Cross-case comparison
| Resulting capability | Core bundled routines | Case 1: Top-down | Case 2: Bottom-up |
|---|---|---|---|
| Improvement system | Understand CI, CI habit, focus CI, lead CI | Routines are systematically embedded through Lean practices across all levels | Routines emerged locally in pilot wards, but scaling was inconsistent |
| Collaborative synergy | Align CI, shared CI | Cross-functional Kaizen, shared A3 practices, Gemba walks, and aligned KPIs supported the alignment of CI and shared problem-solving across teams, departments, and the hierarchy | Collaboration limited to nurse-physician teams; lack of align CI routines; no sustained cross-departmental integration |
| Integrated accountability | Focus CI | Focus CI embedded through hospital-wide scorecards, cascading KPIs, daily stand-ups, and shared PDCA cycles linked strategy to daily routines | No cross-departmental alignment or formal KPI accountability |
| Learning-to-learn | Improvement of improvement and learning organization | Routines embedded via retrospective reviews, visual management, cascaded stand-ups, and KPI-based reflection; double-loop learning | Learning remained local and informal; absence of strategic PDCA, feedback loops, or leadership-driven reflection mechanisms |
| Resulting capability | Core bundled routines | Case 1: Top-down | Case 2: Bottom-up |
|---|---|---|---|
| Improvement system | Understand CI, CI habit, focus CI, lead CI | Routines are systematically embedded through Lean practices across all levels | Routines emerged locally in pilot wards, but scaling was inconsistent |
| Collaborative synergy | Align CI, shared CI | Cross-functional Kaizen, shared A3 practices, Gemba walks, and aligned KPIs supported the alignment of CI and shared problem-solving across teams, departments, and the hierarchy | Collaboration limited to nurse-physician teams; lack of |
| Integrated accountability | Focus CI | No cross-departmental alignment or formal KPI accountability | |
| Learning-to-learn | Improvement of improvement and learning organization | Routines embedded via retrospective reviews, visual management, cascaded stand-ups, and KPI-based reflection; double-loop learning | Learning remained local and informal; absence of strategic PDCA, feedback loops, or leadership-driven reflection mechanisms |