From self-management to a systemized process: the implementation of lean management in a Chinese hospital's pharmacy intravenous admixture services center.

PURPOSE: The purpose of this paper is to explore the importance of lean leadership in an implementation in a Chinese hospital, considering a particular focus on the attitudes of nursing professionals while identifying specific cultural or institutional factors in China that might affect the implementation. DESIGN/METHODOLOGY/APPROACH: The authors use Harrison et al.'s (2016) framework to explore the outcomes of a nine-month action research project whereby the authors observed the process and outcomes of implementing lean in a pharmacy intravenous admixture service of a Chinese hospital. FINDINGS: The implementation of lean had positive results, which improved the efficiency of the operation, reduced the work start time and the amount of staff, and improved clinical satisfaction. In the process of implementation, nursing professionals showed a positive attitude toward the implementation and showed no obvious resistance under the positive influence of the head nurse. The combination of Chinese cultural characteristics, nursing culture and strong leadership enabled lean success. ORIGINALITY/VALUE: The unit moved from self-management to a systemized process of using lean concepts and methods, it is an important change for hospital managers.

Organizational issues for the lean success in China: exploring a change strategy for lean success.

BACKGROUND: The purpose of this paper is to explore a change strategy for lean success in hospitals based on a comprehensive review of the Chinese literature. METHODS: The methodology is a systematic review of the Chinese literature which identified 212 case study papers about lean implementation. We did a thematic content analysis of the 212 papers. RESULTS: Lean applications in Chinese hospitals show significant increases and are mainly used in the fields of outpatient services, operating rooms, pharmacy and logistics. Most hospitals applied lean as a single project but some were beginning to use lean as a systemic path for improvement with an emphasis on lean and strategy. The main goals were to increase the operating efficiency and reduce operating costs. Patients were not central to lean applications. Chinese hospitals appear to lack a full understanding of lean. Four factors appear to be critical for lean success - organizational leadership, adequate technology, stakeholder involvement and individual and organizational benefits. The relationship of these factors changes over time. CONCLUSIONS: This is the first paper to provide a comprehensive view of lean application in Chinese hospitals. The findings presented in this paper provide a systemic evidence to the application of lean in healthcare.

Meeting the challenge in performance management: the diffusion and implementation of the balanced scorecard in Chinese hospitals.

The bonus system used in Chinese hospitals has been criticized for eroding doctors' professional ethics and aggravating patient expense. This research article focuses on one system to improve hospital performance, the balanced scorecard (BSC). We use three data sources to examine the diffusion and implementation of the BSC in China: a questionnaire survey in Shandong Province, a print-media indicators and content analysis of the published BSC papers and semi-structured interviews with managers of Chinese hospitals that use the BSC. The research evidence shows that bonus systems are important, partially because of the poor pay of hospital professionals, and the BSC is perceived as providing a fair system to award such bonuses. This helps explain the relative endurance of the BSC in Chinese hospitals.

Understanding resistance towards electronic patient health data in South Australian family practice.

This paper reports the results from a survey of 131 medical practitioners in South Australian General Practice concerning adoption of a computerised system for storing and potentially amalgamating health information from several practices. Practitioners were primarily influenced by the positively perceived potential for such technology use to improve patient health and well-being outcomes and secondarily by the negatively perceived potential for unwanted change in the status, control and autonomy of their professional role. Practitioner attitude reflected how they resolved the competing influences. The data suggest that strategies for implementing such systems should address individual perceptions by increasing belief in the potential for patient improvement or by decreasing belief of the inevitability of unwanted role change.