Understanding resistance in lean implementation in healthcare environments: an institutional logics perspective

Abstract

While lean thinking has been used in healthcare for almost two decades, its efficacy has been debated extensively by researchers and practitioners alike. This ongoing debate is largely due to the varied results of its implementation; and resistance to change is considered to be the primary reason behind this variation. This study adopts an institutional logics perspective to analyze the nature of this resistance by drawing attention to how clinical staff make judgements about the appropriateness, acceptability and legitimacy of lean thinking. To conceptualize resistance, a systematic literature review based on 33 published studies depicting lean implementations was conducted, which helped to develop a nuanced understanding of resistance and its causes. Subsequently, 47 semi-structured interviews were undertaken with Quality Improvement managers regarding their experience with implementing lean thinking in 15 New Zealand District Health Boards. These interviews were used to identify and evaluate strategies used to minimize resistance within the implementation of lean initiatives in healthcare organizations. The findings of this research suggest that typically there are three strategies adopted by quality improvement managers—(1) communication strategies to create a better narrative for lean implementation; (2) cooperation strategies, which encourage the adherents of lean and medical logics to work together on shared problems, creating opportunities for them to learn about other logics; and (3) performance management strategies with the help of incentives and commitment devices to create a supportive environment for lean implementation. Together, these strategies work to improve the availability, accessibility, and activation of lean thinking logic in healthcare.

Keywords:

• Quality improvement
• institutional logics
• change management
• systematic review
• lean thinking
• New Zealand

Acknowledgements

We would like to thank Professor Ojiako and the anonymous reviewers for their valuable comments and feedback. Also, a very special acknowledgement for Mr Muhammad Akmal for his love, guidance, support and everything else.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The national health targets were discontinued by the new Labour Government in the first quarter of 2018.

Additional information

Notes on contributors

Adeel Akmal

Dr. Adeel Akmal is a postdoctoral fellow in the Centre for Health Systems and Technology (CHeST) in the Otago Business School, University of Otago, New Zealand. He is an active researcher in the fields of lean thinking in production and service organizations (with a particular interest in healthcare organizations), operations management and supply chain management. He has published in Production Planning and Control, Employee Relations, Health Policy.

Jeff Foote

Dr. Jeff Foote is a Lecturer in Operations Management in the Department of Management, University of Otago. His research interests include systems methodology, evaluation, health services research and interdisciplinary and bi-cultural project work. Prior to becoming an academic, Jeff was a Science Leader at the Institute of Environmental Science and Research where he led a team of social scientists undertaking research on public health and sustainability issues.

Nataliya Podgorodnichenko

Dr. Nataliya Podgorodnichenko is a Lecturer in DBA programme at the Otago Business School, University of Otago. Her primary research interests include corporate social responsibility, sustainability, human resource management, sustainable and green human resource management, and lean thinking. She has published in Production Planning and Control, Human Resource Management Review, Employee Relations.

Richard Greatbanks

Dr. Richard Greatbanks is an Associate Professor in Operations Management in the Otago Business School, University of Otago, teaching Operations and Quality Management at undergraduate and postgraduate levels. Prior to this Richard was Lecturer in Quality Management at the University of Manchester, Institute for Science and Technology (UMIST), UK. Richard is a Chartered Manufacturing Engineer and has held several technical and managerial positions within the UK Aerospace industry. He undertakes teaching, research and consulting in the areas of business process improvement and Lean Six Sigma application methods, particularly in conjunction with manufacturing and engineering, healthcare and non-profit organizations.

Robin Gauld

Professor Robin Gauld is Pro-Vice-Chancellor (Commerce) and Dean, Otago Business School, a role he moved to in December 2016. He is also the Co-Director of the Centre for Health Systems and Technology (CHeST) which spans the Business School and Health Sciences Division at the University of Otago. Robin has authored over 160 peer-reviewed journal articles, 40 book chapters and several books including The New Health Policy (Open University Press, 2009) which was awarded First Prize in category at the 2010 British Medical Association Medical Book Awards, and Dangerous Enthusiasms: E-Government, Computer Failure and Information System Development (2006; co-authored with Shaun Goldfinch) which has been widely-used globally including in key reading lists at Harvard Kennedy School of Government.