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Lean in healthcare from employees' perspectives.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.ORCID iD: 0000-0003-4040-8302
2014 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, 177-95 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.

DESIGN/METHODOLOGY/APPROACH: The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.

FINDINGS: The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.

PRACTICAL IMPLICATIONS: Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance.

ORIGINALITY/VALUE: In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2014. Vol. 28, no 2, 177-95 p.
Keyword [en]
Lean production, healthcare, employees’ role
National Category
Reliability and Maintenance
URN: urn:nbn:se:liu:diva-110657DOI: 10.1108/JHOM-03-2013-0066PubMedID: 25065109ScopusID: 2-s2.0-84902509126OAI: diva2:748017
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2015-04-23
In thesis
1. Lean in the Public Sector: Possibilities and Limitations
Open this publication in new window or tab >>Lean in the Public Sector: Possibilities and Limitations
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The demands on efficiency and quality in the public sector have increased over the past few years, which have raised the need for strategies on how the public sector can be improved (Denhardt and Denhardt, 2000). Consequently, the concept of Lean production, or just Lean, have become increasingly spread, especially in health care, but also in government agencies, police, military and social services. Lean production is an integrated operational and socio-technical system with the aim of creating value and reducing waste in operations. Some research has been conducted on Lean in the public sector, but it has been too focused on the a few operational tools and results of these, and there is lack of a comprehensive critical review of Lean from a holistic perspective.

The aim of this thesis is to increase understanding of how Lean production is used in different contexts. The thesis particularly focuses on the public sector, and investigates the possibilities and limitations of Lean production in this context. A total of seven organizations have been studied, including two manufacturing companies, three care units and two local businesses. In particular, qualitative methods have been used, along with some quantitative.

The thesis shows several possibilities and limitations of Lean in public sector. One possibility is the improved flow orientation that reduces the lead time and efficiency in back office processes. Moreover, the new roles and responsibilities can lead to improved job characteristics for public sector employees. One limitation is that Lean is more commonly used to improve the technical quality than the functional, which means that the focus has been placed on improving the instrumental performance of the service, rather than how the service is provided. There is also often a focus on efficiency in the back office rather than the front office processes. This means that Lean initiatives may become too focused on internal efficiency and thereby miss important aspects of user perceived quality.

Abstract [sv]

Kraven på effektivitet och kvalitet inom offentlig sektor har aktualiserats under de senaste åren, vilket har ökat behovet av strategier för hur offentlig verksamhet kan förbättras (Denhardt and Denhardt, 2000). Som ett led i detta har konceptet Lean Production, eller bara Lean, fått en allt större spridning, framförallt inom hälsooch sjukvård, men även inom statliga myndigheter, polisväsen, militär och socialtjänst. Lean Production är ett integrerat operationellt och sociotekniskt system med syfte att skapa värde och minska slöseri i verksamheter. Det har utförts en del forskning om Lean i offentlig sektor, men den har varit allt för inriktad på enskilda operationella verktyg och resultat av dessa och det saknas en övergripande kritisk granskning av Lean ur ett helhetsperspektiv.

Syftet med avhandlingen är att öka förståelsen om hur Lean används i praktiken och vilka möjligheter och begränsningar som det har inom offentlig sektor. Totalt sju organisationer har studerats, varav två tillverkningsföretag, 3 vårdenheter och 2 kommunala verksamheter. Framförallt har kvalitativa metoder använts, men även inslag av kvantitativa.

Avhandlingen visar flera möjligheter och begränsningar med Lean inom offentlig sektor. En möjlighet är ett förbättrat flöde, som minskar ledtider och effektivitet i backoffice processer. Dessutom kan nya roller och ansvarsområden leda till förbättrade jobbegenskaper för anställda i offentligt sektor. En begränsning är att Lean är oftare används för att förbättra den tekniska kvalitet än den funktionella, vilket innebär att fokus har lagts på att förbättra den instrumentella prestandan av tjänsterna, snarare än hur de utförs. Det är ofta ett fokus på effektivitet i backoffice i stället för frontoffice processer. Det innebär att Lean initiativ kan bli alltför fokuserade på intern effektivitet och därmed missa viktiga aspekter av användarens upplevda kvalitet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 62 p.
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1677
National Category
Reliability and Maintenance Economics and Business Public Administration Studies
urn:nbn:se:liu:diva-110660 (URN)10.3384/lic.diva-110660 (DOI)978-91-7519-229-1 (print) (ISBN)
2014-09-19, Sal A35, A-huset, Campus Valla, Linköpings universitet, Linköping, 13:15 (Swedish)
Available from: 2014-09-18 Created: 2014-09-18 Last updated: 2016-06-01Bibliographically approved

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