Interpretative structural model development for the identification of key factors for implementing Lean Healthcare

Erika Tatiana Ruiz Orjuela | Bio
Universidad Pedagógica y Tecnológica de Colombia
Nestor Raul Ortiz Pimiento | Bio
Universidad Industrial de Santander
Diego Andrés Carreño Dueñas | Bio
Universidad Pedagógica y Tecnológica de Colombia


The Lean philosophy has demonstrated benefits in organizations of different business sectors through the elimination of waste and the generation of value; research conducted in this field has sought to identify the critical success factors for its implementation. The objective of thisstudy is to understand the relationships between the factors of Health Care Providing Institutions in Colombia, through surveys with experts, and then classify them according to their power of influence and dependence using the Interpretative Structural Modelling- ISM methodology. The results of this research contribute to identifying the key factors for the implementation of Lean Healthcare in the Colombian context: Management commitment, management understanding, and employee training, and finally recommendations and future research work are presented.


  1. [1] S. Sahoo, “Lean practices and operational performance: the role of organizational culture”, International Journal of Quality & Reliability Management, vol. 39, n. ° 2, pp. 428-467, ene., 2021.
  2. [2] L. Brandao de Souza, “Trends and approaches in lean healthcare”, Leadership Health Services, vol. 22, n. º 2, pp. 121-139, may., 2009.
  3. [3] A. Dixit, S. Routroy y S. K. Dubey, “A systematic literature review of healthcare supply chain and implications of future research”, International Journal of Pharmaceutical and Healthcare Marketing, vol. 13, n. ° 4, pp. 405-435, ene., 2019.
  4. [4] R. Bartnik y Y. Park, “Technological change, information processing and supply chain integration: A conceptual model,” Benchmarking: An International Journal, vol. 25, n. ° 5, pp. 1279-1301, 2018.
  5. [5] H. A. Bahaitham, “A framework for quantifying sustainability of lean implementation in healthcare organizations”, Tesis doctoral, University of Central Florida, 2011.
  6. [6] K. M. Singh, R. Rajeev y S. Mahipal, “Just in time elements extraction and prioritization for health care unit using decision making approach”, International Journal of Quality & Reliability Management, vol. 36, n. ° 7, pp. 1243-1263, 2019.
  7. [7] Z. J. Radnor, M. Holweg y J. Waring, “Lean in healthcare: the unfilled promise?”, Ciencias Sociales Med., vol. 74, n. ° 3, pp. 364-371, feb., 2012.
  8. [8] L. C. Vermeulen, S. J. Beis y S. B. Cano, “Applying outcomes research in improving the medication-use process”, American Journal of Health-System Pharmacy, vol. 57, n. º 24, pp. 2277–2282, 2000.
  9. [9] C. R. Nicolay et al., “Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare”, British Journal of Surgery, vol. 99, n. ° 3, pp. 324-335, 2012.
  10. [10] B. Poksinska, “The current state of Lean implementation in health care: literature review”, Qual Manag Health Care, vol. 19, n. ° 4, pp. 319-329, oct.-dic., 2010. https://pubmed.ncbi.
  11. [11] D. K. Sobek II y M. Lang, “Lean Healthcare: Current State and Future Directions”, en Proceedings of the 2010 Industrial Engineering Research Conference, Cancun, Mexico, 2010.
  12. [12] M. Graban, Lean hospitals: Improving quality, patient safety, and employee satisfaction. New York: Productivity Press, 2008.
  13. [13] L. B. De Souza, “Trends and approaches in lean healthcare”, Leadership in Health Services, vol. 22, n. ° 2, pp. 121-139, 2009.
  14. [14] O. M. Gelves Alarcón, E. del C. Navarro Romero y N. García Corrales, “Estado del arte y la técnica de las prácticas lean en instituciones de salud en América Latina: Revisión de Literatura”, Avances Investigación Ingeniería, vol. 19, n. ° 1, may., 2022.
  15. [15] I. Rozo, F. N. Díaz-Piraquive, L. Serrano, Revisión de literatura de prácticas para evaluar la calidad del servicio en instituciones de salud: Hacia un enfoque de Lean Healthcare. Medellín: Instituto Antioqueño de Investigación, 2018.
  16. [16] N. O. Pimiento y H. C. Grass, “Modelo integrado de calidad Lean Healthcare ISO 9001 en el Departamento de Emergencias diseñado a partir de revisión de literatura Quality Integrated”, Researchgate.Net, n. ° August, 2016.
  17. [17] V. Sharma, A. R. Dixit, M. A. Qadri y S. Kumar, “An interpretive hierarchical model for lean implementation in machine tool sector”, International Journal of Productivity and Quality Management, vol. 15, n.° 3, pp. 38-406, abr., 2015.
  18. [18] M. D. Singh y R. Kant, “Knowledge management barriers: An interpretive structural modeling approach”, International Journal of Management Science and Engineering Management, vol. 3, n.° 2, pp. 141-150, ene., 2008.
  19. [19] D. Jones y J. Womack, Lean Thinking. Gestion 2000, 2005.
  20. [20] S. A. Rooney y J. J. Rooney, “Lean Glossary”, Quality Progress., vol. 38, n. ° 6, pp. 41-47, jun., 2005.
  21. [21] P. Mazzocato, C. Savage, M. Brommels, H. Aronsson y J. Thor, “Lean thinking in healthcare: a realist review of the literature”, Qual. Saf Health Care, vol. 19, n. ° 5, pp. 376-382, oct., 2010.
  22. [22] W. S y H. AJ, “Making cars and making health care: a critical review”, The Medical journal of Australia., vol. 191, n. ° 1, pp. 28-29, 2009.
  23. [23] Z. Radnor y R. Boaden, “Editorial: Lean in Public Services—Panacea or Paradox?”, Public Money & Management, vol. 28, n. ° 1, pp. 3-7, 2008.
  24. [24] N. Westwood, M. J. Moore y M. Cooke, Going lean in the NHS. Institute for Innovation and Improvement, 2007.
  25. [25] V. Nabelsi y S. Gagnon, “Information technology strategy for a patient-oriented, lean, and agile integration of hospital pharmacy and medical equipment supply chains”, International
  26. [26] R. V. Sreedharan, V. M. Sunder y R. Raju, “Critical success factors of TQM, Six Sigma, Lean and Lean Six Sigma: A literature review and key findings”, Benchmarking: An International Journal, vol. 25, n. ° 9, pp. 3479-3504, 2018.
  27. [27] B. Noori, “The critical success factors for successful lean implementation in hospitals”, International Journal of Productivity and Quality Management, vol. 15, n. ° 1, pp. 108-126, dic., 2015.
  28. [28] L. van Rossum, K. H. Aij, F. E. Simons, N. van der Eng y W. D. Ten Have, “Lean healthcare from a change management perspective”, Journal of Health Organization and Management, vol. 30, n. ° 3, pp. 475-493, may., 2016.
  29. [29] M. I. Harrison et al., “Effects of organizational context on Lean implementation in five hospital systems”, Health Care Manage Rev., vol. 41, n. ° 2, pp. 127-144, abr.-jun., 2016.
  30. [30] D. Hung, M. Martinez, M. Yakir y C. Gray, “Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines”, Qual Manag Health Care, vol. 24, n. ° 3, pp. 103-108, jul.-sep., 2015.
  31. [31] C. V. Lukas et al., “Transformational change in health care systems: an organizational model”, Health Care Manage. Rev., vol. 32, n. ° 4, pp. 309-320, oct.-dic., 2007.
  32. [32] R. Patri y M. Suresh, “Factors influencing lean implementation in healthcare organizations: An ISM approach”, International Jpurnal of Healthcare Management, vol. 11, n. ° 1, pp. 1-13, mar., 2017.
  33. [33] L. J. Damschroder, D. C. Aron, R. E. Keith, S. R. Kirsh, J. A. Alexander y J. C. Lowery, “Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science”, Implementation Science, vol. 4, n. ° 1, 2009.
  34. [34] B. Zepeda, D. Tlapa, Y. Báez, J. Romero y A. Maldonado, “Factores y Herramientas Importantes en Lean Healthcare”, Academia Journals., 2015.
  35. [35] E. A Giraldo Betancur, “Estudio sobre la aplicación de Lean Healthcare en el sector hospitalario en Medellín”, Tesis de pregrado, Universidad Eafit, Medellín, 2016.
  36. [36] K. A. Lopez, M. O. Rubio, I. E. D. Forero y E. Molina, “Desarrollo de la metodología lean healthcare en el servicio de medicina interna de una institución hospitalaria de carácter público”, RIMCI, vol. 7, n. ° 13, ene., 2020.
  37. [37] R. Attri, N. Dev y V. Sharma, “Interpretive Structural Modelling ( ISM ) approach : An Overview”, Research Journal of Management Sciences, vol. 2, n. ° 2, pp. 3-8, feb., 2013.
  38. [38] J. N. Warfield, “Developing Interconnection Matrices in Structural Modeling”, IEEE Transactions on Systems, Man, and Cybernetics, vol. SMC-4, n. ° 1, pp. 81-87, ene., 1974.
  39. [39] J. N. Warfield, The Mathematics of Structure. Ajar Publishing Company, 2003.
  40. [40] A. P. Sage y T. J. Smith, “On group assessment of utility and worth attributes using interpretive structural modeling”, Computers & Electrical Engineering, vol. 4, n. ° 3, pp. 185-198, sep., 1977.
  41. [41] N. Kumar, S. Kumar, A. Haleem y P. Gahlot, “Implementing lean manufacturing system: ISM approach”, Journal of Industrial Engineering and Man, vol. 6, n. ° 4, pp. 996-1012, 2013.
  42. [42] R. Waller, “Contextual Relations and Mathematical Relations in Interpretive Structural Modeling”, IEEE Transactions on Systems, Man, and Cybernetics, vol. 10, no. 3, pp. 143-145, mar., 1980.
  43. [43] H. D. Sharma y A. D. Gupta, “The objectives of waste management in India: A futures inquiry”, Technological Forecasting and Social Change, vol. 48, n. ° 3, pp. 285-309, mar., 1995.
  44. [44] M. Malmbrandt y P. Åhlström, “An instrument for assessing lean service adoption”, International Journal of Operations & Production Management, vol. 33, n. ° 9, pp. 1131-1165, 2013.
  45. [45] B. Mathur et al., “Achieving Better Integration in Trauma Care Delivery in India: Insights from a Patient Survey”, Journal of Health Management., vol. 25, n. ° 1, pp. 603-626, 2017.
How to Cite
Ruiz Orjuela, E. T., Ortiz Pimiento, N. R., & Carreño Dueñas, D. A. (2023). Interpretative structural model development for the identification of key factors for implementing Lean Healthcare. Revista Ingenierías Universidad De Medellín, 22(42), 1-18.


Download data is not yet available.

Send mail to Author

Send Cancel

We are indexed in