All ETDs from UAB

Advisory Committee Chair

Robert Hernandez

Advisory Committee Members

K Ria Hearld

Deirdre McCaughey

Joe Alexander

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


THE RELATIONSHIP OF LEAN IMPLEMENTATION AND PATIENT SATISFACTION (HCAHPS) SCORES IN ACUTE CARE HOSPITALS CHARLES V. HAGOOD DOCTOR OF SCIENCE IN HEALTH SERVICES ADMINISTRATION ABSTRACT Background: The purpose of the study was to better understand the relationship of Lean implementation and patient satisfaction (HCAHPS) scores in acute care hospitals. Hospitals are under significant pressure to improve patient satisfaction, thus a number of hospitals are increasingly using Lean improvement methodologies to do so. However, the results that have been achieved are often reported as mixed at best and lack empirical proof, specifically the relationship of Lean methodologies and their impact on patient satisfaction (HCAHPS). Methods: Cross-sectional, quantitative data were collected by Press Ganey, Inc. in June 2017 from a total of 261 acute care hospitals in the United States via market survey research of hospitals and their usage of improvement methodologies. Market survey data was compared to average first quarter 2017 overall top box HCAHPS for said hospitals. Bivariate and regression analysis was conducted for relationships of depth of Lean system implementation, degree of support department implementation, and other factors of Lean implementation, and their relationship to overall top box HCAHPS scores. Results: When controlling for number of FTEs, number of beds, and type of hospital ownership, study findings revealed the use of Lean, degree of Lean implemented as a system of improvement, depth of implementation in support departments, and other factors related to Lean implementation and their relationship to patient satisfaction was not significant. The degree of Lean implementation as a comprehensive system and depth of implementation throughout the hospital in nonclinical and support departments was significantly associated with better patient satisfaction (HCAHPS) scores among all hospitals in the sample when examined independently. The study did show the use of outside Lean consultants and their relationship to better HCAHPS scores was significant. Conclusions: This study provides much needed insight into the implementation of Lean in hospitals and its impact on patient satisfaction. The limitations of the research, which include a study of the impact of Lean on other outcomes over time, provide an opportunity for future research. As hospitals continue to struggle with methods to improve patient satisfaction and other outcomes, continuing to study methods such as Lean and their impact is essential.



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