Barriers and facilitators that challenge/support the sustainability of HLM implementations within LCAH
| Barriers (N. Papers) | References (Supplementary_material_appendix_1) | |
|---|---|---|
| Cultural and organizational factors | Limited resource availability (7) (Insufficient financial support; limited time allocated for the project; conflicts between health staff daily activities and project-related tasks) | [19, 27, 29, 30, 35, 37, 39] |
| Organization and process complexity (3) (Organizational complexity of the setting; poor understanding of the organizational context; lack of systematic process) | [1, 25, 39] | |
| Limited patients’ involvement and engagement in the project (2) (Not considering the “Voice Of the Customer”; not including patients’ point of view in the definition of value; not collecting patients’ satisfaction measures) | [27, 35] | |
| Healthcare staff resistance to change and improvement (2) | [30, 43] | |
| Operational process and improvement factors | Inadequate risk detection and prevention (1) | [6] |
| Lack of continuous monitoring (1) | [39] | |
| Technology and communication factors | Inadequate IT infrastructure (4) (Lack in data availability and reliability; difficulties in collecting data; low digital competencies; limited bandwidth) | [6, 7, 25, 37] |
| Leadership and governance factors | Not adopting a system-wide approach (1) | [3] |
| Barriers (N. Papers) | References | |
|---|---|---|
| Cultural and organizational factors | Limited resource availability (7) | [19, 27, 29, 30, 35, 37, 39] |
| Organization and process complexity (3) | [1, 25, 39] | |
| Limited patients’ involvement and engagement in the project (2) | [27, 35] | |
| Healthcare staff resistance to change and improvement (2) | [30, 43] | |
| Operational process and improvement factors | Inadequate risk detection and prevention (1) | [6] |
| Lack of continuous monitoring (1) | [39] | |
| Technology and communication factors | Inadequate IT infrastructure (4) | [6, 7, 25, 37] |
| Leadership and governance factors | Not adopting a system-wide approach (1) | [3] |
| Facilitators (N. Papers) | References (Supplementary_material_appendix_1) | |
|---|---|---|
| Cultural and organizational factors | Employees’ involvement and commitment (24) (Employees’ willingness to participate; employees’ feedback collection; low turnover rates; team members empowerment to make changes) | [8, 9, 10, 12, 13, 14, 16, 17, 19, 20, 21, 22, 23, 24, 27, 28, 30, 35, 36, 38, 39, 40, 42, 44] |
| Spreading the continuous improvement culture within the organization (11) | [8, 14, 17, 19, 20, 21, 35, 36, 40, 43, 44] | |
| Project team collaboration and mutual trust (9) (Collaboration and team cohesiveness; mutual support and trust among management and healthcare staff) | [6, 13, 14, 19, 20, 21, 23, 37, 40] | |
| Creation of a cross-functional project team (6) (Team members selected from different care units or departments) | [5, 11, 14, 17, 18, 22] | |
| Creation of a multidisciplinary project team (6) (Team members selection including different roles) | [15, 16, 22, 38, 39, 45] | |
| Resource availability (4) (Material resources and infrastructures; human resources; financial support; time allocation) | [23, 28, 38, 40] | |
| Patients involvement and engagement (4) (Collecting patients’ feedback; patients’ value identification) | [5, 21, 22, 41] | |
| Presence of HLM experts and improvement facilitators (3) | [8, 30, 41] | |
| Employees’ change acceptance (3) | [14, 19, 40] | |
| Learning from the past improvement experiences (2) | [20, 21] | |
| Overcoming the hierarchical culture (2) | [14, 20] | |
| Suppliers involvement and engagement (1) (Enhancing suppliers’ collaboration) | [5] | |
| Operational process and improvement factors | Adapting HLM practices, tools, and techniques to the specific context (7) | [1, 5, 3, 14, 28, 40, 41] |
| Streamlined and standardized process (5) | [6, 25, 41, 42, 45] | |
| Monitoring the improvements achieved over time (4) | [4, 8, 13, 18] | |
| Project implementation plan (3) | [5, 37, 38] | |
| Adopting structured problem-solving approaches (3) | [5, 8, 9] | |
| Adopting performance measurement indicators (1) | [5] | |
| Adopting a system-wide improvement approach (1) | [35] | |
| Leadership and governance factors | Top and middle management commitment and personal involvement (16) | [5, 8, 9, 12, 20, 22, 23, 24, 30, 35, 36, 38, 39, 40, 43, 44] |
| Employees’ digital and data analysis abilities (3) | [7, 9, 18] | |
| Top and middle management HLM knowledge (2) (HLM principles; HLM tools and practices) | [9, 30] | |
| Aligning improvement initiatives and objectives with the organization’s strategic plan (2) | [2, 43] | |
| Stakeholders’ support and expectations alignment (1) | [7] | |
| Stakeholders’ support and expectations alignment (1) | [7] | |
| Human resources and capability factors | Employees HLM knowledge (7) (HLM principles; HLM tools and practices) | [16, 18, 20, 24, 30, 36, 42] |
| Employees’ full process understanding (2) (Comprehensive understanding of the target process; training on the target process) | [5, 25] | |
| Employees performance assessment (2) | [22, 30] | |
| Technology and communication factors | Strong IT infrastructure (7) (Data availability and reliability; digital and connected services) | [5, 7, 9, 11, 18, 22, 32] |
| Good communication channels (2) | [17, 22] | |
| Facilitators (N. Papers) | References | |
|---|---|---|
| Cultural and organizational factors | Employees’ involvement and commitment (24) | [8, 9, 10, 12, 13, 14, 16, 17, 19, 20, 21, 22, 23, 24, 27, 28, 30, 35, 36, 38, 39, 40, 42, 44] |
| Spreading the continuous improvement culture within the organization (11) | [8, 14, 17, 19, 20, 21, 35, 36, 40, 43, 44] | |
| Project team collaboration and mutual trust (9) | [6, 13, 14, 19, 20, 21, 23, 37, 40] | |
| Creation of a cross-functional project team (6) | [5, 11, 14, 17, 18, 22] | |
| Creation of a multidisciplinary project team (6) | [15, 16, 22, 38, 39, 45] | |
| Resource availability (4) | [23, 28, 38, 40] | |
| Patients involvement and engagement (4) | [5, 21, 22, 41] | |
| Presence of HLM experts and improvement facilitators (3) | [8, 30, 41] | |
| Employees’ change acceptance (3) | [14, 19, 40] | |
| Learning from the past improvement experiences (2) | [20, 21] | |
| Overcoming the hierarchical culture (2) | [14, 20] | |
| Suppliers involvement and engagement (1) | [5] | |
| Operational process and improvement factors | Adapting HLM practices, tools, and techniques to the specific context (7) | [1, 5, 3, 14, 28, 40, 41] |
| Streamlined and standardized process (5) | [6, 25, 41, 42, 45] | |
| Monitoring the improvements achieved over time (4) | [4, 8, 13, 18] | |
| Project implementation plan (3) | [5, 37, 38] | |
| Adopting structured problem-solving approaches (3) | [5, 8, 9] | |
| Adopting performance measurement indicators (1) | [5] | |
| Adopting a system-wide improvement approach (1) | [35] | |
| Leadership and governance factors | Top and middle management commitment and personal involvement (16) | [5, 8, 9, 12, 20, 22, 23, 24, 30, 35, 36, 38, 39, 40, 43, 44] |
| Employees’ digital and data analysis abilities (3) | [7, 9, 18] | |
| Top and middle management HLM knowledge (2) | [9, 30] | |
| Aligning improvement initiatives and objectives with the organization’s strategic plan (2) | [2, 43] | |
| Stakeholders’ support and expectations alignment (1) | [7] | |
| Stakeholders’ support and expectations alignment (1) | [7] | |
| Human resources and capability factors | Employees HLM knowledge (7) | [16, 18, 20, 24, 30, 36, 42] |
| Employees’ full process understanding (2) | [5, 25] | |
| Employees performance assessment (2) | [22, 30] | |
| Technology and communication factors | Strong IT infrastructure (7) | [5, 7, 9, 11, 18, 22, 32] |
| Good communication channels (2) | [17, 22] | |
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