The development and testing of a contextual model for healthcare quality improvement using Lean and the Model for Understanding Success in Quality (MUSIQ) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Quality Systems at Massey University, Palmerston North, New Zealand
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Date
2017
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Massey University
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Abstract
This study developed a new theoretical model of quality improvement (QI) contextual
factors, for QI activity undertaken at the healthcare microsystem level. The Model for
Understanding Success in Quality (MUSIQ) (Kaplan, Provost, Froehle, & Margolis,
2012), was aligned with Lean improvement activity using the Toyota Way framework.
The aim of the research was to improve the effectiveness of healthcare quality
improvement initiatives by providing more understanding of the associations, relative
importance and precise functioning of critical contextual factors. A new survey
instrument, based on the literature, was developed to collect data and the hypothesised
theoretical relationships were tested using the partial least squares path modelling
(PLSPM) technique.
QI practitioners at a large New Zealand District Health Board were surveyed on a
range of contextual factors hypothesised to influence improvement outcomes. All
survey participants had recently completed a small-scale improvement project using
Lean, or were participants in training programmes that introduced them to Lean
thinking and methods. Some participants worked autonomously on improvements of
their own selection; others were part of a wider training programme derived from the
National Health Service’s (UK) ‘productive ward’ programme. In the healthcare
organisational context, the majority of these improvement initiatives were carried out at
the microsystem level – initiated and delivered by the teams responsible for the work
processes being modified.
Survey responses were first analysed via principal components analysis (to examine
the dimensionality of the scales) and then PLSPM. The defined contextual factors for
‘Teamwork’, ‘Respect for People’, ‘Lean Actions’ and the influence of negatively
motivating factors all reached significance. Defined contextual factors for ‘Previous
Experience’ and the influence of positive motivating factors did not reach significance
at 5% level. The final model showed a statistically significant, moderate predictive
strength, with an overall adjusted R2 of 0.58. This result was an encouraging validation
of the microsystem-level layer of the MUSIQ model using Lean as the QI method
(context). The relative influence of ‘Teamwork’, ‘Respect for People’, ‘Motivation’,
and a mediating mechanism for making process changes (in this instance, Lean) were
measured and found to be consistent with the MUSIQ model. Identifying more detailed
causal mechanisms (the present model was intentionally parsimonious due to the time
frame allowed and the resources available for the research), refining the operational
definitions, and developing and testing predictive models for the defined contextual
factors are the proposed next steps in the research.
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Keywords
Medical care, Quality control, Health services administration, Research Subject Categories::MEDICINE