POLICY DEPLOYMENT FOR CONTINUOUS IMPROVEMENT IN PUBLIC HOSPITALS. From Kaizen Initiatives to a Kaizen Initiative Program: an action research

Purpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program – KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen programPurpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program – KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen progra