Assessing alignment of organizational practices with operational excellence principles: evidence from an eye hospital setting

Purpose Health-care systems are increasingly challenged by chronic diseases, rising costs and aging populations. To improve efficiency, many organizations have adopted methodologies from manufacturing, such as Lean and Six Sigma, yet sustaining such initiatives remains difficult. In contrast, practices that evolve organically within organizations often prove more sustainable. This study aims to assess the alignment of organizational practices with principles of operational excellence (OE) and examine their association with key performance outcomes in a hospital setting. Design/methodology/approach A structured questionnaire was developed to assess adherence to operational practices based on the continuous process improvement (CPI) dimension in Shingo’s model of OE. A survey was conducted among 62 professionals across 16 departments, including clinical and administrative roles, in a large eye hospital. Outcome data including patient satisfaction, patient safety (near misses), outpatients cycle time, process efficiency and capacity utilization were collected. Descriptive statistics, Pearson correlations and Kruskal–Wallis tests were used to analyse relationships between adherence and outcomes. Findings Correlation coefficients ranged from −0.33 to 0.62, with 33 of 45 coefficients being positive. Departments with higher adherence (upper tercile) had better outcomes, particularly in process efficiency and patient satisfaction Research limitations/implications The questionnaire used in this study was newly developed; although it was tested for feasibility, it should be considered a preliminary framework that requires further review, refinement and validation before being applied in diverse settings. In addition, as a cross-sectional study, the findings reflect associations rather than causal relationships. Practical implications The findings provide actionable insights for hospital leaders and quality improvement teams seeking to enhance performance without adopting formal excellence frameworks. The structured self-assessment tool can help identify areas of alignment with CPI principles as well as gaps requiring attention. The positive association between stronger alignment and better departmental outcomes highlights the potential of addressing such gaps to drive consistent, high-quality service delivery. Importantly, the results also underscore the systemic nature of health-care delivery, where standardized processes and a culture of continuous improvement – actively involving frontline staff – are essential for sustaining outcomes. Originality/value This study demonstrates the feasibility of assessing alignment between existing organizational practices and concepts of OE. It highlights the value of embedding structured practices into daily workflows to sustain improved outcomes, even when an organization has not formally adopted specific methods. The findings also support using periodic assessments to guide targeted improvements. Future research should explore the role of organizational culture, team engagement, customer value and goal alignment in sustaining excellence.