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Lean in healthcare: the unfilled promise?

Radnor, Zoe Jane, Holweg, Matthias and Waring, Justin 2012. Lean in healthcare: the unfilled promise? Social Science & Medicine 74 (3) , pp. 364-371. 10.1016/j.socscimed.2011.02.011

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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. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily ‘professional’ in origin but actually more ‘organisational’ and ‘managerial’ and, if not addressed could severely constrain Lean’s impact on healthcare productivity at the systems level.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Business (Including Economics)
Subjects: H Social Sciences > HD Industries. Land use. Labor
H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
H Social Sciences > HJ Public Finance
J Political Science > JN Political institutions (Europe) > JN101 Great Britain
J Political Science > JS Local government Municipal government
R Medicine > RA Public aspects of medicine
Uncontrolled Keywords: Efficiency ; Lean thinking ; Process improvement ; Context-dependence
Publisher: Elsevier
ISSN: 0277-9536
Last Modified: 19 Mar 2016 22:31
URI: https://orca.cardiff.ac.uk/id/eprint/19323

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