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Transformational Performance Improvement: Why Is Progress so Slow?

Dorothy Y Hung1, Justin Lee1, Thomas G Rundall1

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This study examines three transformational performance improvement (TPI) approaches for healthcare work process redesign. It highlights the need for stronger evidence on whole system transformation and effective implementation strategies.

Keywords:
Performance improvementevaluation study designimplementation sciencelean management / lean six sigmasystem transformationwork process redesign

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Area of Science:

  • Healthcare Management
  • Process Improvement
  • Organizational Transformation

Background:

  • Healthcare organizations increasingly adopt transformational performance improvement (TPI) strategies to enhance service delivery.
  • Existing literature provides a foundation for understanding TPI approaches but gaps remain in evidence for whole system transformation.

Purpose of the Study:

  • To identify and describe distinct TPI approaches used in healthcare work process redesign.
  • To summarize empirical evidence on the effectiveness of these TPI approaches.
  • To identify knowledge gaps and propose future research directions for strengthening evidence on whole system transformation.

Main Methods:

  • Review of systematic reviews and recent peer-reviewed studies on TPI effectiveness in healthcare.
  • Analysis of conceptual frameworks for assessing implementation.
  • Examination of facilitators and barriers to change, using the Lean Enterprise Transformation (LET) initiative at the Veterans Health Administration as a case study.

Main Results:

  • Three distinct TPI approaches are identified, each with unique components for improving health service delivery.
  • Empirical evidence on TPI effectiveness varies, indicating a need for more robust research.
  • Facilitators and barriers to change, such as those identified in the LET initiative, influence TPI success and sustainability.

Conclusions:

  • Further research is needed to strengthen the evidence base for whole system transformation in healthcare.
  • Developing conceptual frameworks and addressing implementation facilitators and barriers are crucial for improving TPI effectiveness and sustainability.
  • Appropriate study designs are essential for evaluating TPI interventions in real-world practice settings.