Sustainability of Lean healthcare in South Africa: A practitioner's perspective

Abstract

South African public healthcare organisations have adopted lean as one of the initiatives to enhance service delivery. This aligns with the global trend of Lean applications in healthcare, which has been steadily increasing since 2000. Lean implementation has yielded some positive results. Despite these successes, the long￾term rate of success remains fairly low. This is often attributed to many factors including a lack of well-planned and sustainable implementation and misapplication of Lean. Furthermore, the scarcity of Lean healthcare literature has created a knowledge gap, including reasons for failure, that needs to be addressed to improve Lean sustainability. This study aims to identify the factors that impact the sustainability of Lean healthcare in South Africa and draw lessons from these findings to improve Lean implementation sustainability. The scope of this study is limited to public hospitals because they represent a bigger portion of the public healthcare sector and the majority of literature on Lean implementation is on them. The study employs semi￾structured interviews to explore these factors. The interviews are limited to practitioners who have been involved in Lean implementations in South African public hospitals. Through these interviews, 44 factors were identified and grouped into 13 themes (Long-term philosophy, Lean alignment, Implementation, Leadership, Commitment, Training, Teamwork, Support, Motivation, Communication, Management, Empowerment, and Healthy competition). These themes were grouped into four sustainability pillars (Foundation, Concepts of Lean, People and Organisational culture. The study further employs a systematic literature review (SLR) to explore the factors that would be used to test or evaluate factors from interviews. The SLR identified 46 factors affecting Lean sustainability, that were grouped into 13 themes. The themes identified through both methods were found to be compatible with each other. The findings from the interviews were then used to draw lessons that can be applied to enhance the sustainability of Lean in South African public hospitals.