Embedding Lean Healthcare Training for Sustainability in Health Sciences Education: A Cross-Sectional KAB Model with Cultural–Leadership Moderation
List of Authors
Ghaliya Salah Al Atar
Keyword
Earnings Management; Accrual-Based Earnings Management (AEM); Real Earnings Management (REM); Chinese Listed Companies; Corporate Performance; Ownership Structure; State-Owned Enterprises (SOEs); Agency and Signaling Theories
Abstract
The imperative for sustainable healthcare is intensifying as health systems contribute to climate change, resource depletion and waste. Lean Healthcare (LH), with its focus on value, waste elimination and continuous improvement, offers a potential pathway toward environmental sustainability when integrated into health sciences education. However, most educational evaluations focus only on knowledge, attitude and behaviour (KAB) gains and overlook whether learners translate Lean principles into sustainability-oriented practices. This cross-sectional study used a newly developed Sustainability Outcomes in Healthcare Education (SOHE) scale to investigate whether students’ Lean‐related knowledge, attitudes and behaviours predict sustainability outcomes. A total of 118 health sciences students completed a survey comprising validated KAB subscales and SOHE items. Hierarchical multiple regression tested the main effects of Knowledge, Attitude and Behaviour on SOHE and examined whether the perceived learning Culture and Leadership moderated the Behaviour → SOHE relationship. All subscales showed acceptable reliability (α ≥ 0.80). Behaviour was the strongest predictor of SOHE (β ≈ 0.46, p < .001), while Knowledge and Attitude showed weaker positive associations. Interaction terms revealed that supportive Culture and Leadership significantly strengthened the Behaviour → SOHE relationship (β ≈ 0.15–0.17, ΔR² ≈ 0.03), indicating that when students perceive a culture of continuous improvement and strong leadership support, the translation of Lean behaviours into sustainability outcomes is amplified. Nursing students reported slightly higher SOHE scores than medical students. These findings suggest that embedding Lean training within supportive educational contexts can cultivate sustainability competencies in future clinicians and that curriculum designers should intentionally align process-improvement pedagogy with environmental stewardship.