Management
Monfort College of Business
My primary research area of interest is lean management system implementation and sustainment within a healthcare setting. The exploration of the application of lean management systems in healthcare stems from my time as the Director of Lean Transformation at UNC Chatham Hospital, a 25-bed critical access hospital. During the first three years of its lean transformation, Chatham Hospital made significant improvements in patient satisfaction, quality, and profitability. However, improvements were not sustained, staff were not fully engaged, and organizational leadership was not consistently exhibiting the key behaviors and actions essential to fostering a continuous improvement culture. We mistakenly viewed lean solely as an improvement methodology and not as an overall management system, culture, and leadership style.
In 2015, Chatham senior leaders decided to develop and implement a lean management system to address specific challenges within the organization. In preparation to lead this effort, I conducted benchmarking visits and a literature review. I quickly found few studies focused on evaluating the system-wide implementation of lean in healthcare. Most of the published literature on lean implementation in healthcare has been siloed or project-based, focused on short-term results instead of long-term systemic change (add Hung/Harrsion, Shortell). This literature gap, coupled with my interest in teaching in an academic setting, led me to pursue a Doctorate in Health Administration.
Strategy and organizational alignment are crucial elements of any successful lean management system. In my doctoral dissertation, I utilized a multiple case study design to explore the key strategic decision-making factors rural hospital stakeholders considered when determining the most appropriate business model to implement while focusing on lowering the risk of financial distress and closure. Two significant findings from my study are relevant to lean management system implementation. First, each rural community and hospital are different. Therefore, a "one size fits all" approach to addressing financial challenges among rural hospitals is not feasible. In my personal experience as a lean practitioner, I have witnessed many of my colleagues mistakenly attempt to implement a lean management system from another hospital within their organizations without customizing the system to address their specific contextual challenges. Secondly, rural hospital stakeholders should identify the specific needs of their surrounding community and redesign services to meet those needs, which aligns with the lean principle of defining customer value. My exploration of rural hospital stakeholder strategic decision-making received the 2021 Outstanding Qualitative Doctoral Project Award by the College of Health Professions at the Medical University of South Carolina.
Future Research Direction
Investigating the contextual factors most critical to implementing and successfully spreading a lean management system across a large healthcare delivery system is the general goal of my research aspirations. How to build a robust and scalable lean management system that improves quality outcomes and patient experience while engaging and empowering all care partners in patient safety and continuous improvement is the central question that will drive my research activities. Since healthcare systems are complex, answering this question requires careful research design and implementation. I plan to use a mixed-methods approach that will allow a deep exploration of the contextual factors impacting the spread of lean across a healthcare system that neither qualitative nor quantitative methods could answer alone.
My future research will span across the many interrelated factors critical to implementing and sustaining a lean management system, including care partner engagement, organizational culture, change leadership, strategic alignment, and daily improvement systems. My near term research goals include:
In future work, I would like to establish a relationship with the Center for Lean Engagement and Research in Healthcare (CLEAR) through participation in the Lean Action Research Learning Collaborative. The purpose of the collaborative is to explore the effects of lean management interventions in healthcare, emphasizing the contextual factors such as physician participation in lean thinking and practices that influence the outcomes of the interventions. Insights gained from the research will be used to develop education programs for healthcare stakeholders across the country and world.
In summary, my primary interest is in the implementation, sustainment, and impact of lean management systems within healthcare organizations. Specifically, I am interested in exploring the crucial contextual factors impacting the spread of lean systems across an extensive healthcare delivery system. I would like to further explore associations between performance improvement and contextual factors such as teamwork and care partner engagement in the immediate future. In the long term, I see myself working on expanding my expertise in the area of lean management to discover innovative ways to improve the quality and safety of healthcare delivery.
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