Lean six sigma and its effect on quality performance in Malaysian hospitals

Abstract

Healthcare is a service industry with unique characteristics. In healthcare, customers are the immediate patients followed by their families and quite possibly their friends, as the outcome of the healthcare service potentially affects all their lives. Any error or mistake can be devastating to individuals and groups alike as lives and quality of life are at risk. In 1999, the Institute of Medicine estimated that up to 98,000 people die annually in the United States alone due to medical errors. To overcome medical patient safety and quality problems, healthcare organisations need to implement the lean six sigma approach to improve quality performance. The lean six sigma approach helps healthcare organisations eliminate waste, variation and work imbalance in the service processes. This approach also eliminates the unnecessary long cycle or waiting time between value-added activities to improve hospitals’ performance. The main objective of this study is to investigate the effects of lean six sigma application on the quality performance of Malaysian hospitals. This research also investigates the relationship between top management commitment and quality performance through the mediating effects of the lean six sigma and workforce management of healthcare organisations in Malaysia. This study explores the lean six sigma application and its relationships with top management commitment, workforce management and quality performance based on the theory of constraint (TOC), system thinking theory, and contingency theory. This study applied stratified random sampling to collect data from 15 selected hospitals in Peninsular Malaysia. The self-administered survey questionnaires were distributed to 673 hospital staff (i.e., doctors, nurses, pharmacists and medical laboratory technologists) obtained 335 useful responses with 49.47% valid response rate. The research data were analysed based on exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modelling (SEM) by using SPSS version 22 and AMOS version 22 software. The research findings indicate that lean six sigma and workforce management have significant impact on quality performance of Malaysian hospitals, whereas top management commitment was found to have insignificant relationship with quality performance. Although the research findings indicate that top management commitment has no direct significant relationship with quality performance, it has indirect significant relationship with quality performance through the mediating effects of lean six sigma and workforce management. The results also indicate that top management commitment and workforce management have significant impact on lean six sigma application.