Introduction: Lean sustainability has gained prominence in the health sector for operational and business advantages. However, understanding the link between lean and healthcare sustainability, especially in social and environmental aspects, remains limited. This study introduces a preliminary framework for measuring lean healthcare sustainability in hospitals. The framework aligns Critical Success Factors (CSFs) with sustainability objectives and business strategies to ensure successful and enduring lean deployment. Methods: The study was conducted among 52 Lean Agile Hospitals in Malaysia using a cross-sectional approach. The validated questionnaire was employed for data collection. A reliability test and Exploratory Factor Analysis (EFA) were also performed to assess and validate the framework using Statistical Package for Social Sciences (SPSS) version 27. Results: The content validation was 0.9, which indicates that the instrument is sufficient to measure the research objective. The data screening test was performed to eliminate problem observation. The overall reliability value was over 0.830 which depicts data consistency and stability. The Kaiser-Meyer-Olkin exceeded 0.6, Bartlett’s test was under 0.001 and factor loading was between 0.507 to 0.948, thus indicating a significant correlation matrix among at least some of the variables. Therefore, the latent factors were significant to specific items of the research. Conclusion: It is concluded that important CSF is aligned with the strategic level influence of lean deployment in healthcare, which has a specific impact on certain sustainability performance. Thus, this paper proposed a generic preliminary framework to measure lean healthcare sustainability.

Hospital overcrowding is a major issue in Malaysia which has led to increased patient waiting times. Lean healthcare initiative, which focuses on identifying and eliminating non-value-added activities in work processes, was introduced by the government to tackle congestion by improving day-to-day work efficiency while optimising the use of resources at Emergency Departments and Medical Wards. This paper reports on Lean initiatives applied in major and minor specialist hospitals, their performances and challenges faced. Performances of 36 major and minor specialist Ministry of Health hospitals were analysed using four outcome variables: arrival to consultation (ATC), length of stay (LOS), bed waiting time (BWT) and discharge time (DT). The median difference in minutes between pre- and post-Lean implementation at six months and one year, as well as post-Lean at six months and one-year implementation, were compared using the Wilcoxon-Signed Ranks Test. Significant time reduction (p<0.05) was evident in DT for both major and minor specialist hospitals post six months and one year of Lean implementation. For BWT and LOS, significant reduction was seen only in major specialist hospitals post six months and post one year, respectively. There was no significant time reduction in ATC for both major and minor specialist hospitals. The results indicated that Lean healthcare is important. However, it is not the sole determinant for measuring the hospitals’ performance; other challenges including different departments’ silo mentality, staff’s resistance to change, financial constraints and IT system, also play important roles in Lean implementation.