This study examines lean implementation's effects on hospital financial performance using survey and secondary data for a large sample of US hospitals. Using sociotechnical systems theory, a social context is identified that should motivate the use of lean process improvement tools (LPT) in a hospital setting and accentuate its performance benefits. Shah and Ward's employee involvement (EI) construct is adapted to a hospital setting to define a supportive social context for LPT, which is further shaped by organizational psychological safety (PS). The research model depicts PS as amplifying the effect of EI on LPT, which, in turn, influences a hospital's return on assets (ROA) via three potential pathways: (a) through enhanced revenues; and/or (b) through reduced hospital discharge costs; and/or (c) directly. The results show that EI engenders LPT and that this effect is heightened as PS improves. LPT is shown to positively impact ROA indirectly through higher revenues, but not through lower discharge costs. The findings reveal positive, indirect effects of EI on revenue and profitability at moderate/high levels of PS. Robustness is investigated using an alternate performance metric—hospital excess margin—with consistent results. Post hoc analyses explore potential mechanisms through which lean implementation may increase hospital revenues, including hospital throughput (discharges), readmission rate, experiential quality, length of stay, and overall patient recommendation. The analyses reveal that the impact of LPT on hospital revenue is potentially realized through higher hospital discharges. Overall, the study demonstrates that lean implementation as a sociotechnical system contributes to superior performance.

中文翻译：

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精益实施对医院财务绩效的影响

本研究使用大量美国医院样本的调查和二手数据来检验精益实施对医院财务绩效的影响。使用社会技术系统理论，确定了一种社会背景，该社会背景应激发在医院环境中使用精益流程改进工具 (LPT) 并突出其绩效优势。Shah 和 Ward 的员工参与 (EI) 结构适用于医院环境，以定义 LPT 的支持性社会背景，这进一步受到组织心理安全 (PS) 的影响。该研究模型将 PS 描述为放大 EI 对 LPT 的影响，进而通过三个潜在途径影响医院的资产回报率 (ROA)：(a) 通过增加收入；和/或 (b) 通过降低出院费用；和/或 (c) 直接。结果表明，EI 产生 LPT，并且这种效应随着 PS 的提高而增强。LPT 显示通过更高的收入间接对 ROA 产生积极影响，但不是通过降低排放成本。研究结果揭示了 EI 在中等/高水平的 PS 对收入和盈利能力的积极、间接影响。使用替代性能指标（医院超额保证金）研究稳健性，结果一致。事后分析探索了精益实施可能增加医院收入的潜在机制，包括医院吞吐量（出院）、再入院率、体验质量、住院时间和整体患者推荐。分析表明，LPT 对医院收入的影响可能通过更高的出院率来实现。全面的，