Beyond the ostensible: an exploration of barriers to lean implementation and sustainability in healthcare

Abstract

The barriers to implement lean have been well researched and have generated consistent results; this study identifies these as ostensible barriers. There is a dearth of research that focuses on understanding the causes of these ostensible barriers. Thus, this study aims to empirically investigate the deeper causes that produce ostensible barriers to implement lean in emergency areas of healthcare. To achieve this aim, the paper draws on rich, qualitative data from four different sources of data, using exploratory case studies as the main approach. Undertaking thematic analysis, six main underlying barriers emerge as the root cause of ostensible barriers. The results suggest that addressing each of the underlying barriers in healthcare is likely to support lean implementation and sustainability, by reducing the impact of restraining forces that come from stakeholders and the public healthcare system.

Keywords:

• Lean production
• lean healthcare
• lean implementation
• barriers
• public healthcare

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Higor Leite

Dr Higor Leite is an Assistant Professor in Operations Management at the Federal Technological University of Paraná in Brazil (UTFPR). He holds a Bachelor of Science in Business Administration, MBA in Global Marketing and a Masters degree in Industrial Engineering. He has over 15 years of professional experience working within lean production, process design, services area, sales and accounts management as well as purchasing processes. In 2012, he moved to the United Kingdom to undertake his Ph.D. in Operations Management at Loughborough University. During this time, he won several funding awards, including two times the Santander Mobility Award. He was also the Ph.D. representative for the Centre for Service Management where he currently is an associate member. Higor’s research focuses on lean healthcare and healthcare 4.0, and he has presented and published it in international Conferences, for instance, the Production and Operation Management Society and the European Operations Management Association. He is also associate fellow of the Higher Education Academy in the UK.

Nicola Bateman

Dr. Nicola Bateman studied manufacturing engineering at Brunel University and after working in the food industry went to lecture and study part time for a PhD at De Montfort University in Systems flexibility. Returning to industry, she then worked in the area of Continuous Improvement (CI) in the aircraft industry. From industry, she resumed her academic career and undertook research looking at sustainability of CI in the automotive sector with Cardiff University’s Lean Enterprise Research Centre (LERC) and the Department of Trade and Industry. From LERC Nicola moved to Loughborough University’s School of Business and Economics where she continued work in CI in a wide range of sectors. Nicola was a founder member of the Centre for Service Management at Loughborough University. In 2017, I moved to the University of Leicester as an Associate Professor in Operations Management. She has published in a wide range of journals including Public Money and Management, Australian Journal of Public Administration, International Journal of Production Research, and International Journal of Operations and Production Management. She is an active member of the British Academy of Management and European Operations Management Association.

Zoe Radnor

Professor Zoe Radnor is the Vice President (Strategy and Planning) at City, University of London where she leads not only the University’s Strategy and Planning processes but also the Equality and Diversity agenda. She is also a Professor of Service Operations Management at Cass Business School. Zoe’s research interest is in performance and process improvement and service management within public sector organizations. She has led research projects for a number of Government and healthcare organizations, evaluating the use of ‘lean’ and associated techniques and continues to maintain a strong ongoing research profile. Zoe is a Fellow of the British Academy of Management (FBAM) and the Academy of Social Science (FAcSS). She has published over 100 articles, papers, chapters and reports and has presented widely, nationally and internationally, to academic, governmental and practitioner audiences.