Lean in healthcare: The unfilled promise?

Abstract

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities.

When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act

“…While Germany has privatised by selling entire hospitals to profit-making firms (Anonymous, 2013a), the UK has contracted out particular services to private providers. Limits to privatisation include state dominance in funding (Moody, 2011), economies of scale in public-sector provision (Davies, 2013), the conservatism of public management (Radnor, Holweg and Waring, 2012), and centralisation in contracting (Petsoulas et al, 2011). The private sector shares this scepticism: in a 2012 survey of private healthcare professionals, only 20% expected increased competition (Nabarro and HealthInvestor, 2013).…”

Lean production tools and decision latitude enable conditions for innovative learning in organizations: A multilevel analysis

“…Aspects of lean production are common in all sectors, in Sweden (Johansson & Abrahamsson, 2009) as well as in other European countries (Arundel et al, 2007;Radnor et al, 2012). However, there is an ongoing debate concerning its effect on learning, possibly due to the many different ways of interpreting and operationalizing lean production (Pettersen, 2009;Westgaard & Winkel, 2010); Hasle, 2011;Brännmark, Langstrand, Johansson, Halvarsson, Abrahamsson & Winkel, 2012;Hasle, Bojesen, Langaa Jensen & Bramming, 2012).…”

“…The philosophical level concerns how to understand value (what is needed and wanted by the customer or client) and how the work process can be improved by removing steps without value (Womack & Jones, 1996;Womack, Jones & Roos, 2007). Lean production tools are often implemented in order to eliminate non-value-adding activities and 4 reduce variability in the work process, without considering the lean production philosophy (Shah & Ward, 2001;Radnor, Holweg & Waring, 2012;Joosten, Bongers, & Janssen, 2009;Mazzocato, Savage, Brommels, Aronsson & Thor, 2010). It is often argued that failure to consider the holistic, process view of lean production and the socio-technical aspects of the interaction between human behaviour and operational tools leads to restricted success (Liker & Morgan, 2006;Joosten et al, 2009;Mazzocato et al, 2010;Radnor et al, 2012).…”

“…Lean production tools are often implemented in order to eliminate non-value-adding activities and 4 reduce variability in the work process, without considering the lean production philosophy (Shah & Ward, 2001;Radnor, Holweg & Waring, 2012;Joosten, Bongers, & Janssen, 2009;Mazzocato, Savage, Brommels, Aronsson & Thor, 2010). It is often argued that failure to consider the holistic, process view of lean production and the socio-technical aspects of the interaction between human behaviour and operational tools leads to restricted success (Liker & Morgan, 2006;Joosten et al, 2009;Mazzocato et al, 2010;Radnor et al, 2012). If aspects of lean production is combined with socio-technical thinking, where the social as well as the technical system of the organization are considered and aspects such as work content and variation, learning, decision making, recognition and coherence are acknowledged (Thorsrud & Emery, 1969), this may have beneficial effects on the work environment (Seppälä & Klemola, 2004).…”

Implantação do modelo lean thinking em saúde: um estudo de caso em serviço de medicina diagnóstica

“…Apoio da alta administração 3.1 Para implantação e operacionalização do modelo lean thinking é necessário um trabalho com a equipe integrada (da diretoria até a operação, além da participação ativa e direta da alta administração dentro da operação (GROVE et al, 2010b;RADNOF;HOLWEG;WARING, 2012;MCCULLOCH et al, 2010;HSU et al, 2012;NG et al, 2010;HERRING, 2009). As proposições foram divididas em seis temas que geraram as questões orientadoras das entrevistas, conforme modelo abaixo (Quadro 1).…”