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Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects

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Abstract

The outcomes of lean projects have been mixed, with some being successful while many others have not. An explanation for this is a paradox that can develop depending on the focus of the project. Ironically, in projects where the focus is on maximizing the efficiency of a resource (‘resource efficiency’), this focus might lead to worsening of the resource’s efficiency, thereby generating an ‘efficiency paradox’. This paradox does not usually arise in projects where the focus is on the subject of interest being processed through the system in the most efficient manner (‘flow efficiency’). The aim of this paper is to investigate the factors that give rise to either form of efficiency. We conducted a detailed study of eight lean projects in two large hospitals. In doing so, we advance the theory of lean service operations by identifying four key contextual factors that drive the orientation of a project to resource or flow efficiency. These are: service variety, interdependency, capital resource intensity, and service uniqueness. We propose a conceptual framework and four propositions that integrate the contextual factors to determine the dominant focus in lean projects. Through this, recommendations are made as to how the efficiency paradox can be avoided.

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Author information

Authors and Affiliations

  1. School of Business, Singapore University of Social Sciences, Singapore, Singapore

    Huay Ling Tay

  2. Department of Management & Marketing, Faculty of Business & Economics, The University of Melbourne, Melbourne, Australia

    Prakash J. Singh & Vikram Bhakoo

  3. College of Economics and Political Science, Sultan Qaboos University, Muscat, Sultanate of Oman

    Shahid Al-Balushi

Authors
  1. Huay Ling Tay
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  2. Prakash J. Singh
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  3. Vikram Bhakoo
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  4. Shahid Al-Balushi
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Corresponding author

Correspondence to Huay Ling Tay.

Appendices

Appendix 1: Questions in the Semi-Structured Interview Protocol

  • How would you describe the constraints that are limiting the work processes in this project?

  • What are the main causes of these limiting factors?

  • How has lean affected the current practice in managing the internal operations in your service areas?

  • How would you describe the impact of the lean project in your service areas?

  • Is there improvement in efficiency performance?

  • What outcomes have resulted from the lean practices?

  • Have the expected outcome/s been achieved?

  • Have the improved outcomes been able to sustain over time?

Appendix 2

Table 7 Representative quotes that are evidence of the contextual factors
Full size table

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Tay, H.L., Singh, P.J., Bhakoo, V. et al. Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects. Oper Manag Res 10, 118–136 (2017). https://doi.org/10.1007/s12063-017-0126-3

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  • DOI: https://doi.org/10.1007/s12063-017-0126-3

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