An Empirical Investigation of Critical Success Factors for Continuous Improvement Projects in Hospitals

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Virginia Tech


A continuous improvement project (CIP) is a structured improvement project using a team of people "typically representing different departments or units in the organization" working to improve a process or work area over a relatively short period of time, such as a few days or up to several months. A CIP may use different improvement methodologies and tools, and may thus be defined according to the improvement approach. For instance, an organization adopting Lean as an improvement approach is likely to have CIPs implementing Lean tools, such as 5S or value stream mapping. These projects may be referred to as Lean projects in general, although they may also represent accelerated improvement projects such as Kaizen events, Kaizen blitz, or rapid improvement projects. Alternatively, an organization utilizing Six Sigma as an improvement approach may have Six Sigma projects that use the Define-Measure-Analyze-Improve-Control (DMAIC) process and statistical tools. Some organizations adopt an integrated improvement approach, such as Lean Six Sigma, and therefore may have CIPs with an even broader set of tools from which to choose. Lastly, many organizations may have an improvement approach not characterized by any single set of improvement processes and tools, and thus, may be thought of generally as process improvement, or quality improvement, projects using a traditional methodology as plan-do-study/check-act (PDSA or PDCA). In this dissertation, all of these types of improvement projects are referred as CIPs.

Since the 1980s, hospitals have been using CIPs to address some of the problems in hospitals, such as quality in healthcare delivery, internal process efficiency, communication and coordination, and the cost of services. Some hospitals have achieved significant improvements, such as reducing the turnaround time for clinical laboratory results by 60 percent and reducing instrumentation decontaminations and sterilization cycle time by 70 percent. However, as with many other companies, hospitals often experience difficulty achieving their desired level of improvements with CIPs. Therefore, the purpose of this dissertation is to identify the critical success factors (CSFs) related to CIP success. In order to achieve this goal, five objectives were achieved: creating a methodology to assess the maturity or evolution of a research field (manuscript #1), identifying a comprehensive list of CSFs for CIPs (manuscript #2), assessing the maturity of the published literature on CIPs in hospitals (manuscript #3), identifying the most important factors related to CIPs in hospitals (manuscript #4) , and conducting an empirical investigation to define the CSFs for CIPs in hospital settings (manuscript #5 and #6). This investigation was conducted in three phases: research framing, variable reduction, and model development and testing. During these phases, the researcher used the following methodologies and data collection tools: systematic literature review, maturity framework (developed as part of this dissertation), expert study, retrospective survey questionnaire, exploratory factor analysis, partial-least squares structural equation modeling, and regression modeling.

A maturity framework with nine dimensions was created (manuscript #1) and applied in order to identify a list of 53 factors related to CIP in general, involving any organization (manuscript #2). Additionally, the maturity framework was used to assess the literature available on CIPs in hospitals, considering only the authorship characteristic dimension (manuscript #3). Considering the frequency of new authors per year, the relative new integration of research groups, and the limited set of predominant authors, the research field, or area, of CIPs in hospitals is one with opportunities for improving maturity. Using the systematic literature review from manuscript #3, the list of 53 factors, and the list of predominant authors, a review of the literature was conducted, along with an expert study to more fully characterize the importance of various factors (manuscript #4). A conclusion from this particular work was that it is not possible to reduce the list of 53 factors based on these results, thus, a field study using the complete comprehensive list of factors was determined to have stronger practical implications. A field study was conducted to identify factors most related to CIP perceived success (manuscript #5) and CIP goal achievement (manuscript #6). The final results and practical implications of this dissertation consist in the identification of the following CSFs for CIP success in hospitals: Goal Characteristics, Organizational Processes, Improvement Processes, and Team Operation. These CSFs include several specific factors that, to the researcher's knowledge, have not been previously studied in empirical investigations: goal development process, organizational policies and procedures, CIP progress reporting, and CIP technical documentation.

Practitioners involved with CIPs, such as CIP leaders, facilitators, stakeholders/customers, and continuous improvement managers/leaders, can utilize these results to increase the likelihood of success by considering these factors in planning and conducting CIPs.



systematic literature review, Kaizen event, Six Sigma, Lean Six Sigma, improvement project, partial least squares