Construction and validation of an instrument for evaluating Lean Healthcare in healthcare institutions

Fernandes, Hellen Maria de Lima Graf; Silva, Dirceu da; Tarifa, Rosana Ribeiro; Guirardello, Edinêis de Brito

doi:10.1590/1983-1447.2024.20230061.en

Hellen Maria de Lima Graf Fernandes

project administration

formal analysis

conceptualization

writing – original draft

writing – review & editing

investigation

methodology

Universidade Estadual de Campinas (UNICAMP). Faculdade de Enfermagem. Campinas, São Paulo, Brasil.

Faculdade Anhanguera. Graduação em Enfermagem. Joinville, Santa Catarina, Brasil.

Associação Educacional Luterana Bom Jesus (IELUSC). Graduação em Enfermagem. Joinville, Santa Catarina, Brasil.

https://orcid.org/0000-0002-0716-0950

Dirceu da Silva

formal analysis

conceptualization

data curation

methodology

supervision

Universidade Estadual de Campinas (UNICAMP). Faculdade de Educação. Campinas, São Paulo, Brasil.

https://orcid.org/0000-0003-3267-511X

Rosana Ribeiro Tarifa

formal analysis

writing – original draft

writing – review & editing

Universidade Estadual de Campinas (UNICAMP). Colégio Técnico de Campinas. Campinas, São Paulo, Brasil.

Faculdade Anhanguera de Sumaré (FSU). Graduação em Enfermagem. Sumaré, São Paulo, Brasil.

https://orcid.org/0000-0002-5785-4504

Edinêis de Brito Guirardello

project administration

funding acquisition

conceptualization

writing – review & editing

methodology

resources

supervision

validation

Universidade Estadual de Campinas (UNICAMP). Faculdade de Enfermagem. Campinas, São Paulo, Brasil.

https://orcid.org/0000-0003-0457-2850

Corresponding author:
Hellen Maria de Lima Graf Fernandes E-mail: hellenmlima@gmail.com

Associate editor:

Aline Marques Acosta

Editor-in-chief:

João Lucas Campos de Oliveira

The authors declare that there is no conflict of interest.

Models	Structure	Process	Outcome	Removed items
1^st Round	0.309	0.284	0.313	S01, S10, S12, S19, P01, P02, P03, P07, P09, P13, O02, O08, O10, O11 e O13
2^nd Round	0.370	0.362	0.427	S05, S13, S15, S17, S18, P06, P08, P11, P12, R06 e O12
3^rd Round	0.417	0.455	0.475	S14, P17, O04
4^th Round	0.429	0.491	0.503	S08, P10 e P16
5^th Round	0.446	0.528	0.503	S04, S11 e S16
6^th Round	0.527	0.537	0.503

ITEMS
S01	Q1	The infrastructure of my sector was changed to facilitate service flows
S02	Q2	Professional performance evaluation is used positively to correct failures/problems
S03	Q3	The culture of continuous improvement in my sector, with investments in infrastructure, material resources and personnel development, favors my professional development
S04	Q5	Continuing education focuses on the demands of patients/users
S05	Q6	Continuing education focuses on the demands of professionals
S06	Q7	The physical structure (flow organization and layout) enhances work performance
S07	Q16	I feel safe in my work environment
S08	Q17	I have good conditions to perform my job
S09	Q24	My team is always encouraged to incorporate new knowledge into practices
S10	Q25	My team is open to new information/knowledge
S11	Q26	In my institution there is a training and updating program for professionals
S12	Q29	In my sector, changes regarding improvement processes are the exclusive responsibility of my supervisors
S13	Q30	In my sector, quality indicators are available and/or easily accessible to the entire team
S14	Q32	My sector has material resources in quantity and quality to meet healthcare demands
S15	Q33	My sector has technological resources in quantity and quality to meet healthcare demands
S16	Q38	Quality indicators (costs, process and patients/users) are presented to the team periodically
S17	Q43	I feel that my opinion is valued to promote change
S18	Q44	I feel satisfied working in this sector
S19	Q46	I am encouraged to report incidents related to patient/user safety
P01	Q11	The standardization of healthcare promotes physical and emotional safety for the patient/user
P02	Q12	Active participation in change processes in the sector is part of the routine of medical team members
P03	Q14	In my sector there is standardization of conduct (protocols, standards) between professionals in the same category, such as nursing, physicians, cleaning and others
P04	Q18	There is a routine for the team to periodically discuss the sector’s quality indicators
P05	Q19	I am part of a team that maintains continuous communication on a daily basis
P06	Q20	Materials are requested and used without excess or surplus in the sector
P07	Q21	My work process is centered on value to the patient/user
P08	Q23	My supervisor encourages positive discussions about errors, difficulties and lessons learned
P09	Q27	Overall, the team I work for makes decisions together
P10	Q31	Flow mapping enables discussions on continuous improvement in my sector
P11	Q34	The patient/user is promptly attended to in this sector
P12	Q35	The work process flows without interruptions
P13	Q37	The use of standardized procedures and actions increased the recording and documentation of activities in my sector
P14	Q41	Action plans for improvement projects are discussed with the team periodically
P15	Q48	I am sure that now my functions/attributions are very well defined
P16	Q49	All sectors are involved in continuous improvement
P17	Q50	We work to reduce waste in service, such as: unnecessary inventory, no waiting queues, no excess production, no rework, no failures and no lengthy transport
O01	Q4	The culture of continuous improvement has contributed to increasing productivity year after year
O02	Q8	Continuous improvement in healthcare is the result of the work of the team in each sector
O03	Q9	Continuous improvement, based on Lean principles, is part of the routine in my work sector
O04	Q10	My team is recognized for good results in their work
O05	Q13	Currently my sector is more organized and efficient
O06	Q15	I would feel safe being served in this sector
O07	Q22	My sector had immediate positive results with the implementation of Lean
O08	Q28	In my sector, improvements in service and organization are only discussed during audits
O09	Q36	Teamwork improved after implementing Lean in our sector
O10	Q39	Patients/users recognize this institution for its excellence
O11	Q40	I participate in decisions made in my sector
O12	Q42	Little or nothing changed in my sector after implementing Lean
O13	Q45	Problem solving with long-term projects is valued by the team
O14	Q47	We have less waste in the sector compared to last year
O15	Q51	Lately, the perception of value delivered to the patient/user by workers has improved

Dimensions	Average Variance Extracted	Composite Reliability	Cronbach’s Alpha	R2
Structure	0.527	0.847	0.774	0.794
Process	0.537	0.822	0.712	0.630
Outcome	0.503	0.875	0.833	0.818

IALEH - Lean Healthcare evaluation instrument
Instructions: Please answer the items below considering the extent to which you agree that they are present in your sector or area of work. Physicians and other healthcare professionals who are not assigned to a single unit must respond based on their experiences in the workplace where they spend most of their time.		Completely disagree	Partially disagree	Neutral	Partially agree	Completely agree
ITEMS						Completely agree
1	Professional performance evaluation is used positively to correct failures/problems	Completely disagree	Partially disagree	Neutral	Partially agree	1	2	3	4	5
2	The culture of continuous improvement in my sector, with investments in infrastructure, material resources and personnel development, favors my professional development	1	2	3	4	5
3	Continuing education focuses on the demands of patients/users	1	2	3	4	5
4	The physical structure (flow organization and layout) enhances work performance	1	2	3	4	5
5	I feel safe in my work environment	1	2	3	4	5
6	I am part of a team that maintains continuous communication on a daily basis	1	2	3	4	5
7	Overall, the team I work for makes decisions together	1	2	3	4	5
8	Action plans for improvement projects are discussed with the team periodically	1	2	3	4	5
9	I am sure that now my functions/attributions are very well defined	1	2	3	4	5
10	The culture of continuous improvement has contributed to increasing productivity year after year	1	2	3	4	5
11	Continuous improvement, based on Lean principles, is part of the routine in my work sector	1	2	3	4	5
12	Currently my sector is more organized and efficient	1	2	3	4	5
13	My sector had immediate positive results with the implementation of Lean	1	2	3	4	5
14	Teamwork improved after implementing Lean in our sector	1	2	3	4	5
15	We have less waste in the sector compared to last year	1	2	3	4	5
16	Lately, the perception of value delivered to the patient/user by workers has improved	1	2	3	4	5

[1] Corresponding author:
Hellen Maria de Lima Graf Fernandes E-mail: hellenmlima@gmail.com

Brasil

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Construction and validation of an instrument for evaluating Lean Healthcare in healthcare institutions

Construcción y validación de un instrumento para evaluar el Lean Healthcare en instituciones de salud

ABSTRACT

Objective:

Method:

Results:

Conclusion: