Enhancing Pediatric Outpatient Performance through Leadership and Continuous Improvement Culture: The Mediating Role of Lean Healthcare

Abstract

Objective: This study examines the association of leadership and continuous improvement culture with Lean Healthcare implementation and their subsequent relationship with service performance in a pediatric outpatient clinic.

Design: A quantitative explanatory study with a cross-sectional design was conducted among 46 healthcare staff selected through stratified random sampling. The hypothesized relationships were tested using Structural Equation Modeling–Partial Least Squares (SEM–PLS).

Setting: The study was carried out in the Pediatric Outpatient Clinic of a private hospital in South Sumatra, Indonesia.

Main outcome measures: Self-reported scores for Leadership, Continuous Improvement Culture, Lean Healthcare implementation, and Service Performance, measured using a validated and reliable structured questionnaire with a five-point Likert scale.

Results: Leadership (β=0.527, p<0.001) and Continuous Improvement Culture (β=0.639, p<0.001) significantly predicted Lean Healthcare (R²=0.733). Lean Healthcare (β=0.244, p=0.021), Leadership (β=0.477, p<0.001), and Continuous Improvement Culture (β=0.507, p<0.001) demonstrated direct associations with Service Performance. Furthermore, Lean Healthcare partially mediated the pathways from Leadership (β=0.128, p=0.039) and Continuous Improvement Culture (β=0.156, p=0.031) to performance.

Conclusions: Lean Healthcare was found to partially mediate the relationships between leadership, continuous improvement culture, and service performance. Findings suggest that healthcare managers should integrate leadership development and continuous improvement initiatives to strengthen Lean implementation and service outcomes. However, findings should be interpreted cautiously due to the small sample size and single-site design. The cross-sectional design and reliance on self-reported measures limit causal inference.