefits of kaizen initiatives in healthcare so far. Additionally, most of these studies are theoretical, others are anecdotal and not based on robust empirical basis. To address this issue, a theoretical framework of kaizen initiatives was adapted to the healthcare context. Drawing on this input-process-outcome framework, it was distinguished determinants into input and process factors, and developed hypotheses related to the direct and indirect effects of the determinants on the social outcomes. These hypotheses were tested using data from 105 kaizen initiatives performed at two Italian public hospitals following a systematic regression analysis. The research found statistical significant support to the proposed hypotheses. Specifically, it was found that goal clarity, team autonomy and management support affect employee’ kaizen capabilities and attitude whereas affective commitment to change only influences employee’s kaizen capabilities and goal difficulty influences employees’ attitude only. Moreover, support for mechanism that describe the indirect effect of input factors on social outcomes through the process factors was found. Namely, it was found that goal clarity, goal difficulty and management support affect both the social outcomes through affective commitment to change. Team autonomy affects both social outcomes through internal processes. Finally, goal clarity and team autonomy affect employee’ kaizen capabilities through action orientation whereas this process factor mediates the effect of management support on the employees’ attitude. Many of these findings confirm the scholar recommendations in lean healthcare literature and team effectiveness literature in healthcare. Furthermore, these findings will be valuable for lean healthcare practitioners who can invest the few resources available for the improvement of the healthcare service in developing effective ad hoc strategies that may guarantee the natural grow of the kaizen mentality of healthcare professionals, guaranteeing sustainable operational performance improvements.