Emergent barriers to the lean healthcare journey: baronies, tribalism and scepticism

Abstract

Healthcare systems are essential service organizations for citizens. However, the increasing demand for healthcare provisions and limited resources are challenging the public healthcare system to its limit. To respond to these constraints, healthcare managers and practitioners have worked together to adapt industrial practices of process improvements, such as lean production, to healthcare operations. Although the implementation of lean has gained considerable traction in the complex healthcare ecosystem and provided several benefits, its journey has been and continues to be challenged by contextual barriers not encountered in manufacturing settings. Amongst these barriers, the literature identifies professionalism, implementation fidelity, and the need for evidence-based research as being the most disruptive to lean implementation. These emergent barriers have impacted on the implementation and sustainability of lean in healthcare, and scholars have called for empirical studies to provide an in-depth understanding of these issues to fill this knowledge gap. This study responds to this call by empirically investigating the impact of these barriers in practice by using an exploratory case study in three emergency areas of a public healthcare system. Thirty-seven semi-structured interviews were conducted with nurses, physicians, coordinators, and lean management specialists involved in lean improvement projects. Two key concepts of value destruction and balanced centricity were identified as being crucial to understanding the impact of these emergent barriers. Research propositions are provided that identify baronies, tribalism and scepticism as being the main elements that constrain the implementation and sustainability of lean in healthcare.

Keywords:

• Barriers
• lean healthcare
• process improvements
• professionalism
• value destruction

Disclosure statement

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

Additional information

Notes on contributors

Higor Leite

Dr Higor Leite is an Associate Professor in Operations and Supply Chain Management and Leader of e-healthcare Research Group at the Federal Technological University of Paraná. He is an associate member of the Centre for Service Management at Loughborough University in the UK. Higor’s research interests include lean healthcare, e-healthcare, telemedicine and healthcare improvement. His work has been published in journals, such as Production Planning & Control, Public Management Review, Public Money & Management, Leadership and Health Services, Australian Journal of Public Administration, TQM Journal and the International Journal of Quality & Reliability Management. He is an active member of the British Academy of Management. School of Management and Economics; Biomedical Engineering Postgraduate Research Programme - Federal University of Technology Paraná – Brazil.

Sharon Williams

Professor Sharon Williams is a Professor of Healthcare Operations Management with the Faculty of Medicine, Health & Life Sciences, Swansea University where she leads the Swansea Centre for Improvement and Innovation in Health & Social Care. Currently she has a part-time secondment with Hywel Dda University Health Board. Before joining Swansea, Sharon held academic positions at Cardiff Business School and Warwick Medical School. Sharon’s research interest lies within services operations, supply chain management and quality improvement within healthcare organizations and systems. In 2014, Sharon was awarded an Improvement Science Fellowship with the Health Foundation. She has published in a wide range of journals including International Journal of Operations and Production, Supply Chain Management: An International Journal, Production Planning & Control and Journal of Health Organization and Management. School of Health & Social Care, Faculty of Medicine, Health & Life Sciences, Swansea University, Swansea SA2 8PD, UK

Zoe Radnor

Professor Zoe Radnor Professor Zoe Radnor is Deputy Vice-Chancellor at The University of Law (ULaw) specifically focusing on the provision of high quality, innovative academic teaching and developing excellence in research and thought leadership. Previously she was Vice President (Strategy and Planning; EDI) at City, University of London where she led on not only the University’s Strategy and Planning processes but also the Equality, Diversity and Inclusion. She is also a Visiting Professor at Bayes 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. The University of Law, Birmingham Campus, 133 Great Hampton St | Birmingham, B18 6AQ. Bayes Business School, City, University of London, London UK EC1V 0HB, United Kingdom.

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. School of Management, University of Leicester, Leicester UK LE1 7RH, United Kingdom.