Original Article Published on 14 Mar, 2024

Malay Language Translation of an Instrument to Assess Perception of Lean Adoption in Healthcare Service

Translation of Lean in Healthcare Questionnaire
Vol. 19 No. 1 : 2024 (192-203)

Azizul Rahman MJ Azizul Rahman MJ
Mohd Rizal AM Mohd Rizal AM
Sharifa Ezat WP Sharifa Ezat WP
Kiran GB Kiran GB

Abstract
Based on thorough literature search, Lean in Healthcare Questionnaire (LiHcQ) has not yet been validated in Malay, so the purpose of this study was to create a validated Malay version of LiHcQ for the purpose of assessing perceptions of lean adoption among healthcare workers. The translated LiHcQ could encourage more studies to examine the perception of lean adoption in Malaysia. The translation using forward-backward method was carried according to the established guideline available involving multiple committee members. Ten respondents involved in face validity assessment with universal face validity index was 0.91. Assessment of construct validity was done using 251 Emergency Department personnel which included doctors, nurses and medical assistants. The goodness of fit indices for the four LiHcQ-M factors were good. The composite reliability of the four domains ranged from 0.784 to 0.902 and average variance extracted (AVE) ranged from 0.547 to 0.653. The internal consistency ranged from 0.750 to 0.905 and stability reliability was acceptable. LiHcQ-M is a suitable instrument for measuring the perception of lean adoption among medical staff based on the results of its validity and reliability assessments. It is highly recommended for additional validity study to be carried out in order to validate LiHcQ-M’s credentials.
Keywords : Healthcare service, lean management, translation,
Abstrak
Berdasarkan carian literatur yang menyeluruh, "Lean in Healthcare Questionnaire" (LiHcQ) belum disahkan dalam Bahasa Melayu, jadi matlamat kajian ini ialah untuk mencipta versi Bahasa Melayu yang telah disahkan bagi tujuan menilai persepsi penerimaan "Lean" di kalangan pekerja penjagaan kesihatan. LiHcQ yang diterjemahkan boleh menggalakkan lebih banyak kajian untuk mengkaji persepsi penerimaan "Lean" di Malaysia. Terjemahan menggunakan kaedah ke hadapan dan ke belakang dijalankan mengikut garis panduan tersedia yang melibatkan pelbagai ahli jawatankuasa. Sepuluh responden terlibat dalam penilaian kesahan muka dengan indeks kesahan muka universal adalah 0.91. Penilaian kesahan konstruk dilakukan menggunakan 251 kakitangan Jabatan Kecemasan yang terdiri daripada doktor, jururawat dan penolong pegawai perubatan. Nilai indeks kesepadanan untuk empat faktor dalam LiHcQ-M adalah baik. Kebolehpercayaan komposit bagi empat domain adalah antara 0.784 hingga 0.902 dan ekstrak varians purata (AVE) berjulat dari 0.547 hingga 0.653. Konsistensi dalaman berkisar antara 0.750 hingga 0.905 dan kebolehpercayaan kestabilan boleh diterima. LiHcQ-M adalah instrumen yang sesuai untuk mengukur persepsi penerimaan lean di kalangan kakitangan kesihatan berdasarkan hasil penilaian kesahan dan kebolehpercayaan tersebut. Ia adalah disyorkan supaya lebih banyak kajian dijalankan bagi mengesahkan kesesuaian LiHcQ-M.
Kata Kunci : pengurusan,

Correspondance Address
Mohd Rizal Abdul Manaf. Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6019-3208925 Email: mrizal@ppukm.ukm.edu.my

References
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Bolarinwa, O. 2015. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J 22(4): 195-201.

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Burgess, N., Radnor, Z. 2013. Evaluating Lean in healthcare. Int J Health Care Quali Assur 26(3): 220-35.

Byrne, A., Womack, J.P. 2012. The lean turnaround: how business leaders use lean principles to create value and transform their company: How business leaders use lean principles to create value and transform their company. New York: McGraw Hill Professional.

Camacho-Minano, M.D.M., Moyano-Fuentes, J., Sacristán-D́az, M. 2013. What can we learn from the evolution of research on lean management assessment? Int J Prod Res 51(4): 1098-116.

Cowling, T.E., Soljak, M.A., Bell, D., Majeed, A. 2014. Emergency hospital admissions via accident and emergency departments in England: Time trend, conceptual framework and policy implications. J Royal Soc Med 107(11): 432-8.

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Koo, T.K., Li, M.Y. 2016. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropractic Med 15(2): 155-63.

Liker, J.K. 2004. The toyota way. New York: McGraw-Hill.

Malmbrandt, M., Åhlström, P. 2013. An instrument for assessing lean service adoption. Int J Oper Prod Manag 33(9): 1131-65.

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Martínez, M.D.C.V., Ramírez-Orellana, A., Grasso, M.S. 2021. Health investment management and healthcare quality in the public system: A gender perspective. Int J Env Res Public Health 18(5): 1-25.

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., Thor, J. 2010. Lean thinking in healthcare: A realist review of the literature. Qual Saf Health Care 19(5): 376-82.

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Muhammad, D.N., Karningsih, P.D. 2020. Development of lean assessment tool for healthcare industry. International Conference on Business and Engineering Management: 1st Feb 2020; Indonesia.

Muka, T., Imo, D., Jaspers, L., Colpani, V., Chaker, L., van der Lee, S.J., Mendis, S., Chowdhury, R., Bramer, W.M., Falla, A., Pazoki, R., Franco, O.H. 2015. The global impact of non-communicable diseases on healthcare spending and national income : A systematic review. Eur J Epidemiol 30(4): 251-77.

Pan, Y., de la Puente, M. 2005. Census Bureau guideline for the translation of data collection instruments and supporting materials: Documentation on how the guideline was developed. Survey Methodology 6: 1-38.

Roszell, S.S., Lynn, M.R. 2016. A measure of lean quality improvement for hospital staff nurses. J Nurs Care Qual 31(4): 373-9.

Saunders, M., Lewis, P., Thornhill, A. 2009. Research methods for business students. Harlow: Pearson Education.

Shazali, N.A., Habidin, N.F., Ali, N., Khaidir, N.A., Jamaludin, H. 2013. Lean healthcare practice and healthcare performance. Int J Sci Res Publ 3(1): 1–5.

Shortell, S.M., Blodgett, J.C., Rundall, T.G., Henke, R.M., Reponen, E. 2021. Lean management and hospital performance: Adoption vs. implementation. Jt Comm J Qual Patient Saf 47(5): 296-305.

Squires, A., Aiken, L.H., van den Heede, K., Sermeus, W., Bruyneel, L., Lindqvist, R., Schoonhoven, L., Stromseng, I., Busse, R., Brzostek, T., Ensio, A., Moreno-Casbas, M., Rafferty, A.M., Schubert, M., Zikos, D., Matthews, A. 2013. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud 50(2): 264-73.

Wickramasinghe, G.L.D., Wickramasinghe, V. 2017. Implementation of lean production practices and manufacturing performance: The role of lean duration. J Manuf Technol Manag 28(4): 531-50.

Womack, J.P., Jones, D.T. 1996. Lean thinking-banish waste and create wealth in your corporation. New York: Free Press.

Yusoff, M.S.B. 2019. ABC of response process validation and face validity index calculation. Educ Med J 11(3): 55-61.
Correspondance Address

Awang, Z. 2015. SEM made simple: A gentle approach to learning structural equation modelling. Bandar Baru Bangi: MPWS Rich Resources.

Bahensky, J.A., Roe, J., Bolton, R. 2005. Lean sigma - Will it work for healthcare? J Healthc Inf Manag 19(1): 39-44.

Bayou, M.E., De Korvin, A. 2008. Measuring the leanness of manufacturing systems-a case study of Ford Motor Company and General Motors. J Eng Technol Manag 25(4): 287-304.

Bolarinwa, O. 2015. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J 22(4): 195-201.

Boyer, K.K. 1996. An assessment of managerial commitment to lean production. Int J Oper Prod Manag 16(9): 48-59.

Burgess, N., Radnor, Z. 2013. Evaluating Lean in healthcare. Int J Health Care Quali Assur 26(3): 220-35.

Byrne, A., Womack, J.P. 2012. The lean turnaround: how business leaders use lean principles to create value and transform their company: How business leaders use lean principles to create value and transform their company. New York: McGraw Hill Professional.

Camacho-Minano, M.D.M., Moyano-Fuentes, J., Sacristán-D́az, M. 2013. What can we learn from the evolution of research on lean management assessment? Int J Prod Res 51(4): 1098-116.

Cowling, T.E., Soljak, M.A., Bell, D., Majeed, A. 2014. Emergency hospital admissions via accident and emergency departments in England: Time trend, conceptual framework and policy implications. J Royal Soc Med 107(11): 432-8.

Hair, J., Black, W., Babin, B., Anderson, R. 2010. Multivariate data analysis: A global perspective. Upper Saddle River: Pearson

Hall, D.A., Zaragoza Domingo, S., Hamdache, L.Z., Manchaiah, V., Thammaiah, S., Evans, C., Wong, L.L.N. 2018. A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures. Int J Audiology 57(3): 161-75.

Henrique, D.B., Filho, M.G., Marodin, G., Jabbour, A.B.L. de S., Chiappetta Jabbour, C.J. 2021. A framework to assess sustaining continuous improvement in lean healthcare. Int J Prod Res 59(10): 2885-904.

Kaltenbrunner, M., Bengtsson, L., Mathiassen, S.E., Engström, M. 2017. A questionnaire measuring staff perceptions of Lean adoption in healthcare: Development and psychometric testing. BMC Health Serv Res 17(1): 235.

Karlsson, C., Åhlström, P. 1996. Assessing changes towards lean production. Int J Oper Prod Manag 16(2): 24-41.

Koo, T.K., Li, M.Y. 2016. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropractic Med 15(2): 155-63.

Liker, J.K. 2004. The toyota way. New York: McGraw-Hill.

Malmbrandt, M., Åhlström, P. 2013. An instrument for assessing lean service adoption. Int J Oper Prod Manag 33(9): 1131-65.

Marsilio, M., Pisarra, M., Rubio, K., Shortell, S. 2022. Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems. BMC Health Serv Res 22(1): 1-10.

Martínez, M.D.C.V., Ramírez-Orellana, A., Grasso, M.S. 2021. Health investment management and healthcare quality in the public system: A gender perspective. Int J Env Res Public Health 18(5): 1-25.

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., Thor, J. 2010. Lean thinking in healthcare: A realist review of the literature. Qual Saf Health Care 19(5): 376-82.

Mohamad Marzuki, M.F., Yaacob, N.A., Yaacob, N.M. 2018. Translation, cross-cultural adaptation, and validation of the Malay version of the system usability scale questionnaire for the assessment of mobile apps. JMIR Hum Factors 5(2): e10308.

Muhammad, D.N., Karningsih, P.D. 2020. Development of lean assessment tool for healthcare industry. International Conference on Business and Engineering Management: 1st Feb 2020; Indonesia.

Muka, T., Imo, D., Jaspers, L., Colpani, V., Chaker, L., van der Lee, S.J., Mendis, S., Chowdhury, R., Bramer, W.M., Falla, A., Pazoki, R., Franco, O.H. 2015. The global impact of non-communicable diseases on healthcare spending and national income : A systematic review. Eur J Epidemiol 30(4): 251-77.

Pan, Y., de la Puente, M. 2005. Census Bureau guideline for the translation of data collection instruments and supporting materials: Documentation on how the guideline was developed. Survey Methodology 6: 1-38.

Roszell, S.S., Lynn, M.R. 2016. A measure of lean quality improvement for hospital staff nurses. J Nurs Care Qual 31(4): 373-9.

Saunders, M., Lewis, P., Thornhill, A. 2009. Research methods for business students. Harlow: Pearson Education.

Shazali, N.A., Habidin, N.F., Ali, N., Khaidir, N.A., Jamaludin, H. 2013. Lean healthcare practice and healthcare performance. Int J Sci Res Publ 3(1): 1–5.

Shortell, S.M., Blodgett, J.C., Rundall, T.G., Henke, R.M., Reponen, E. 2021. Lean management and hospital performance: Adoption vs. implementation. Jt Comm J Qual Patient Saf 47(5): 296-305.

Squires, A., Aiken, L.H., van den Heede, K., Sermeus, W., Bruyneel, L., Lindqvist, R., Schoonhoven, L., Stromseng, I., Busse, R., Brzostek, T., Ensio, A., Moreno-Casbas, M., Rafferty, A.M., Schubert, M., Zikos, D., Matthews, A. 2013. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud 50(2): 264-73.

Wickramasinghe, G.L.D., Wickramasinghe, V. 2017. Implementation of lean production practices and manufacturing performance: The role of lean duration. J Manuf Technol Manag 28(4): 531-50.

Womack, J.P., Jones, D.T. 1996. Lean thinking-banish waste and create wealth in your corporation. New York: Free Press.

Yusoff, M.S.B. 2019. ABC of response process validation and face validity index calculation. Educ Med J 11(3): 55-61.



Awang, Z. 2015. SEM made simple: A gentle approach to learning structural equation modelling. Bandar Baru Bangi: MPWS Rich Resources.

Bahensky, J.A., Roe, J., Bolton, R. 2005. Lean sigma - Will it work for healthcare? J Healthc Inf Manag 19(1): 39-44.

Bayou, M.E., De Korvin, A. 2008. Measuring the leanness of manufacturing systems-a case study of Ford Motor Company and General Motors. J Eng Technol Manag 25(4): 287-304.

Bolarinwa, O. 2015. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J 22(4): 195-201.

Boyer, K.K. 1996. An assessment of managerial commitment to lean production. Int J Oper Prod Manag 16(9): 48-59.

Burgess, N., Radnor, Z. 2013. Evaluating Lean in healthcare. Int J Health Care Quali Assur 26(3): 220-35.

Byrne, A., Womack, J.P. 2012. The lean turnaround: how business leaders use lean principles to create value and transform their company: How business leaders use lean principles to create value and transform their company. New York: McGraw Hill Professional.

Camacho-Minano, M.D.M., Moyano-Fuentes, J., Sacristán-D́az, M. 2013. What can we learn from the evolution of research on lean management assessment? Int J Prod Res 51(4): 1098-116.

Cowling, T.E., Soljak, M.A., Bell, D., Majeed, A. 2014. Emergency hospital admissions via accident and emergency departments in England: Time trend, conceptual framework and policy implications. J Royal Soc Med 107(11): 432-8.

Hair, J., Black, W., Babin, B., Anderson, R. 2010. Multivariate data analysis: A global perspective. Upper Saddle River: Pearson

Hall, D.A., Zaragoza Domingo, S., Hamdache, L.Z., Manchaiah, V., Thammaiah, S., Evans, C., Wong, L.L.N. 2018. A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures. Int J Audiology 57(3): 161-75.

Henrique, D.B., Filho, M.G., Marodin, G., Jabbour, A.B.L. de S., Chiappetta Jabbour, C.J. 2021. A framework to assess sustaining continuous improvement in lean healthcare. Int J Prod Res 59(10): 2885-904.

Kaltenbrunner, M., Bengtsson, L., Mathiassen, S.E., Engström, M. 2017. A questionnaire measuring staff perceptions of Lean adoption in healthcare: Development and psychometric testing. BMC Health Serv Res 17(1): 235.

Karlsson, C., Åhlström, P. 1996. Assessing changes towards lean production. Int J Oper Prod Manag 16(2): 24-41.

Koo, T.K., Li, M.Y. 2016. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropractic Med 15(2): 155-63.

Liker, J.K. 2004. The toyota way. New York: McGraw-Hill.

Malmbrandt, M., Åhlström, P. 2013. An instrument for assessing lean service adoption. Int J Oper Prod Manag 33(9): 1131-65.

Marsilio, M., Pisarra, M., Rubio, K., Shortell, S. 2022. Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems. BMC Health Serv Res 22(1): 1-10.

Martínez, M.D.C.V., Ramírez-Orellana, A., Grasso, M.S. 2021. Health investment management and healthcare quality in the public system: A gender perspective. Int J Env Res Public Health 18(5): 1-25.

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., Thor, J. 2010. Lean thinking in healthcare: A realist review of the literature. Qual Saf Health Care 19(5): 376-82.

Mohamad Marzuki, M.F., Yaacob, N.A., Yaacob, N.M. 2018. Translation, cross-cultural adaptation, and validation of the Malay version of the system usability scale questionnaire for the assessment of mobile apps. JMIR Hum Factors 5(2): e10308.

Muhammad, D.N., Karningsih, P.D. 2020. Development of lean assessment tool for healthcare industry. International Conference on Business and Engineering Management: 1st Feb 2020; Indonesia.

Muka, T., Imo, D., Jaspers, L., Colpani, V., Chaker, L., van der Lee, S.J., Mendis, S., Chowdhury, R., Bramer, W.M., Falla, A., Pazoki, R., Franco, O.H. 2015. The global impact of non-communicable diseases on healthcare spending and national income : A systematic review. Eur J Epidemiol 30(4): 251-77.

Pan, Y., de la Puente, M. 2005. Census Bureau guideline for the translation of data collection instruments and supporting materials: Documentation on how the guideline was developed. Survey Methodology 6: 1-38.

Roszell, S.S., Lynn, M.R. 2016. A measure of lean quality improvement for hospital staff nurses. J Nurs Care Qual 31(4): 373-9.

Saunders, M., Lewis, P., Thornhill, A. 2009. Research methods for business students. Harlow: Pearson Education.

Shazali, N.A., Habidin, N.F., Ali, N., Khaidir, N.A., Jamaludin, H. 2013. Lean healthcare practice and healthcare performance. Int J Sci Res Publ 3(1): 1–5.

Shortell, S.M., Blodgett, J.C., Rundall, T.G., Henke, R.M., Reponen, E. 2021. Lean management and hospital performance: Adoption vs. implementation. Jt Comm J Qual Patient Saf 47(5): 296-305.

Squires, A., Aiken, L.H., van den Heede, K., Sermeus, W., Bruyneel, L., Lindqvist, R., Schoonhoven, L., Stromseng, I., Busse, R., Brzostek, T., Ensio, A., Moreno-Casbas, M., Rafferty, A.M., Schubert, M., Zikos, D., Matthews, A. 2013. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud 50(2): 264-73.

Wickramasinghe, G.L.D., Wickramasinghe, V. 2017. Implementation of lean production practices and manufacturing performance: The role of lean duration. J Manuf Technol Manag 28(4): 531-50.

Womack, J.P., Jones, D.T. 1996. Lean thinking-banish waste and create wealth in your corporation. New York: Free Press.

Yusoff, M.S.B. 2019. ABC of response process validation and face validity index calculation. Educ Med J 11(3): 55-61.