Conceptual framework air developed a conceptual

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Conceptual Framework AIR developed a conceptual framework to guide the case study research, drawing on the results of the systematic literature review and, specifically, on the literature about health care quality improvement (including such related topics as implementation and diffusions of innovations) and on the literature about organizational learning, innovation, and change (Exhibit 1). This framework builds on and integrates theoretical/conceptual literature on organizational learning, innovation, and change and related work in health care, such as quality improvement. At the most basic level, hospitals, medical groups, and other health care organizations that attempt to use Lean are seeking to improve or fundamentally reconceptualize core administrative and/or clinical processes.
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3 Exhibit 1. Conceptual Framework
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4 As shown in Exhibit 1, our theoretical/conceptual framework comprises five major elements, as follows: 1. The local environment in which the health care organization is operating. According to the literature, the local environment is likely to be an important factor affecting the ability of health care organizations to successfully implement, disseminate, and integrate Lean. Specific aspects of the external context or local environment that previous research suggest are particularly important include: a) the extent to which health care purchasers are organized and able to put pressure on health care organizations to reduce spending or total costs and improve quality; b) the extent to which purchasers use any new, non-fee-for-service (FFS) payment methods (e.g., pay for performance, partial capitation) designed to provide a greater incentive to reduce spending or costs or improve quality; c) the competitiveness of the market, including whether other providers are using Lean; and d) sources of expertise in Lean, for example, universities, corporations outside the health care sector that have used Lean, or consultants. Some schools of organizational theory point out that all organizations are dependent on their environment, because no organization possesses or can produce all the resources (e.g., inputs, distribution channels) required to fulfill their aims (see Scott and Davis, 2006, 3 for an overview of resource dependency theory). In the case of Lean, one key resource is Lean knowledge and skills. Currently, most health care organizations lack this expertise in-house, so typically they are in the position of looking for this expertise from external individuals or groups that have experience in other industries. In addition, health care organizations often seek out this expertise locally, via linkages to university departments (e.g., engineering programs that use the technique with manufacturing firms) or local manufacturing firms or consultants. Therefore, the availability and capability of these entities with expertise in Lean, and the nature of the relationships they establish (e.g., frequent, positive interaction, “ownership” of the project taken by the organization versus remaining with the outside
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