INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE最新文献

{"title":"Access barriers for severe mental disorders in Colombia.","authors":"Juan Camilo Rodriguez Fandino","doi":"10.1108/IJHCQA-08-2024-0077","DOIUrl":"10.1108/IJHCQA-08-2024-0077","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to identify the barriers to accessing mental health services in Colombia, analyze the causes that generate them and how they perpetuate over time and critically call for the strengthening of the provision and guarantee of access to these services in the country.</p><p><strong>Design/methodology/approach: </strong>A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. The databases Science Direct, Proquest and Google Scholar were consulted, and the following search terms were used: Accessibility to health services, health disparities, bipolar disorder, schizophrenia and Colombia. A total of 35 articles meeting the inclusion criteria were analyzed, which allowed the classification of access barriers into five categories: governmental, personal, familial, social and institutional, all of which directly or indirectly affect access to mental health services.</p><p><strong>Findings: </strong>Colombia regularly faces various social issues; thus, progress in the field of mental health in terms of treatment, research and prevention is imperative. For such a change to be possible, contributions from legislation and health authorities are required, taking into account the individuality of the patient, their context and their limitations.</p><p><strong>Originality/value: </strong>This study offers a critical view of the barriers that hinder access to mental health services in Colombia, highlighting the need to strengthen the provision and guarantee access to these services.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":" ","pages":"79-93"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health insurance for the elderly: an insight from bibliometric analysis.","authors":"Gaurav Agrawal, Amit Kumar","doi":"10.1108/IJHCQA-03-2023-0019","DOIUrl":"10.1108/IJHCQA-03-2023-0019","url":null,"abstract":"<p><strong>Purpose: </strong>The study examines worldwide public health insurance and ageing studies. This was accomplished by doing a thorough bibliometric analysis of publications published between 2002 and 2022 (till 31st May), which includes 479 articles for the analysis.</p><p><strong>Design/methodology/approach: </strong>This study used the Web of Science database to analyse the vast quantity of data from the journals referenced above. VOSviewer creates network maps, keyword concurrences and cross-country co-authorship. The research analyses parameters like article distribution by year and citation frequency to determine top publications. After that, co-authorship, country co-authorship and keyword co-occurrence bibliometric network maps are shown.</p><p><strong>Findings: </strong>The finding of the study reveals that the year 2020 is the most productive year for publication; BMJ Open is referred to as the most productive journal in this area, and \"Depression in the Elderly\" is the most referenced paper. The US has published the highest number of articles. We've seen 21 authors work with \"Akishita and Ishizaki\". The USA is the most collaborative author with other countries and conducted a keywords-based cluster analysis in which \"Public health insurance, older adults and long-term care\" are the most frequent keywords in this domain.</p><p><strong>Originality/value: </strong>This article aligns with the current literature on elderly public health insurance. The authors utilize bibliometric analysis to provide a more comprehensive and robust understanding of this area. Those interested in conducting further research in this field can use the findings of this study as a guide.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"38 2","pages":"94-111"},"PeriodicalIF":2.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The response of the benchmark healthcare index of India to COVID-19 pandemic: a return volatility approach.","authors":"Peeyush Bangur","doi":"10.1108/IJHCQA-01-2023-0005","DOIUrl":"10.1108/IJHCQA-01-2023-0005","url":null,"abstract":"<p><strong>Purpose: </strong>From poor healthcare infrastructure to vaccine donors, India has traveled a long way. In this study, the author tried to find the investment certainty and persistence of volatility in the Indian healthcare system due to COVID-19.</p><p><strong>Design/methodology/approach: </strong>Using the Generalized Autoregressive Conditional Heteroskedasticity (GARCH 1,1) model, this study quantifies the change in the conditional variance after the first case report of COVID-19. The author has used the S&P BSE HEALTHCARE index time series to analyze India's healthcare infrastructure and practices.</p><p><strong>Findings: </strong>The author found evidence of a decrease in investment certainty in investments related to India's healthcare infrastructure and practices after the first case report of COVID-19. Furthermore, the estimation of the econometric model suggests the presence of a large degree of volatility persistence in the S&P BSE HEALTHCARE index.</p><p><strong>Originality/value: </strong>This research would be the first of its kind where the return volatility of the Indian healthcare sector has been discussed. Also, this research quantifies the return volatility of the healthcare sector during the pre- and post-COVID-19 period.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":" ","pages":"39-50"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of family members' communication mode choice on the family's perceptions of care.","authors":"Adi Gerblich, Eran Rubin, Kathleen Kennedy","doi":"10.1108/IJHCQA-06-2023-0040","DOIUrl":"10.1108/IJHCQA-06-2023-0040","url":null,"abstract":"<p><strong>Purpose: </strong>Family-centered rounds (FCR) are a multidisciplinary process in which patients and/or family members are present and actively participate in medical rounds. While research has shown that FCR may enhance collaborative information exchange and reduce family anxiety, the impact of the information exchange modality on the experience has been largely unexplored. Medical rounds are typically assumed to be carried out in person at the bedside. In this research, we challenge this perception. We ask whether FCR communication is best conducted at the bedside or if similar communication outcomes are obtained when family members choose the communication mode according to their preferences.</p><p><strong>Design/methodology/approach: </strong>Using a field experiment in which participants choose the communication mode, we empirically analyze perceptions of the resulting communication in terms of information exchange. Three communication modes are available for participants to choose from (i.e. patients' families): face-to-face (FtF), phone and video conferencing. A questionnaire is distributed, and the responses of the patients' family members are analyzed. ANOVA tests are carried out to analyze the effect of communication mode on family perceptions.</p><p><strong>Findings: </strong>Perceptions following video conferencing or FtF interaction were significantly higher than perceptions following the use of a phone. Thus, our results show clear superiority of video and FtF communication modes as facilitators of effective communication perceptions. There is also marginal evidence that FtF communication is perceived as superior than video conferencing in supporting the receipt of information and understanding but not in the ability to convey information and input to the care team. These results suggest that allowing family members to choose their communication preferences does not always support effective communication. A case can be made for motivating patient family members to use face-to-face or video communication rather than phone if possible.</p><p><strong>Originality/value: </strong>The possible ramifications of allowing family members to choose communication mode with the care team have been largely unexplored. Medical rounds are typically assumed to be carried out in person at the bedside. In this research, we challenge this perception. We ask whether communication is best conducted at the bedside or whether similar communication outcomes are obtained when family members choose the communication mode according to their preferences.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":" ","pages":"28-38"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk management in Moroccan public hospitals: a literature review.","authors":"Asma Oumghar, Issam Izza","doi":"10.1108/IJHCQA-08-2023-0057","DOIUrl":"10.1108/IJHCQA-08-2023-0057","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this review is to provide a comprehensive analysis of risk management practices in the healthcare sector, with a particular focus on identifying challenges and strategies in Moroccan hospitals.</p><p><strong>Design/methodology/approach: </strong>A literature search was carried out on several academic search engines using search terms reflecting the relationship between risk management and public hospitals in Morocco.</p><p><strong>Findings: </strong>The Moroccan public hospital is confronted with several disjunctions, which can be sources of multiple risks. This influences the quality of care provided to patients and can sometimes threaten their vital prognosis. The risk management process can help health professionals, researchers and risk managers to be agile and identify and anticipate risks in order to avoid serious accidents that can affect the whole organization, especially after the pandemic lived experiences (COVID-19).</p><p><strong>Originality/value: </strong>Protecting human life in an environment where risks are omnipresent is a dilemma that every hospital organization must confront. So, risk management in the hospital is not a simple process, given the interaction of several components and the sensitivity of the field. Risk management in this establishment must be rigorous because every error can cost human life. In this sense, the analysis of risk management processes in Moroccan hospitals, based on what really exists, enables the identification of shortcomings in order to master the risk management system and thus protect goods and services as well as human life, which is the ultimate goal of the hospital organization's existence.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":" ","pages":"1-27"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality.","authors":"Parvathi Jayaprakash, Rupsa Majumdar, Somnath Ingole","doi":"10.1108/IJHCQA-05-2023-0030","DOIUrl":"10.1108/IJHCQA-05-2023-0030","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design/methodology/approach: &lt;/strong&gt;The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Practical implications: &lt;/strong&gt;For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Originality/value: &lt;/strong&gt;The study's originality resides ","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":"42-67"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation in the digital transformation of healthcare: a review of qualitative studies.","authors":"Lisabet Wieslander, Ingela Bäckström, Marie Häggström","doi":"10.1108/IJHCQA-03-2024-0021","DOIUrl":"10.1108/IJHCQA-03-2024-0021","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this review is to identify how health professionals perceive participation in implementation of new technology in healthcare organizations.</p><p><strong>Design/methodology/approach: </strong>A qualitative systematic review based on the PRISMA diagram, was conducted using qualitative synthesis. NVivo software was used for thematic analysis. The searches were performed in PubMed, CINAHL and Scopus.</p><p><strong>Findings: </strong>A total of 15 articles were included in the review, four themes describing how participation of health professionals in digital transformation affects the outcomes were identified, and three themes describing the factors that are necessary to promote participation. The underlying latent theme of an unmet desire to participate in the digital transformation was also identified in the analysis.</p><p><strong>Originality/value: </strong>The digital transformation of healthcare is complex and faces many obstacles if not managed correctly. Professional participation in the implementation seems to be essential for success. Focus on increased resources and planning during early stages, as well as teamwork and ethical reflection is important addressing the challenges that professionals face in digital transformation of healthcare.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":"68-84"},"PeriodicalIF":2.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Governance of healthcare quality: exploring the relationships between hospital board performance and healthcare quality outcomes.","authors":"Yassmine Mourajid, Mohamed Chahboune, Abdelhadi Ifleh, Nadia Al Wachami, Maryem Arraji, Karima Boumendil, Younes Iderdar, Fatime Zahra Bouchachi, Abderraouf Hilali","doi":"10.1108/IJHCQA-09-2023-0065","DOIUrl":"10.1108/IJHCQA-09-2023-0065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This paper aims to contribute to the existing literature in the field of hospital governance by exploring the relationship between the attributes and performance of hospital boards and hospital performance in terms of quality of healthcare.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design/methodology/approach: &lt;/strong&gt;A survey of board performance in public hospitals in Morocco was carried out, in which we surveyed all board members of the 13 hospitals in the Casablanca-Settat region. A total of 82 members responded (82% response rate) to the previously adapted and validated self-evaluation questionnaire on board self-assessment questionnaire (BSAQ) board member performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;On average, the hospital boards studied had eight members. In terms of clinical expertise, half the members were physicians and 17% were nurses. In addition, positive correlations were found between certain board characteristics, notably age, seniority, members' perceptions of their impact on the quality of healthcare and several dimensions of board performance. In parallel, the results showed strong and significant associations between turnover rate and BSAQ score. Negative correlations were also found between average length of stay and BSAQ score. With regard to mortality parameters, it should be noted that we were unable to establish a strong empirical correlation between hospital boards' self-assessed performance and other hospital mortality indicators.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research limitations/implications: &lt;/strong&gt;The present study offers a rigorous rationale for the use of the French-translated BSAQ in the hospital context, and we hope that others will use this tool in future work within the framework of evidence-based research. In addition, the BSAQ tool's focus on board competencies (and not just structure, composition or processes) provides valuable insights into what boards need to learn in order to function effectively. However, despite the insistence of the authors of this study on the need for a comprehensive census of public hospital board members in the region, several obstacles were encountered. Firstly, there were difficulties related to vacancies within the hospitals, which had the effect of restricting the representativeness of the sample. Secondly, access to hospital board members proved complex due to their busy schedules and the confidential nature of their meetings. Finally, it is important to note that national performance indicators in Morocco may not be as reliable as in other countries, which could complicate the identification of high-performing hospital systems and, consequently, make inference difficult.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Originality/value: &lt;/strong&gt;This study provides large-scale empirical evidence of processes related to the governance of quality of healthcare and elucidates the existence of an association between hospital board performance and clinical performance. The use of validated tools such as the BSAQ should th","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":"25-41"},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking organizational cronyism, time theft and nurse's proactive behavior: an evidence from public sector hospitals of Pakistan.","authors":"Muhammad Awais Khan","doi":"10.1108/IJHCQA-06-2023-0044","DOIUrl":"10.1108/IJHCQA-06-2023-0044","url":null,"abstract":"<p><strong>Purpose: </strong>The main objective of this study was to understand <i>why</i> employees engage in time theft behavior and <i>what</i> is the behavioral consequence of this deviant behavior. To do this, the conservation of resources theory helps to examine the role of organizational cronyism behind employee time theft behavior and decreased proactive behavior.</p><p><strong>Design/methodology/approach: </strong>A three-wave self-administered employee survey was used for data collection. The data were collected through an adopted questionnaire from nurses working in the public sector hospitals of Pakistan. Structural equation modeling (SEM) was used to analyze data collected from 256 respondents.</p><p><strong>Findings: </strong>The results of this three-wave study supported the hypotheses which are: (1) Organizational cronyism positively predicts employee involvement in time theft behavior. (2) Employee time theft behavior negatively impacts their proactive behavior. (3) Organizational cronyism is detrimental to employee proactive behavior. (4) The relationship between organizational cronyism and proactive behavior is mediated by time theft.</p><p><strong>Practical implications: </strong>In the presence of organizational cronyism, employees use time theft as a dysfunctional coping strategy to conserve their valued resources rather than allowing the organization to consume them. Organizational leaders of public sector hospitals must promote merit-based HRM practices to discourage time theft behavior as well as to improve the proactive performances of the nurses.</p><p><strong>Originality/value: </strong>This study is one of the initial attempts to extend the scant literature on the antecedents and consequences of time theft behavior and its dimensions in the South Asian context.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":"1-23"},"PeriodicalIF":2.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-organizational Lean deployment in an Italian regional healthcare system.","authors":"Angelo Rosa, Giuliano Marolla, Olivia McDermott","doi":"10.1108/IJHCQA-06-2023-0045","DOIUrl":"10.1108/IJHCQA-06-2023-0045","url":null,"abstract":"<p><strong>Purpose: </strong>This study explores how Lean was deployed in several hospitals in the Apulia region in Italy over 3.5 years.</p><p><strong>Design/methodology/approach: </strong>An exploratory qualitative design was drawn up based on semi-structured interviews.</p><p><strong>Findings: </strong>The drivers of Lean in hospitals were to increase patient satisfaction and improve workplace well-being by eliminating non-value-add waste. The participants highlighted three key elements of the pivotal implementation stages of Lean: introduction, spontaneous and informal dissemination and strategic level implementation and highlighted critical success and failure factors that emerged for each of these stages. During the introduction, training and coaching from an external consultant were among the most impactful factors in the success of pilot projects, while time constraints and the adoption of process analysis tools were the main barriers to implementation. The experiences of the Lean teams strongly influence the process of spontaneous dissemination aided by the celebration of project results and the commitment of the departmental hospital heads.</p><p><strong>Practical implications: </strong>Lean culture can spread to allow many projects be conducted spontaneously, but the Lean paradigm can struggle to be adopted strategically. Lean in healthcare can fail because of the lack of alignment of Lean with leadership in healthcare and with their strategic vision, a lack of employees' project management skills and crucially the absence of a Lean steering committee.</p><p><strong>Originality/value: </strong>The absence of managerial expertise and a will to support Lean implementation do not allow for systemic adoption of Lean. This is one of the first and largest long-term case studies on a Lean cross-regional multi-hospital application in healthcare.</p>","PeriodicalId":47455,"journal":{"name":"INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE","volume":"ahead-of-print ahead-of-print","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92156890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}