A framework to assess sustaining continuous improvement in lean healthcare.

Many hospitals have achieved high levels of lean performance only to lose it later on. This research develops a theoretical understanding of how organisations can sustain lean in healthcare, through a practical and innovative framework to assess the maturity level of lean in healthcare that can be used by both practitioners and academics. Through the analysis of the literature, it was possible to compile 22 main critical success factors of lean sustainability in hospitals. A comparative case study provides evidence to confirm these 22 theoretical propositions, and also to add other 3 new success factors to the framework. The proposed framework allows hospitals to conduct a structured process of change, with all the foundation needed to succeed and sustain the lean journey in the long-term. New insights are revealed by studying hospitals after minimum 18 months of lean implementation and comparing the ones that have achieved a high level of lean sustainability with those that did not. To the best of our knowledge, this article is the first to attempt to bring together the key factors that influence hospitals to sustain lean improvements in the long term. [ABSTRACT FROM AUTHOR]