![]() The daily management system, leadership commitment, education and training indexes were higher or the same in the US while in Italy, hospitals had a higher self-reported performance index. Italian hospitals reported being at a higher maturity stage while the US implemented a more system-wide approach, developing Lean in more operational units. Each country averages 4 years of experience with Lean. Lean has been adopted less by Italian public hospitals (36%) than US public hospitals (53%). Descriptive statistics including T-tests were used to examine differences between the two countries on the study variables. ![]() The National Survey of Lean, developed in 2017 in the US and adapted in Italy in 2019 was used to compare the two healthcare systems along three dimensions: the maturity of adoption, the implementation approach, identifying both strategic and operational activities and tools, and the Lean performance, investigated through patients, employed, and affiliated staff, costs, and service provision areas. This study provides a comparative international benchmarking of Lean adoption, implementation, and outcomes of hospitals in the US and Italy. Cross-comparative research could allow an appreciation of the extent of Lean’s use in healthcare and a better evaluation of possible cultural influences on Lean implementation. Despite the growing interest in transformational performance improvement among nearly all countries, international benchmarking has rarely been used.
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