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

INTRODUCTION: 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, little is known whether lean is sustained within the hospitals and the critical success factors (CSFs) affecting sustainability. Therefore, this study protocol aims to fill the gap by (i) identifying the critical success factors [CSFs] for lean sustainability in the MOH, (ii) developing a validated framework to support hospitals in sustaining lean, (iii) the framework will be adapted into a checklist to measure the level of lean sustainability (iv) interviewing hospitals with the lowest and highest level of lean sustainability to further explore the barriers and boosters in sustaining lean. METHODS AND ANALYSIS: 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 present them in a validated framework. In the second phase, the framework will be adapted into a checklist to measure the level of lean sustainability in the MOH hospitals. The findings will be used to select the hospital with the lowest and highest level of lean sustainability for an interview in the third phase. DISCUSSION: The lean sustainability framework will be able to provide more relevant guidance on how to increase the likelihood of lean sustainability and serve 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.