Measuring Lean Management Penetration on the Hospital Nursing Frontline: Instrument Development

Roszell, Sheila Serr

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March 22, 2019

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Roszell, Sheila Serr
- School of Nursing

Abstract

Purpose: It is imperative to assure that health care organizations provide excellent care and create value by improving quality while eliminating unnecessary costs. Lean management is a continuous improvement management plan that uses work flow design to produce improvements in quality, safety, cost and productivity; it has been used in manufacturing, service and, more recently, healthcare industries. This study developed and tested an instrument to measure frontline nurse caregivers' perception of the penetration of lean management in hospitals that report using lean strategies. Methods: The study consisted of three phases. In Phase 1, using the Delphi technique, an on-line survey of experts (n=10) and a review of the literature identified the domains and subdomains of lean management. Ideas from each domain were formed into items on the Frontline Improvement Thinking (FIT) instrument. The experts also assessed content validity. In Phase 2, nurses assessed the instrument's format, on-line usability of the instrument and content validity. In Phase 3, the instrument was administered to frontline nurses working on units in hospitals that reported using lean methods. Their responses (n= 212) provided the data for assessing the instrument's psychometric properties. Results: Exploratory factor analysis yielded a scale with 75 items in 12 factors. Three domains were identified: organizational, unit and individual areas of improvement. The 4-factor, 29-item, FIT Unit had the highest reliability (α=.86-0.94; inter-item correlation range=.26-0.63). The 2-factor, 10-item FIT Organization was also acceptable (α=.87 and 0.79, inter-item correlation range=.30-0.72. The FIT Individual had less than desired reliability on one factor (α=.66) but had acceptable reliability on the other six factors (0.75-0.94; inter-item correlation range =.25-0.89). Test-retest reliability estimates were acceptable for the organization and unit based on Pearson's R correlations (0.53-0.77). Conclusion: In the early stage of development, the FIT instrument proved helpful in describing diffusion of lean management. Sample size and quality proved to be problems, however. Nurses from hospitals with a history of lean quality improvement did not participate in the study and some of the hospitals studied were in the very early phases of lean management. Recommendations include continuing work on measure development by increasing the sample of lean-thinking nurses.

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