Purpose The purpose of this paper is to present the supportive conditions that the first-line health-care managers claim that they need from their own managers and what they experience as their own roles and responsibilities in relation to their coworkers when applying Lean principles and practices. Design/methodology/approach A survey with a Web-based questionnaire was designed and used in a Swedish health-care organization two years after the initiation of Lean to investigate the managers’ views on their role, conditions and ability to create change according to Lean. The result from two of the questions will be presented where one focuses on the relationship to the first-line managers’ own manager and the second on the relationship to their coworkers. Findings The results show that to initiate improvement, work based on Lean first-line managers ask for own managers who are assured about Lean, include them in discussions and ask for follow-ups and results about Lean. Concerning first-line managers’ relation to their coworkers they experience themselves as responsible for leading toward creating a culture where problems and mistakes are viewed as possibilities to improve, for encouraging that new work procedures are tested and for creating commitment and inspiration in relation to their coworkers. Originality/value The questions can be used separately or as part of an entire questionnaire before and along the Lean process to highlight organizational issues such as shared responsibility and supportive relations when developing health care.

Purpose The purpose of this paper is to present the results from a study that investigates first-line healthcare managers’ views on their role and the conditions that influence their ability to drive improvement work based on Lean. Design/methodology/approach A questionnaire was sent to all first-line managers in a healthcare organization to investigate their views on their role, conditions and ability to create change according to Lean. The results from four of the questions are presented, which focus on how crucial they consider their role to be for managing improvement work based on Lean, what work tasks their time is spent on, what factors they consider to be important to their ability to drive change and what factors best describe what Lean provides. Findings The results show that first-line managers claim that their role is crucial in improvement work, but when they defined their work tasks, the time spent on improvements was not frequently described. Time, support from coworkers, and a clear vision and clear goals were the three factors that they considered to be most important to their ability to drive improvement work. Considering their leadership, Lean contributed to the structure with tools and supportive methods. Originality/value The questions can be used separately or as part of the entire questionnaire before and along a Lean process to obtain a better understanding of how to create a sustainable Lean approach in healthcare. Understanding the factors that first-line managers consider supporting their ability in improvement work and what they consider Lean provides is important in creating a development force in Swedish healthcare.

The purpose of this article is to present the results from a survey concerning first-line managers' assuredness about the effects of Lean after two years of Lean application in a Swedish healthcare organization. The purpose is also to reflect about assuredness as a driving force for sustainable change. Questionnaires were sent to all first-line managers in a healthcare organization in order to investigate how these managers consider their role, ability and conditions to create change according to Lean. One of the questions included 17 statements about how assured these managers were about the effects of Lean. The results from this question will be presented in this paper. The study showed that the majority of the first-line managers in this particular healthcare organization were assured that developmental work supported by Lean contributes to a higher patient focus, supports first-line managers with useful tools and methods, contributes to the development of an improvement culture and that the Lean concept in general is a support in improvement work. The question can either be used separately or as a part of an entire questionnaire in healthcare organizations. Asking first-line managers about their assuredness about the effects of Lean on a regular basis is one way to follow the Lean process from their perspective. The survey question might encourage discussions about the process of Lean and hopefully contribute to a greater understanding about the importance of assuredness and about the desired effects when applying Lean.