The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals

The main objective of this research is to study the mediating effect of soft total quality management on the relationship between lean practices and innovation skills among the staff of Lebanese hospitals. Lean practices are essential to eliminate wastes and advance the quality of healthcare service...

Full description

Saved in:
Bibliographic Details
Main Author: Aoun, Malak lbrahim
Format: Thesis
Language:eng
eng
Published: 2015
Subjects:
Online Access:https://etd.uum.edu.my/5414/1/s94224.pdf
https://etd.uum.edu.my/5414/2/s94224_abstract.pdf
Tags: Add Tag
sgia 1
id my-uum-etd.5414
record_format uketd_dc
institution Universiti Utara Malaysia
collection UUM ETD
language eng
eng
advisor Hasnan, Norlena
topic RA410.55 Hospital Care.
TS 156.6 Quality Control
spellingShingle RA410.55 Hospital Care.
TS 156.6 Quality Control
Aoun, Malak lbrahim
The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
description The main objective of this research is to study the mediating effect of soft total quality management on the relationship between lean practices and innovation skills among the staff of Lebanese hospitals. Lean practices are essential to eliminate wastes and advance the quality of healthcare services through the standardization and continuous improvement strategies of Total Quality Management (TQM). However, there is a need to sustain the effectiveness of such strategies by developing the innovation skills of employees and placing greater emphasis on the soft side of TQM. Thus, a theoretical framework was developed based on the theory of constraints and the resource based view theory. After identifying the gaps of previous literature, a quantitative methodology was applied by surveying 352 employees from public and private hospitals in Lebanon. Primary data collected by self-administered questionnaires was found to be valid and reliable when analyzed through SPSS and AMOS software. Based on the SEM analysis, six hypotheses were accepted while four were rejected. Lean practices through its two dimensions; lean strategies and standardization have shown a significant and positive influence on innovation skills. However, soft TQM has a non-significant influence on innovation skills. On the other hand, lean practices have a significant and positive influence on soft TQM through standardization but not through lean strategies. As for the mediating effect, it was proven that soft TQM mediates the relationship between lean practices and innovation skills at the level of standardization but not of lean strategies. This study contributes by offering good implications for healthcare practitioners at the Lebanese hospitals and healthcare organizations in general, to invest more efforts in implementing lean tools and soft TQM. Finally, future researches are suggested to extend this study at geographical factors and different methodological procedure
format Thesis
qualification_name Ph.D.
qualification_level Doctorate
author Aoun, Malak lbrahim
author_facet Aoun, Malak lbrahim
author_sort Aoun, Malak lbrahim
title The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
title_short The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
title_full The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
title_fullStr The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
title_full_unstemmed The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals
title_sort mediating effect of soft tqm on the relationship between lean practices and innovation skills in lebanese hospitals
granting_institution Universiti Utara Malaysia
granting_department Othman Yeop Abdullah Graduate School of Business
publishDate 2015
url https://etd.uum.edu.my/5414/1/s94224.pdf
https://etd.uum.edu.my/5414/2/s94224_abstract.pdf
_version_ 1747827930532151296
spelling my-uum-etd.54142021-03-18T03:59:17Z The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals 2015 Aoun, Malak lbrahim Hasnan, Norlena Othman Yeop Abdullah Graduate School of Business Othman Yeop Abdullah Graduate School of Business RA410.55 Hospital Care. TS 156.6 Quality Control The main objective of this research is to study the mediating effect of soft total quality management on the relationship between lean practices and innovation skills among the staff of Lebanese hospitals. Lean practices are essential to eliminate wastes and advance the quality of healthcare services through the standardization and continuous improvement strategies of Total Quality Management (TQM). However, there is a need to sustain the effectiveness of such strategies by developing the innovation skills of employees and placing greater emphasis on the soft side of TQM. Thus, a theoretical framework was developed based on the theory of constraints and the resource based view theory. After identifying the gaps of previous literature, a quantitative methodology was applied by surveying 352 employees from public and private hospitals in Lebanon. Primary data collected by self-administered questionnaires was found to be valid and reliable when analyzed through SPSS and AMOS software. Based on the SEM analysis, six hypotheses were accepted while four were rejected. Lean practices through its two dimensions; lean strategies and standardization have shown a significant and positive influence on innovation skills. However, soft TQM has a non-significant influence on innovation skills. On the other hand, lean practices have a significant and positive influence on soft TQM through standardization but not through lean strategies. As for the mediating effect, it was proven that soft TQM mediates the relationship between lean practices and innovation skills at the level of standardization but not of lean strategies. This study contributes by offering good implications for healthcare practitioners at the Lebanese hospitals and healthcare organizations in general, to invest more efforts in implementing lean tools and soft TQM. Finally, future researches are suggested to extend this study at geographical factors and different methodological procedure 2015 Thesis https://etd.uum.edu.my/5414/ https://etd.uum.edu.my/5414/1/s94224.pdf text eng public https://etd.uum.edu.my/5414/2/s94224_abstract.pdf text eng public Ph.D. doctoral Universiti Utara Malaysia Abou-Mrad, F. & Tarabey, L. (2013). Healthcare quality in a fragmented society: The Lebanese model. The Italian Journal of Neurological Sciences, 35(2), 179-83. Abrunhosa, A., & Moura, P. (2008). Are TQM principles supporting innovation in the Portuguese footwear industry? Technovation, 28(4), 208–221. Abu Bakar, L., & Ahmad, H. (2010).Assessing the relationship between firm resources and product innovation performance. Business Process Management Journal, 16(3), 420 - 435 Acemoglu, D., Gancia, G., & Zilibotti, F. (April, 2010). Competing Engines of Growth: Innovation and Standardization. NBER Working Paper No. 15958. National Bureau of Economic Research. Retrieved from http://www.nber.org/papers/w15958 Adinolfi, P. (2003). Total quality management in public health care: A study of Italian and Irish hospitals. Total Quality Management & Business Excellence, 14 (2), 141–150. Adler, P., & Lee, B. (2003). Performance improvement capability: keys to accelerating performance improvement in hospitals. California Management Review, 45 (2), 12-33. Ahire, S., Golhar, D., & Waller, M. (1996). Development and validation of TQM implementation constructs. Decision Sciences, 27 (1), 23-56. Ahmed, S. (2009). Lecture 5: Methods in sample surveys: Cluster sampling. Maryland: The Johns Hopkins University. Retrieved from http://ocw.jhsph.edu/courses/statmethodsfor samplesurveys/PDFs/Lecture5.pdf Leiponen, A. (2005). Skills and innovation. International Journal of Industrial Organization, 23(5–6), 303-323. Aikens, C. (2011). Quality inspired management: The key to sustainability. New Jersey: Pearson Education, Inc. Alameddine, M., Saleh, S., El-Jardali, F., Dimassi, H., & Mouradet, Y. (2012). The retention of health human resources in primary healthcare centers in Lebanon: A national survey. BMC Health Services Research. Retrieved from http://www.biomedcentral.com/1472-6963/ 12/419 Alkhenizana, A., & Shawb, C. (2011). Impact of accreditation on the quality of healthcare services: A systematic review of the literature. Ann Saudi Med, 31(4), 407–416. Alolayyan, M. & Idris, F. (2011). The influence of total quality management (TQM) on operational flexibility in Jordanian hospitals: Medical workers’ perspectives. Asian Journal on Quality, 12 (2), 204–222. Al-Samman, T. (2012). The integration between quality management systems, lean manufacturing and agile manufacturing. Al-rafedayn development, 109(34), 9–28. Ammar, W. (2011). Health reform in Lebanon: key achievements at a glance. Publications of Ministry of Public Health. Beirut: Lebanon. Retrieved from: http://www.moph.gov.lb/Public ations/Documents/HealthStrategy.pdf Ammar, W., et al. (2007). Accreditation of hospitals in Lebanon: A challenging experience. Eastern Mediterranean Health Journal, 13 (1), 138–49. Andersson, R., Eriksson, H., & Torstensson, H. (2006). Similarities and differences between TQM, six sigma and lean. The TQM Magazine, 18(3), 282-296 Anglim, J. (2007). Lecture: Seminar on structural equation modeling [PowerPoint slides]. Australia: University of Melbourne, retrieved from http://web.psych.unimelb.edu.au/ jkanglim/introductiontosem.pdf Anouti, J. (2012, November). Paperless quality management system documentation: A practical approach. [PowerPoint slides]. Presentation at the Lebanese Hospital in 2020 Conference, Beirut: Med Health. Retrieved from http://ahfonline.net/images/activities.html Anvari, A., Ismail, Y., & Hojjati, S. (2011). A study on total quality management and lean manufacturing: Through lean thinking approach. World Applied Sciences Journal, 12(9), 1585–1596. Aphrodite, K. (2011). Demand-led innovation policies in the United Kingdom – Biometrics standardization. In Demand-side Innovation Policies, 169–176. OECD: Paris. Appleby, A., & Jackson, C. (2000). The impact of IIP on TQM and staff motivation in general practice. International Journal of Health Care Quality Assurance, 13 (2), 53-64. Badr, L., Rizk, U., & Farha, R. (2010). The divergent opinions of nurses, nurse managers and nurse directors: The case in Lebanon. Journal of Nursing Management, 18, 182–193. Bakri, T. (2005). Marketing of healthcare services. Amman: Dar- Yazouri. Balle, M., & Regnier, A. (2007). Lean as a learning system in a hospital ward. Leadership in Health Services, 20(1), 33-41 Banque BEMO. (2013). Hospital industry in Lebanon. Beirut: Bank BEMO. Retrieved from http://www.bemobank.com/files/Hospital%20 Industry%20Report.%20June%202013.pdf Barreiro, P., & Albandoz, J. (2001). Sampling techniques: Population and sample. University of Seville: Management Mathematics for European Schools. Retrieved from http://www.mathematik.unikl.de/mamaeusch. Bartlett, E., Kotrlik, W., & Higins, C. (2001). Organizational research; determining appropriate sample size in survey research. Information Technology, Learning, and Performance Journal, (19)1, 43–50 Bassim, C. (2012, November). Transformation of hospital feasibilities, consolidations and design. [PowerPoint slides]. Presentation at the Lebanese Hospital in 2020 Conference. Beirut: Med Health. Retrieved from http://ahfonline.net/images/activities.html Bastedo, M. (2004). Open Systems Theory. The SAGE Encyclopedia of Educational Leadership and Administration, University of Michigan. Retrieved from wwpersonal.umich.edu/~bastedo/ papers/bastedo.opensystems.pdf Bates, S. (2013). Lecture: Theory of Constraints [PowerPoint Slides]. Department of Technology, College of Engineering. Retrieved from http://www.engr.sjsu.edu/sbates/images/mfg/ Theory_of_Constraints.pdf Bedi, K. & Sharma, J. (2006, November). Quality function deployment in business case studies. U21Global Working Paper No. 015/2006. Retrieved from http://ssrn.com/abstract=1606302. doi.org/10.2139/ssrn.1606302. Bedi, K. (2006). Quality management. India: Oxford University Press. Bentler, P., & Wu, E. (2006). EQS 6.1 for Windows. Multivariate Software, Encino. Bicheno, J., & Holweg, M. (2009). The lean toolbox: The essential guide to lean transformation (4th Ed.). Buckingham: PICSIE Books. Black, K., & Revere, L. (2006). Six sigma arises from the ashes of TQM with a twist. International Journal of Health Care Quality Assurance, 19(3), 259–266. Blackstone, J. (2010). Theory of Constraints. Scholarpedia, 5(5). doi:10.4249/scholarpedia.10451 Blind, K. (August, 2009). Lecture: Standardization as a Catalyst for Innovation [PowerPoint slides]. Inaugural Address at Rotterdam School of Management, Erasmus University. Blind, K. (November, 2013). The impact of standardization and standards on innovation. Nesta, Working Paper 13/15. Berlin: Rotterdam School of Management and Fraunhofer. Retrieved from www.nesta.org.uk/wp13-15 Blommerde, T., & Lynch, P. (2014). Dynamic capabilities for managing service innovation: towards a conceptual framework. In: Irish Academy of Management Conference, Limerick. Available at: http://repository.wit.ie/2877/1/ Dynamic%20Capabilities%20for%20Managing%20Service%20Innovation%20Towards%20a%20Conceptual%20Framework.pdf Bolwijn, T., & Kumpe, T. (1990). Manufacturing in the 1990s: Productivity, flexibility and innovation. Long Range Planning, 23(4), 44–57. Bosch, P., & Postma, T. (2004). A knowledge-based approach to innovation: An application for project-based firms. Paper presented at the European conference on Organizational Knowledge, Learning and Capabilities (OKLC04), Innsbruck. Bounds, G., Adams, M., & Yorks, L. (1994). Beyond total quality management toward the emerging paradigm. Irwin/McGraw-Hill: McGraw-Hill Series in Management. ISBN-10: 0070066787 Bowen, D., & Youngdahl, W. (1998). Lean practices: In defense of a production- line approach. International Journal of Service Industry Management, 9(3), 207–225 Brace, N., Kemp, R., & Snelgar, R. (2009). Chapter 7: Multiple regressions: An introduction to multiple regressions performing a multiple regression on SPSS. In SPSS for psychologists (pp. 206-220). London: Palgrave Macmillan. ISBN: 139780230594593 Buggy, J., & Nelson, J. (2005). Applying lean production in healthcare facilities. Implications Informe Desgin, 6(5). Retrieved from http://scholar.google.com/scholar?hl=en&bt nG=Search&q=intitle:Applying+Lean+Production+ in+Healthcare+Facilities#0 Burke, J. (2011). John Burke's education project: Lean in education. Retrieved from http://jbep.blogspot.com/search?updated-min= 2011-01-01T00:00:00Z&updatedmax=2012-01-01T00: 00:00Z&max-results=3. Accessed June 2013 Byrne, B. (2010). Structural equation modeling with AMOS: Basic concepts, applications, and programming. New Jersey: Lawrence Erlbaum Associated CAS. (2013). Map of Lebanon. Beirut: The Central Administration of Statistics. Retrieved from CAS website: http://www.cas.gov. lb/index.php/en/about-lebanonen Casey, J. (2007). A lean enterprise approach to process improvement in a health care organization. Massachusetts: Massachusetts Institute of Technology. Retrieved from http://dspace.mit.edu/handle/1721.1/42345 Cedefop. (2010). Skills supply and demand in Europe: Medium-term forecast up to 2020. European Centre for the Development of Vocational Training, Luxembourg. Available at www.cedefop.europa.eu/en/files/3052_en.pdf. Chalice, R. (2007). Improving healthcare using Toyota lean production methods. ASQ Quality Press (2nd Ed., p. 62). Milwaukee,Wisconsin: ASQ Press. Changkaew, L., Vadhanasindhu, P., Taweesangsakulthai, D., & Chandrachai, A. (2012). Three dimensions model : stage for service innovation in hospital. Interdisciplinary Journal of Contemporary Research in Business, 4(2), 806–814. Chelimsky, E. (1992). Quantitative data analysis: An introduction. Report to program evaluation and methodology division at the United States General Accounting Office (GAO). Retrieved from: http://www.gao.gov/special.pubs/ pe10111.pdf Chen, C., & Huang, J. (2009). Strategic human resource practices and innovation performance: the mediating role of knowledge management capacity. Journal of Business Research, 62(1), 104–114. Chen, H., & Taylor, R. (2009). Exploring the impact of lean management on innovation capability. In Proceedings of PICMET conference, pp. 826–834. Portland, Oregon USA: University of Minnesota. Chen, W. & Hirschheim, R. (2004). A paradigmatic and methodological examination of information systems research from 1991 to 2001. Information Systems Journal, 14, 197-235. Cheng, S., Ho, Y., & Chung, K. (2002). Hospital quality information for patients in Taiwan: can they understand it? International Journal for Quality in HealthCare, 14, 155-160. Cheung, G., & Lau, R. (2008). Testing mediation and suppression effects of latent variables: Bootstrapping with structural equation models. Organizational Research Methods, 11(2), 296-325 Chomeya, R. (2010). Quality of psychology test between Likert scale 5 and 6 points. Journal of Social Sciences, 6 (3), 399-403. Coakes, S., & Ong, C. (2011). SPSS Version 18.0 for Windows. Australia: John & Wiley. Cooper, D., & Schindler. P. (2014). Business Research Methods (12th Ed.). New York: McGraw- Hill. Cooper, J. (1998). A multidimensional approach to the adoption of innovation. Management Decision, 36 (8), 493-502. Crean, A., (2010, September). Lean Six Sigma culture survey [PowerPoint slides]. Retrieved from http://www.slideshare.net/alancrean/lean-six-sigma-culturesurvey-5180707 Creswell, J. (2003). Research design: qualitative, quantitative, and mixed methods approaches. London: Sage Publications. Creswell, J. (2009). Research Design (3rd Ed.). Thousand Oaks, CA: SAGE. Cribbie, R. (2012). Introduction to structural equation modeling (SEM). Online Course Materials: Quantitative Methods Program at York University: Toronto. Available at: http://www.psych.yorku.ca/cribbie/SEM%20Course% 202012/Intro%20to%20SEM_day%203_nov2012.pdf Cumberbatch, T. (2004). Research methods: Data analysis. Psychology Press Ltd. Retrieved from http://www.smartpsych.co.uk/wcontent/uploads/ 2012/02/psych_methods1.pdf DalPont, G. (2010). Enablers and inhibitors of lean adoptions in services. Retrieved from http://paduaresearch.cab.unipd.it/2965/. Accessed on Oct, 15, 2013 Damanpour, F. (1987).The Adoption of technological, administrative and ancillary innovations: impact of organizational factors. Journal of Management, 13(4), 675-88. Davis, M. (1985). Lebanon 1982: The imbalance of political ends and military means. Quantico, Virginia: Marine Corps Command and Staff College, Marine Corps Development and Education Center. Retrieved from http://www.globalsecurity.org/military/library/ report/1985/DTM.htm Dawson, C. (2007). A practical guide to research methods: a user friendly manual for mastering research techniques and projects (3rd Ed.). UK: Spring Hill House. Retrieved from http://medcontent.metapress.com/index/A65RM03P4 874243N.pdf DeMaio, T., Rothgeb, J., & Hess, J. (1998). Improving survey quality through pretesting. In proceedings of the Section on Survey Research Methods, Alexandria, VA: US Census Bureau, American Statistical Association. Retrieved from http://www.census.gov/srd/papers/pdf/sm98-03.pdf Denning, P., & Dunham, R. (2010). The Innovator’s way: Essential practices for successful innovation. The MIT Press, ISBN-13: 978-0262014540. Dervitsiotis, K. (2010). A framework for the assessment of an organization’s innovation excellence. Total Quality Management, 21(9), 903-918. Dettmer, W. (2006). The logical thinking process: a system approach to complex problem solving. Milwaukee, Wisconsin: ASQ Quality Press. Diab, S. (2009). Management of hospitals and healthcare centers. Amman: AL-Feker publishers. Dibia, I., & Onuh, S. (2010). Lean revolution and the human resource aspects. In proceedings of the world congress on engineering, III (June 30 - July 2), London. Retrieved from http://www.iaeng.org/publication/WCE201/WCE2010_ pp2347-2350.pdf Dilbert, M., Bayyurt, N., Zaim, S. & Tarim, M. (2005). Critical factors of total quality management and its effect on performance in health care industry: a Turkish experience. Problems and Perspectives in Management, 4, 220-234. Dillman, D. (2000). Mail and internet surveys: the tailored design (2nd Ed.) New York: John Wiley and Sons. Djellal, F., & Gallouj, F. (2007). Innovation in hospitals: a survey of literature. The European Journal of Health Economics, 8, 181-193. Dolcemascolo, D. & McBride, D. (2003). Learning to Lean. The Newsletter of EMS Consulting Group, Retrieved from http://www.emsstrategies. com/newsletter110103.htm Dulhai, G., & Asachi, G. (2008). The 5S strategy for continuous improvement of the manufacturing processes in Autocar Exhaust. Management & Marketing, 3 (4), 115-120. Dutz, M., O'Connell, S., & Troncoso, J. (2014). Public and private investments in innovation capabilities: structural transformation in the Chilean wine industry. World Bank Policy Research Working Paper No. 6983. Available at SSRN: http://ssrn.com/abstract=2475070 Eleid, G. (2009). Exploring the Perceptions of Healthcare Quality among Lebanese Stakeholders. University of Phoenix, ProQuest, UMI Dissertations Publishing, 3405030. Elhaj, A. (2012) Continuous Performance Readiness. Beirut: The Lebanese Hospital in 2020 Conference, Med Health. Available at: http://ahfonline.net/images/activities.html El-Jardali, F., Jamal, D., Dimassi, H., Ammar, W., & Tchaghchaghian, V. (2008). The Impact of Hospital Accreditation on Quality of Care: Perception of Lebanese Nurses. International Journal for Quality in Health Care, 20(5), 363-371. Erfan, O. (2010). Application of Lean Manufacturing To Improve the Performance of Health Care Sector in Libya Lean Manufacturing Tools. International Journal of Engineering & Technology IJET-IJENS, 10(6), 117–128. Erzberger, C., & Kelle, U., (2003). Making inferences in mixed methods: The rules of integration. In: Tashakkori, A., Teddlie, C. (Eds.), Handbook of Mixed Methods in Social & Behavioral Research. Sage, Thousand Oaks, pp. 457–488. Esain, A. (2012). Healthcare Quality Improvement – Policy Implications and Practicalities. International Journal of Health Care Quality Assurance, 25(7), 565–581. European Commission (2010). New skills for new jobs: action now. Report by the expert group on new skills for new jobs prepared for the European Commission, Publications Office, Luxembourg. European Commission. (2013). Trade, Lebanon. Available at: http://ec.europa.eu/trade/policy/ countries-and-regions/countries/lebanon/. Accessed June 2013. Evershed, G. (2013) Innovation from Lean Six Sigma - Soft Skills. The TRIZ Journal. Retrieved March 26, 2013, from http://www.trizjournal.com/content/c101018a.asp Fabrizio,T., & Tapping, D. (2006), 5s for the Office: Organizing the Workplace to Eliminate Waste.US: Productivity Press. ISBN: 1563273187 Fedurko, J. (2013). Through Clouds to Solutions: Working with UDEs and UDE clouds. Estonia: Ou Vali Press. Fillingham, D. (2007). Can Lean Save Lives? Leadership in Health Services, 20(4), 231–241. Fornell, C. & Larcker, D. G. (1981). Evaluating structural equation models with unobservable variables. Journal of Marketing Research, 18, 39-50. Fox N., Hunn A., & Mathers N. (2009). Sampling and sample size calculation. National Institute for Health Research, UK: the NIHR RDS for the East Midlands / Yorkshire & the Humber. Francis, D. & Bessant, J. (2005), Targeting innovation and implications for capability development, Technovation, 25(3), 171-83. Frazer, L. & Lawley, M. (2000). Questionnaire design & administration. Australia: John Wiley & Sons. Frechtling, J. (2002). An overview of quantitative and qualitative data collection methods. Chapter 3. The 2002 User Friendly Handbook for Project Evaluation. The National Science Foundation. Galbreath, J. (2005). Which resources matter the most to firm success? An exploratory study of resource-based theory. Technovation, 25, 979–987 Gebara, K (2008). The Project of Revenue Transparency: A Case Study of the Lebanese Republic. The Global Organization of Parliamentarians against Corruption, available at: http://arpacnetwork.org/arpdocs/ transparency_in_revenu/Lebanese_Study_Ar.pd Gowen, C. (2012). Contrasting Continuous Quality Improvement, Six Sigma, and Lean Management for Enhanced Outcomes in US Hospitals. American Journal of Business, 27(2), 133–153. Green, L., Jones, B., & Mileset, I. (2007). Mini study 02 – Skills for innovation. In Global Review of Innovation Intelligence and Policy Studies. UK: IINNO—GRIIPS. Available at: http://grips.proinnoeurope.eu/knowledge_base/dl/ 222/orig_doc_file/ Greenfield, D. (2013). Developing the evidence base for accreditation of healthcare organizations: a call for transparency and innovation. Retrieved from qualitysafety.bmj.com. Accessed on May 7, 2013, GRIPS. (2009). Introducing Kaizen in Africa. Tokyo: GRIPS Development Forum. Retrieved from URL: http://www.grips.ac.jp/forum-e/ Gronroos, C. (1990). Service management: a management focus for service competition. International Journal of Service Industry Management, 1(1), 6 – 14 Grove, A., Meredith, J., MacIntyre, M, Angelis, J., & Neailey, K. (2010). UK health visiting: challenges faced during lean implementation. Leadership in Health Services, 23(3), 204–218. Gwinner, C. (2011). 5-point vs. 6-point Likert Scales. Infosurv. Available at: http://www.infosurv.com/wp-content/uploads/2011/ 01/Likert_Scale_Debate.pdf Hair, J., Black, W., Rabin, B., & Anderson, R. (2010). Multivariate data analysis: a global analysis. New Jersey: Pearson. Hamandi, M. (2012). How Lebanese hospitals tried to overcome key challenges for achieving accreditation? Beirut: The Lebanese Hospital in 2020 Conference, Med Health. Available at: http://ahfonline.net/images/activities.html Hanna, J. (2007). Bringing lean principles to service industries. Harvard Business School Working Knowledge, 1–2. Retrieved from http://hbswk.hbs.edu/pdf/item/5741.pdf Haroun, S. (2012b) Accreditation of hospitals in Lebanon. Beirut: The Lebanese Hospital in 2020 Conference, Med Health. Available at: http://ahfonline.net/images/activities.html Haroun, S. (2014, July 15). Haroun in Press conference: hospitals’ dues in all official edema the guarantors nearly 1300 billion LP. Retrieved from http://www.eliktisad.com/news/ show/131898/ Haroun, S. (2013). Lebanese Republic Ministry of Information: national news agency. A Press Conference on 23 June 2013. Available at: http://www.nnaleb.gov.lb/ar/show-news/45997/ Haroun, S. (2012a) An interview with Dr. Sleiman Haroun, Health Care Sector in Lebanon: Syndicate of Private Hospitals, July, 11, 2012. Retrieved from: http://www.marcopolis.net/health -care-sector-in-lebanon-syndicate-of-private hospitals-1107.htm. Harrison, R. (2013). Using mixed methods designs in the Journal of Business Research, 1990–2010. Journal of Business Research, 66, 2153–2162. Harwell, M. (2011). Research design: Qualitative, quantitative, and mixed methods. In C. Conrad & R.C. Serlin (Eds.), The Sage handbook for research in education: Pursuing ideas as the keystone of exemplary inquiry (Second Edition). Thousand Oaks, CA: Sage. Hau, K., & Marsh H. (2004). The use of item parcels in structural equation modeling: Non-normal data and small sample sizes. British Journal of Mathematical Statistical Psychology. 57(2), 327–351. Herzlinger, R. (2006). Why innovation in health care is so hard. Harvard Business Review, 84(5), 58-66. Hill, D. (2008). What makes total quality management work: a study of obstacles and outcomes. Capella University. ProQuest, UMI Dissertations Publishing, 2008. 3303697. Hines, P., Holweg, M., & Rich, N. (2004). Learning to evolve: a review of contemporary lean thinking. International Journal of Operations & Production Management, 24(10), 994–1011. Hoerl, R., & Gardner, M. (2010). Lean six sigma, creativity, and innovation. International Journal of Lean Six Sigma, 1(1), 30–38. Hoidn, S., & Kärkkäinen, K. (2014). Promoting skills for innovation in higher education: A literature review on the effectiveness of problem-based learning and of teaching behaviours .OECD Education Working Papers, No. 100, OECD Publishing. http://dx.doi.org/10.1787/5k3tsj67l226-en Hovgaard, A., & Hansen, E. (2004). Innovativeness in the Forest Products Industry, Forest Products Journal, 54(1), 26-33. Hox, J., & Bechger, T. (2007). An introduction to structural equation modeling. Family Science Review, 11, 354-373. Available at: http://igiturarchive.library.uu.nl/fss/2007-1115 -201225/hox_98_an%20introduction%20to%20 structural%20equation.pdf HPP.(2011). Lean healthcare philosophy. Healthcare Performance Partners Available at: http://www.hpp.bz/leanhealthcare/leanhealthcare. php. Accessed June 2013. HPP.(2012). Lean healthcare case studies. Healthcare Performance Partners. Available at: http://leanhealthcareperformance.com/lean casestudies.php. Accessed June 2013. Hu, C. & Wang, Y. (2010). Bootstrapping in Amos [PowerPoint Presentation]. Retrieved June 13, 2014 from http://www3.nccu.edu.tw/~changya/ SEMworkshop/Amos_bootstrapping_20100630.pdf Huijer, H. (2008). The Nursing workforce in Lebanon; challenges and opportunities. In proceedings of Human Health & Envt Challenges Conference, Doha. Retrieved from www.FulbrightAcademy.org/ Huijer, H. (2012) Nurse: leader & agent of future change. In the proceedings of the Lebanese Hospital in 2020 Conference, Beirut: Med Health. Retrieved from http://ahfonline.net/images/activities.html Hulland, J. (1999). Use of partial least squares (PLS) in strategic management research: A review of four recent studies. Strategic Management Journal, 20(2), 195-204 Hung, R., Lienb, B., Fangc, S., & McLeanet, G. (2010). Knowledge as a facilitator for enhancing innovation performance through total quality management. Total Quality Management & Business Excellence, 21(4), 425–438. Hung, R. Lienb, B., Fangc, S., & McLeanet, G. (2011). Impact of TQM and organizational learning on innovation performance in the high-tech industry. International Business Review, 20(2), 213–225. Hunter, J. (2013), Deming and lean: the disparities and similarities, The Edwards Deming Institute Blog. Accessed on 20-7-2013, Retrieved from http://blog.deming.org/2013/07/de ming-and-lean-the-disparities-and-similarities/ Husin, H. (2012). Soft skills practices among employees of Cosmopoint International College of Technology (CICT). Master Thesis at University Utara Malaysia. Retrieved from http://etd.uum.edu.my/3159/ IGSPS. (2012), National Health Statistics Report in Lebanon. The Institute of Health Management and Social Protection, Beirut: Saint Joseph University. Available at: http://www.igsps.usj.edu.lb/docs/recherche/ recueil12en.pdf IMA. (1999). Theory of constraints (TOC) management system fundamentals. Montvale: Institute of Management Accountants. Publication Number 99342. Jaafaripooyan, E., Agrizzi, D., & Akbari-Haghighi, F. (2011). Healthcare accreditation systems further perspectives on performance measures. International Journal for Quality in Health, 23(6), 645-656. Jekiel, C. (2011) Lean human resources: redesigning hr processes for a culture of continuous improvement. New York: Taylor and Francis Group, Productivity Press. Jha, V., & Joshi, H. (2007), Relevance of total quality management (TQM) or business excellence strategy implementation for enterprise resource planning (ERP): A conceptual study. In the Proceedings of the 12th International Conference on Information Quality, ICIQ, MIT: Cambridge, MA. Jiménez-Jimenez, D., & Hernandez-Espallardo, M. (2008). Fostering innovation: the role of market orientation and organizational learning. European Journal of Innovation Management, 11(3), 389–412. Jimmerson, C., & Jimmerson, A. (2010) Value stream mapping for healthcare made easy. Productivity Press. Available at: http://www.processexcellencenetwork.com/six- sigma-quality/articles/valuestream-mapping-for- healthcare-made-easy/ John, G., & Reve, T. (1982). The reliability and validity of key informant data from dyadic relationships in marketing channels. Journal of Marketing Research, 19(4), 517-524 Jonathan, B., Reedy, A., & Pascalet, L. (2012). Quality initiatives lean approach to improving performance and efficiency in radiology. Radiographics, 32(2), 573–587. Kaluzny, D., Veney, J., & Gentry, J. (1974). Innovation of health services: a comparative study of hospitals and health departments. The Milbank Memorial Fund quarterly. Health and society, 52(1), 51–82. Kanji, G. (2002). Business excellence: make it happen, Total Quality Management, 13(8), 1115-1124 Kemenade, E. (2012). Soft Skills for TQM in Higher Education Standards. ASQ Higher Education Brief, 5(2). Retrieved from http://asq.org/edu/2012/04/total-qualitymanage ment/soft-skills-for-tqm-in-higher-education-standards.html Kenny, D. (2012). Measuring model fit. Available at: http://davidakenny.net/cm/fit.htm. Accessed on 20 October 2013. Khayat, M. (2007). Health management. World Health Organization for the Middle East- WHO, p: 114. Beirut: International Academic. Khurana, V. (2007). Management of technology and innovation. Delhi: Ane Books India. ISBN: 978-81-8052-187-4 Kim, Y., & Lui, S. ( 2015).The impacts of external network and business group on innovation: Do the types of innovation matter? Journal of Business Research, 68(9), 1964-1973 King, H. (August, 2011). 5 Ways that standardization can lead to innovation. Retrieved from http://www.fastcodesign.com/ 1664682/5-ways-that-standardization-can-leadto- innovation Knight, K. (1967). A descriptive model of intra-firm innovation process. Journal of Management, 40(4), 478-96. Kostopoulos, Y., Spanos, G., & Prastacos, P. (2002). The resource-based view of the firm and innovation: identification of critical linkages. The 2nd European Academy of Management Conference, Stockholm, Retrieved from http://ecsocman.hse.ru/data/165/663/1219/rb_view .pdf Kovacheva, A. (2010). Challenges in lean implementation; Successful transformation towards lean enterprise. Thesis at University of Aarhus. Retrieved from https://publications. theseus.fi/bitstream/handle/10024/58871/Mwacharo _Fiona.pdf?sequence=1 Krosnick, J., & Presser, S. (2010). Chapter 9: Question and questionnaire design. In Handbook of Survey research (2nd edition). Edited by Wright J, & Marsden P. Bingley: Emerald Group Publishing Ltd. Landsbergis, P., Cahill, J., & Schnall, P. (1999). The impact of lean production and related new systems of work organization on worker health. Journal of occupational health Psychology, 4(2), 108–130. Lawson, B., & Samson, D. (2001). Developing innovation capability in organisations: a dynamic capabilities approach. International Journal of Innovation Management, 5(3), 377–400 Leary, M. (2004). Introduction to behavioral research methods (4th Ed). Pearson Education: USA. Leggat, S., & Dwyer, J. (2002). Innovation in Australian hospitals. Australian Health Review, 25 (5), 19-31. Lei, P., & Wu, Q., (2007). Introduction to structural equation modelling: issues and practical considerations. Educational Measurement: Issues and Practice. The Pennsylvania State University. Available at: http://ncme.org/linkservid/47EFEB5A-1320-5CAE- 6EC90BFDF09AA39E/showMeta/0/ Lema, R., Quadros, R., & Schmitz, H. (2015). Reorganising global value chains and building innovation capabilities in Brazil and India. Research Policy, 44 (7), 1376–138 Levene, H. (1960). Contributions to Probability and Statistics: Essays in Honor of Harold Hotelling. Olkin, I., Hotelling, H. ed. Stanford University Press. pp. 278–292. Lewis, W., Pun, K., & Lalla, T. et al (2007). Exploring soft versus hard factors for TQM implementation in small and medium-sized enterprises. International Journal of Productivity and Performance Management, 55(7), 539-554. Lewis, W., Pun, K., & Lalla, T. (2006). Empirical investigation of the hard and soft criteria of TQM in ISO 9001 certified small and medium-sized enterprises. International Journal of Quality & Reliability Management, 23(8), 964–985. Liker, J. (2004). The Toyota Way. New York: McGraw Hill. Lovelace, K., Shapiro, D., & Weingart, L. (2013). Conflict communications perspective maximizing cross-functional new product teams’ innovativeness and constraint adherence : A conflict communications perspective. The Academy of Management Journal, 44(4), 779–793. LP (2008). National Plan for Human Rights: The right to health. P: 22. The Parliamentary Committee on Human Rights. Beirut: the Lebanese Parliament. MacKinnon, D., Fairchild, A., & Fritz, M. (2004). Mediation analysis. Annu Rev Psychol, 58, 593–614. Mahoney, J. (2005). Resource-based theory, dynamic capabilities, and real options. In Foundations for Organizational Science: A SAGE Publications Series: Economic foundations of strategy. (pp. 167-219). Thousand Oaks, CA: SAGE Publications Mangiarotti, G., & Riillo, C. (2010). ISO9000 certification and innovation: an empirical analysis for Luxembourg. Working papers (46). Economie et Statistiques: STATEC. Retrieved from http://www.iso.org/iso/home/about/training-technicalassistance/standards-in-education/ education_innovationlist/educational_innovation- detail.htm?emid=461 Manos, A., Sattler, M., & Alukal, G. (2006). Make healthcare lean. Quality Progress, (July), 24–30. Mansour, A. (2012) Standards of evaluation of nursing practice at hospital; Lebanon; raising the bar; responsiveness to client needs. In proceedings of the Lebanese Hospital in 2020 Conference, Med Health, Beirut. Available at: http://ahfonline.net/images/activities.html Mcgrath, W. (2007). Impact analysis of large-scale lean manufacturing initiatives upon manufacturing process innovation Irish companies. Waterford Institute of Technology. Available at: http://repository.wit.ie/974/ Meyer, J., Carroll, S., & Alteras, T. (2007). Hospital quality improvement : strategies and lessons from U.S. hospitals. The Commonwealth Fund, Available at: http://www.commonwealthfund.org/Publications/ Fund-Reports/2007/Apr/Hospital-Quality-Improvement--Strategies-and-Lessons-From-U-S-- Hospitals.aspx Meyers, L. & Gamst, G. et al. (2006). Applied multivariate research: design and interpretation. London: Sage Publication. MOPH &WHO, (2012). Emergency health contingency plan. Beirut: Ministry of Public Health of Lebanon. Available at: http://www.moph.gov.lb/ Publications/Pages/EHCPlan.aspx MOPH. (2011). Statistical Bulletin 2010, Beirut: Ministry of Public Health. Available at: http://www.moph.gov.lb/Statistics/Pages/ StatBulletin2011.aspx Moreno, A. (2011). The influence of quality management on orientation to innovation in service firms. African Journal of Business Management, 5(17), 8997–9006. Morris, L. (2008). Innovation Metrics: the innovation process and how to measure it. Innovation Labs. Retrieved from http://www.innovationlabs.com/publications/ innovation-metrics/ Morris, L. (2011) The innovation master plan: the CEO’s guide to innovation (p. 327), Walnut Creek: Innovation Academy. Retrieved from http://www.innovationlabs.com/publications/ innovation-metrics/ Mouro, G. (2012). Shaping the future of nursing: nurse retention strategies. In the proceedings of the Lebanese Hospital in 2020 Conference, Med Health, Beirut. Retrieved from http://ahfonline.net/images/activities.html Muris, T., et al. (2004). Improving health care: A dose of competition. Washington: U.S. Federal Trade Commission & Department of Justice. Retrieved from http://scholar.google. com/scholar?hl=en&btnG=Search&q=intitle:Improvi ng+Health+Care:+A+Dose+of+Competition#0. Naraghi, A., & Ravipati, U. (2009). Lean healthcare in the emergency ward of Sahlgrenska hospital. Thesis at University College of Borås. Retrieved from: bada.hb.se/bitstream/.../ Mohajeri%20Naraghi,%20Pavan%20Ravipati.pdf Natarajan, R. (2006).Transferring best practices to healthcare: opportunities and challenges. The TQM Magazine, 18(6), 572–582. Nelson, B., Wilson, J., Rosen, D., & Yen, J. (2009). Refined metrics for measuring ideation effectiveness. Design Studies, 30(6), 737–743. Newbold, P., Carlson, W., & Thorne, B. (2012). Chapter: 14.2: analysis of categorical data. Statistics for Business and Economics (8th Ed.) PH Professional Business. ISBN-13: 978-0-13-274565-9 NHS. (2008). Quality and service improvement tools; Lean. Institute for Innovation and Improvement. Accessed on May 2013, available at: http://www.institute.nhs.uk/quality_and_value/ lean_thinking/lean_thinking.html. Norman, G., & Streiner, D. (2003). PDQ Statistics (3rd Ed.). London: BC Decker Inc. Available at: http://fhs.mcmaster.ca/surgery/ documents/pdq_stats.pdf O’Cathain, A. (2009). Reporting mixed methods projects. In Mixed Methods Research for Nursing and the Health Sciences, pp. 135–158. Chichester: Wiley-Blackwell OAG. (2007). Conducting surveys: pre-testing data collection instruments, (section 12). The Office of the Auditor General. Available at: http://www.oagbvg.gc.ca/internet/English/meth_ gde_e_19734.html Oakland, J. (2000). Total quality management: text with cases (2nd Ed). Oxford, Burlington: Butterworth-Heinemann. O'Connell, D. (2011). .Harvesting external innovation: managing external relationships and intellectual property. England: Gowel Publishing Limited. OECD. (2010). The OECD innovation strategy: Getting a head start on tomorrow. Paris: OECD. Oke, A., Burke, G., & Myers, A. (2007). Innovation types and performance in growing UK SME, International Journal of Operations & Production Management, 27(7), 735-53. Omachonu, V., & Einspruch, N. (2010). Innovation in healthcare delivery systems: A conceptual framework. The Innovation Journal: The Public Sector Innovation Journal, 15(1), 1–20. Oman, S., Tumer, I., Wood, K., & Seepersad, C. (2013). A comparison of creativity and innovation metrics and sample validation through in-class design projects. Research in Engineering Design, 24(1), 65–92 Ooi, K., Lin, B., & Teh, P. (2012). Does TQM support innovation performance in Malaysia’s manufacturing industry? Journal of Business Economics and Management, 13(2), 366–393. Ortiz, C. (2012) The psychology of lean improvements: why organizations must overcome resistance and change the culture. Boca Raton, FL: CRC Press. ISBN13: 9781439878798. Ortiz, J., Benitob, J., & Galende, J. (2009). The intervening effect of business innovation capability on the relationship between total quality management and technological innovation. International Journal of Production Research, 47(18), 5087–5107. Osborne, J., & Waters. E. (2002). Four assumptions of multiple regression that researchers should always test. Practical Assessment, Research & Evaluation, 8(2). Osbourne, J. (2011). Challenges Facing Healthcare Managers : What Past Research Reveals Front Line Managers? Cranfield Healthcare Management Group, Research Briefing 6. UK: The National Institute for Health Research. Osgood, A (2011), Deming's 7 deadly diseases of management. Accessed on 20, July 2013. Retrieved from http://info.ibs-us.com/blog/bid/ 49709/Quality-101- Deming-s-7-Deadly-Diseases-of-Management. Ostlund, U., Kidd, L., Wengstro¨m, Y., & Rowa-Dewar, N. (2011).Combining qualitative and quantitative research within mixed method research designs: A methodological review. International Journal of Nursing Studies, 48, 369–383. Papadopoulos, T. (2011a). Continuous improvement and dynamic actor associations: a study of lean thinking implementation in the UK National Health Service. Leadership in Health Services, 24(3), 207–227. Partanen, J., Chetty, S., & Rajala, A. (2014). Innovation types and network relationships. Entrepreneurship Theory and Practice, 38, 1027–1055. Patton, F. & Pini, J. (2009). Lean six sigma speeds testing for hospital emergency rooms. Available at: http://www.processexcellencenet work.com/six-sigmaquality/articles/lean-six- sigma-speeds-testing-for-hospital-emergen/ Pettersen, J. (2009). Defining lean production: some conceptual and practical issues. The TQM Journal, 21(2), 127–142. Prajogo, D., & Sohal, A. (2004). The multidimensionality of TQM practices in determining quality and innovation performance — an empirical examination. Technovation, 24(6), 443–453. Prajogo, D., & Sohal, A.. (2006). The relationship between organization strategy, total quality management (TQM), and organization performance––the mediating role of TQM. European Journal of Operational Research, 168(1), 35–50. Putkonen, A., Kairisto, L., & Penttilä, T. (2010). Enhancing engineering students’ innovation skills through innovation pedagogy – Experiences in Turku University of Applied Sciences. International Conference on Engineering Education, Gliwice, Poland. Rahman, S. (2004). The future of TQM is past. Can TQM be resurrected? Total Quality Management & Business Excellence, 15(4), 411-422. Rahman, S. (1998). Theory of constraints. International Journal of Operations & Production Management, 18(4), 336 – 355. Rahman, S., & Sohal, A. (2002). A review and classification of total quality management research in Australia and an agenda for future research. International Journal of Quality & Reliability Management, 19(1), 46–66. Raphael, P. (2010). Maximizing innovation using Total Quality Management. California State University Dominguez Hills. ProQuest Dissertations & Theses, UMI number: 1489984. Reinard, J. (2006). Chapter 17: Modeling communication behavior. Communication Research Statistics, pp 451-487. California State University, USA: SAGE Publications. Rizk, K. (2011). The hospital accreditation system -a comprehensive review & executive summary of articles in Arabic. Human & Health (16), Beirut: Ministry of Public Heath publications. Robbins, H. (2009) Herb Robbins shows how to identify and eliminate the eight inefficiencies in healthcare. Accessed on May 2013, Interview available at: http://www.processexcellencenet work.com/business-process-managementbpm/articles /herb-robbins-shows-how-to-identify-and-elimina te-t/. Romanos, A. (2012). Ministry of Public Health vision, planning and legislation. In the Lebanese Hospital in 2020 Conference, Med Health, Beirut. Roscoe, J. (1975). Fundamental research statistics for the behavioral science. US: Holt, Rinehart & Winston, Inc. Rothgeb, J., Willis, G., & Forsythet, B. (2001). Questionnaire pretesting methods: do different techniques and different organizations produce similar results? Proceedings of the annual Meeting of the American Statistical Association. Retrieved from http://www.amstat.org/sections/srms/Proceedings/ y2001/Proceed/00476.pdf Rousek, J. (2012). The application of lean and human factors engineering techniques to improve quality in healthcare delivery. Thesis at University of Nebraska. ProQuest Dissertations & Theses, UMI number: 3518156. Rowley, J., Baregheh, A., & Sambrook, S. (2011). Towards an innovation-type mapping tool. Management Decision, 49(1), 73–86. Salge, T., & Vera, A. (2009). Hospital innovativeness and organizational performance: evidence from English public acute care. Health Care Management Review. 34(1), 54-67. Sarkar, D. (2006). 5S for Service organizations and offices - a lean look at improvement. ASQ Press. Available at: http://asq.org/quality-press/display-item/?item=E1271 Sarkar, D. (2007). Lean for service organizations and offices - a holistic approach for operational excellence. ASQ Press. Available at: http://asq.org/qualitypress/ display-item/?item=H1316 Sarkar, D. (2009). Challenges of service lean implementation. Accessed on May 2013. Available at: http://www.processexcellencenet work.com/process-improvementcase-studies/columns/challenges-of-service-lean-implementation. Schneider, D. (2005). Quantitative data analysis: analysis-quant. In Research Design for Educational Technologists, University of Geneva: Switzerland. Available at: http://tecfa.unige.ch/guides/methodo/edu-tech/ slides/analysis-quant.pdf Seddon, J., O’Donovan, B., & Zokaei, K. (2011). Ch.4: Rethinking lean practices. In Service Design and Delivery (XXII., pp. 41–60). US: Springer. Sekaran, U. & Bougie, R. (2011). Research methods for business: A skill building approach (5th Ed.). London: Wiley. Sekaran, U. (2003). Research methods for business: A skill building approach (4th Ed). New York: John Wiley and Sons. Shaaban, R. (2012) What is a green building? In proceedings of the Lebanese Hospital in 2020 Conference, Med Health, Beirut. Available at: http://ahfonline.net/images/activities.html Shah, R. & Ward, P. (2007). Defining and developing measures of lean production, Journal of Operations Management, 25(4), 785-805. Shook, C., Ketchen, D., Hult, T., & Kacmar, M. (2004). An assessment of the use of structural equation modeling in strategic management research. Strategic Management Journal, 25 (4), 397-404 Simon, G. (2003). Multiple regression basics. New York University, Stern School of Business. Available at: http://people.stern.nyu.edu/ wgreene/Statistics/MultipleRegressionBasics Collection.pdf Singh, T., Geetika, P., & Dubey, R. (2011). A theoretical framework for soft dimensions of total quality management. In the proceedings of the International Conference on Economics and Finance Research IPEDR 4, 529–533. Singapore: IACSIT Press. Smith, A., & Rupp, W. (2002). Communication and loyalty among knowledge workers: a resource of the firm theory view. Journal of Knowledge Management, 6(3), 250–261. Souza, L. (2009). Trends and approaches in lean healthcare. Leadership in Health Services, 22(2), 121–139. Stephen, R. (2000). Innovation within the hospital : organizational-climate determinants. University of La Verne, California. ProQuest Dissertations & Theses, UMI number: 9965051. Sureshchandar, G., Rajendran, C., & Ananthraman, R. (2001). A holistic model for total quality service. International Journal of Service Industry Management, 12 (4), 378-412. Swann, G. & Lambert, R. (2010). Why do standards enable or constrain innovation? In EURAS conference, Université de Lausanne: Switzerland. Available at http://www.euras.org/ uploads/2010presentations/Swann&Lambert.pdf Tabrizi, J., Gharibi, F., & Wilson, A. (2011). Advantages and disadvantages of health care accreditation models. Health Promotion Perspectives, 1(1), 1-31. Todd, A., Meifen, Wei., & Daniel, W. (2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53 (3), 372–378. Toner, P. (2011). Workforce skills and innovation: an overview of major themes in the literature. Centre for Educational Research and Innovation (CERI). Paris: OECD. Tracey, M., & Flinchbaugh, J. (2006). HR’s role in the lean organizational journey. World at Work Journal, 4,49 –58. Tuli, F. (2010). The basis of distinction between qualitative and quantitative research in social science: reflection on ontological, epistemological and methodological perspectives. Ethiopian Journal of Education and Science, 6(1), 97-108. UN. (2013) World population prospects, the 2012 revision. Department of Economic and Social Affairs, United Nations: New York. Retrieved from http://esa.un.org/unpd/wpp/Documentation/ pdf/WPP2012_HIGHLIGHTS.pd Valenstein, M., Mitchinson, A., Ronis, D., Alexander, J., Duffy, S., Craig, T., & Barry, K. (2004). Quality indicators and monitoring of mental health services: what do front-line providers think? Journal of Psychiatry, 161, 146-154. Vaske, J., & Needham, M. (2008). Survey implementation, sampling, and weighting data. In survey research and analysis: applications in parks, recreation, and human dimensions. Chapter 8 (pp 173-222). ISBN: 1-892132-79-6 Venkatesh, R. (2008). Innovation and technology in healthcare sector. The Icfaian Journal of Management Research, VII (3), 73–85. Von Bertanlanffy, L. (1950). The theory of open system in Physics and Biology. Science, New series, 111(2872), 23-29. Wadhwa, S. (2007). Need for flexibility and innovation in healthcare management systems. Global Journal of Flexible Systems Management, 8(1 & 2), 45–54. Walshe, K., Harvey, G., Jas, P. (2010). Connecting knowledge and performance in public services: from knowing to doing. New York: Cambridge University Press. ISBN 13: 9780521195461 Wan Asri, A., Muda, S., & Mohamed, S. (2012).The mediating effect of quality practices on lean management in the Malaysian small and medium manufacturing industries. In Proceedings of International Conference of Technology Management, Business and Entrepreneurship, Melaka: Malaysia. Wang, C., & Ahmed, P. (2004). The development and validation of the organizational innovativeness construct using confirmatory factor analysis. European Journal of Innovation Management, 7(4), 303–313. Weaver, M. (2006). Formulae for calculating sample size. School of Nursing, North Carolina: Chapel Hill. Weber, J. (December, 2013). Seven advantages of kanban over par for hospital material management. Retrieved from http://blog.spacesaver.com/Storagesolvedwith Spacesaver/bid/93968/Seven-Advantages-of-Kanban- over-Par-for-Hospital-Material-Management Wehbe, M. (2011). The University Hospital earns more! Al-akhbar (1351), p.14. Retrieved from http://www.alakhbar.com/sites/default/files/ pdfs/20110301/p14_20110301.pdf Weng, R., Huang, J., Kuo, Y., & Huang, C. (2011). Determinants of technological innovation and its effect on hospital performance. African Journal of Business Management, 5(11), 4314–4327. WHO. (2008). The country cooperation strategy-Lebanon. World Health Organization. Retrieved from http://www.who.int/countryfocus. Accessed on April 10, 2013. Womack, J., Jones, D., & Roos, D. (1990). The Machine that changed the world: the story of lean production- Toyota's secret weapon in the global car wars that is now revolutionizing world industry (1st Ed.). New York: Free Press, Simon & Schuster, Inc. Womack, J., Byrne, A., Fiume, O., Kaplan, G., & Toussaint, J. (2005). Going lean in health care. In D. Miller (Ed.), Institute for Healthcare Improvement (p. 15). Cambridge, Massachusetts: Institute for Healthcare Improvement. Wothke, W. (2010). Introduction to structural equation modeling course notes. The American Institute of Research. United States: SAS Institute Inc. Retrieved from http://www.smallwaters.com/Courses%20and%20Pres entations/Structural%20Equation%20Modeling/ Introduction%20to%20SEM%20with%20Proc%20Calis/ Introduction%20to%20SEM%20(Webinar%20Slides).pdf Wu, A., & Zumbo, B. (2007). Understanding and using mediators and moderators. Social Indicators Research, 87(3), 367–392. Ya’acob, Z. (2008). A structural relationship between total quality management, strategic control systems and performance of Malaysian local governments. Thesis at Universiti Utara Malayasia. Retrieved from http://etd.uum.edu.my/ 53/ Yeh, C. (2011). Soft total quality management and organization sustainability : national culture implications. Phd thesis, Benedictine University. ProQuest Dissertations & Theses, UMI number: 3471402. Young, G., Charns, M., & Shortell, S. (2001). Top manager and network effects on the adoption of innovative management practices: a study of TQM in a public hospital system. Strategic Management Journal, 22(10), 935–951. Yrjänäinen, M., et al. (2010). Pretesting of the 5th European Working Conditions Survey questionnaire. Ireland: Eurofound. Retrieved from http://www.eurofound.europa.eu/surveys/ ewcs/2010/documents/pretest.pdf Zainal Abidin, S., Mokhtar, S., & Yusoff, R. (2011). A systematic analysis of innovation studies : a proposed framework on relationship between innovation process and firm’s performance. The Asian Journal of Technology Management, 4(2), 65–83. Zaiţ, A., & Bertea, P. (2011). Methods for testing discriminant validity. Management & Marketing, IX (2), 217-224. Zehir, C., Ertosun, Ö., Zehir, S., & Müceldilli, B. (2012). Total quality management practices’ effects on quality performance and innovative performance. Procedia - Social and Behavioral Sciences, 41, 273–280. Zeinali, Z. (2010). Developing a relationship matrix for organizational learning and innovativeness : with a case study in a manufacturing company. International Journal of Business and Management, 5(7), 187–203. Zikmund, W. (2003). Essential of marketing research (2nd Ed.) Sydney: Thomson learning. Zurn, P., Dolea, C., & Stillwell, B. (2005). Nurse retention and recruitment: developing a motivated workforce, Issue 4. In The Global Nursing Review Initiative, pp. 1–31. International Council of Nurses, Geneva.