The sustainability of lean implementations at the hospitals of Ministry of Health Malaysia: a study protocol

Background: In Malaysia, lean was initiated in 2012 as part of an effort to reduce waiting time at the Ministry of Health (MOH) hospitals. As of now, there are 52 public hospitals that have officially implemented lean however these hospitals have demonstrated difficulties in sustaining it. In addition, monitoring on the progress and maintenance of lean within the MOH are based on performance indicators that prove inadequate in indicating whether lean is sustaining. Therefore, this study protocol aims to fill the gap by (i) identifying the critical success factors (CSFs) for lean sustainability in the MOH and using it to (ii) develop a validated framework to support hospitals in sustaining lean (iii) the framework will be adapted into a measurement tool in the form of checklist to measure the level of lean sustainability (iv) interview hospitals with the lowest and highest level of lean sustainability to further explore the barriers and boosters in sustaining lean Methods This study will employ a mixed-method approach and will be conducted in three phases. The first phase involves a combination of scoping review and interviews with key informants to identify the CSFs known to affect lean sustainability at the MOH hospitals and the findings will be presented in a validated framework. In the second phase, the framework will then be converted into a checklist to measure the level of lean sustainability in the MOH hospitals. Results from the second phase will subsequently be used to select the hospital with the lowest and highest level of lean sustainability for a further interview in the third phase. Discussion The findings from this study will benefit policymakers and lean practitioners involved in evidence-based lean implementations in the MOH. The developed lean sustainability framework will be able to provide more relevant guidance on how to increase the likelihood of lean sustainability and serves as a validated measurement tool for MOH hospitals. In addition, this study will be able to outline the differences in the contributing factors between health organizations that showed a high level of lean sustainability compared to those struggling to sustain.