Common sense put to work: The capitalisation of affects in the introduction of a Lean management model to healthcare professionals

ABSTRACT

This article investigates how Lean model is introduced in a management training course targeted at healthcare professionals in Finland. Lean management originated in the Japanese car industry; since the 1990s it has become a key management doctrine for healthcare reform in Western welfare states. Drawing on ethnographic research on a two-day Lean management training course in 2019, and by applying the analytical lenses of affects and sociomateriality, the article illustrates how Lean is made attractive to healthcare professionals. The article results that Lean training serves as an example of complex mechanism of biocapitalist production in which people’s cognition, feelings, sensitivities and experiences are transformed into tools of labour and are put to work through common sense. Methodologically, the article demonstrates in an illuminating fashion how capitalisation of affects may be studied.

KEYWORDS:

• Affect
• biocapitalism
• common sense
• healthcare
• Lean management
• sociomateriality

Healthcare management as a site of capitalisation

Over the past few decades, bureaucratic governance has been increasingly criticised as hierarchical and inefficient (Duleavy & Hood, 1994). Consequently, a variety of market-based solutions have been implemented in healthcare service organisations in the hope of delivering more efficient, flexible, customer-driven and employee-friendly ways to organise services. Following in the footsteps of corporate management consultants and their management style toolkits, the public sector (including healthcare) has gradually become a laboratory for various private-sector management techniques (Kantola, 2014; Thedvall, 2017). In this article, we investigate one of these fashionable management techniques, Lean, through an ethnographic study of a management training course targeted at healthcare professionals in Finland.

Lean is applied in different industries and services around the world, and it has become one of the most widely implemented management doctrines in Finnish health and social care (Jorma et al., 2016). Lean thinking was originally developed in Japan at Toyota’s factories in the 1940s and was later modified by American consultants. Since the 1980s, Lean has been widely used in manufacturing industries. It was first applied to healthcare in 1996 by James Womack and Daniel Jones (Aij & Teunissen, 2017, p. 714). Lean includes the idea of economic potentiality, as well as the managerialist idea of applicability. It aims to delegate more power to employees and harness an organisation’s intangible assets in order to produce value for customers through just-in-time service delivery and the elimination of waste. This means optimising the use of material and immaterial resources such as time, professional skills and knowledge. As a management doctrine, Lean understands management as collective and interactive. It is based on the principle of the constant improvement of performance. Every employee, their organisation and the stakeholders are seen as potential participants in Lean projects and in the development of the organisation’s (Lean) culture (Hirvonen et al., 2020). However, critics have questioned whether the principles of Lean, such as its standardisation and various measurement tools, are suitable for managing public-sector work and complex healthcare processes (see McCann et al., 2015).

The first step in the implementation of Lean in the healthcare sector is for managers and employees to participate in a Lean management training course. Consultancy firms that organise Lean training have become influential players in the reform and restructuring of public-service organisations (Thedvall, 2017). Lean training programmes are usually provided to employees as staff training. Training and learning carry positive connotations of self-development and emancipation as well as the opportunity to take part in the transformation of one’s organisation. In addition, workers are supposed to pay the new knowledge forwards in their workplace, to show that they are not only maintaining their individual ‘productive skills’ but also contributing to the transformation of the whole organisation’s culture (Silvennoinen & Lindberg, 2015, p. 269). In accordance with the idea of human capitalisation, workers who participate in Lean training are seen to be investing in their own future working lives as responsible subjects, but they are also considered a flexible workforce to be adjusted to the demands of the labour market and organisation (Paju et al., 2019). Furthermore, as workplace and staff training has become commonplace in Finnish working life, consultants are under constant pressure to arrange ever more memorable training opportunities (Silvennoinen & Lindberg, 2015).

Like many management trends Lean promotion is a huge industry in itself. Management models are made persuasive by referring to guru-led revolutionary based ideas and to scientific rationalities. (Kantola, 2014; McCann et al., 2015, p. 1559). However, in their study of Lean in healthcare, McCann et al. (2015) note that ‘staff appeared attracted (at a general level) to the principles of Lean even when the principles were ‘sold’ in a somewhat ‘folksy’ manner’ (p. 1567). In our own ethnographic study, we found that it was precisely this ordinariness and folksiness that characterised the atmosphere of the training course in which we participated. Moreover, appropriate justifications are required if the idea of Lean is to be sold successfully to the healthcare sector. Previous studies have found that such justifications are made in public debates through a focus on widely shared cultural principles (Ylä-Anttila & Luhtakallio, 2016), or by turning to what can be identified as ‘common sense’ (Herranen & Vaden, 2017).

Moreover, by focusing on how people’s emotions and bodily capacities are put to work with the help of Lean consultants, we are in agreement with previous studies that attendees’ active participation plays a crucial role in creating a suitable affective atmosphere (Kolehmainen & Mäkinen, 2019; Thedvall, 2017). Thus, Lean training exemplifies a form of biocapitalism and production in which not only general skills but also emotions and affects are understood to be productive and prone to capitalisation (Hardt & Negri, 2009; Morini & Fumagalli, 2010). Moreover, training participants learn Lean by labour, through the embodied activation of material, corporeal, social and affective links (Morini & Fumagalli, 2010; on affective labour, see Kolehmainen & Mäkinen, 2019).

Our article is based on ethnographic research conducted in a two-day Lean management training in which our purpose was to study how Lean is introduced and made attractive. In the course of analysing the data, we narrowed our focus to analysing how common sense was repeatedly ‘put to work’ and applied as a source of value, justification and affective force during the training. Based on this groundwork, the article responds to the question of how the capitalisation of affects manifests in Lean management training. Our article draws from theories on affect (e.g. Deleuze, 1998; Seigworth & Gregg, 2010), biocapitalism (Morini & Fumagalli, 2010) and sociomaterial thinking (e.g. Barad, 2007; Orlikowski, 2007). The results contribute to the microanalyses on how novel management ideas are introduced and how, in biocapitalism, affects are central to this process. The aim is to shift attention away from the human actor to the wider field of the sociomateriality of life, in order to investigate (workplace) staff training and capitalisation through material, corporeal and affective entanglements.

Theorising affects in current formations of capitalism

We look at Lean from the perspective of biocapitalist production. The concept of biocapitalism emphasises the affective, cognitive and relational aspects of life as sources of commodification (Morini & Fumagalli, 2010). It highlights how material objects, communication, human abilities and sociality become potentially productive. In biocapitalism, the production of wealth lies on knowledge and human experience which are implicit in (human) existence itself (Morini & Fumagalli, 2010, p. 238). There has been only little attention paid to the biocapitalization of management models. However, the theorisation of affects has been applied in previous analyses of new management models such as Lean. For instance, Thedvall’s (2017) study shows how the idea of Lean as a ‘mechanism of hope’ (Brunsson, 2006) is crafted through an ‘affective atmosphere’ (Anderson, 2009) during Lean training. In this article, we show that it is the affective atmosphere of common sense in particular that makes Lean attractive. We understand affective atmosphere as a shared ground from which affect emerges (Brennan, 2004), and which actively ‘surrounds’ and ‘envelops’ people and things (Gherardi, 2019, p. 749).

In our analysis we apply a Deleuzian understanding of affect, according to which bodies have the capacity to affect and become affected (Deleuze, 1988). To be more precise, firstly, we understand affect as ‘an active, moving relation, and a collectively formed and circulated capacity’ (Karppi et al., 2016, p. 3). Secondly, we conceptualise affect as a force of encounter. However, this does not mean that affect has to be particularly forceful; it can work in the unnoticed and subtlest intensities and events that emerge in encounters (Seigworth & Gregg, 2010, p. 2). Thirdly, we use affect as an analytical tool to highlight relationships between the human and non-human, individual and collective bodies that converge in a Lean training event (Kolehmainen & Juvonen, 2018, p. 5).

While we find affect to be a useful conceptual starting point for understanding contemporary capitalism, we also suggest that the role of material(ity) – not only as an object of production or a passive entity, but as something that possesses ‘agential power’ (Barad, 2003) – should also be a focus in analyses of capitalist production and management trends. Thus, to make sense of affects, we employ a sociomaterial approach in our analysis. Sociomaterial theorising calls for a relational ontology that makes no a priori distinction between the ‘social’ and ‘material’ (or human and non-human) realms but conceives them to be constitutively entangled (Orlikowski, 2007). The idea of interactive agency typically starts from a notion of independently existing entities with inherent ‘social’ and ‘material’ characteristics. This notion also presumes that individual agencies precede their interactions. In contrast to this, the sociomaterial approach emphasises the constitution of entangled or distributed agencies that emerge through ‘intra-action’ between human and non-human elements (Barad, 2003, 2007; Blackman & Venn, 2010; Kolehmainen & Juvonen, 2018; Orlikowski, 2007).

In accordance with the sociomaterial understanding of agential power, we understand affect as a bodily response or capacity that becomes actualised in temporally and spatially situated encounters with materialities. These bodies all possess a capacity to affect the constitution of the entangled agencies that emerge through the intra-action between human and non-human elements in Lean management training. From a sociomaterial point of view, this capacity of inanimate artefacts works through their ‘inscripted’ material composition and characteristics (Akrich, 1992), which set the conditions and their usability (Latour, 2005). In other words, the properties of the object suggest the ways it can be used.

To investigate the capitalisation of affects that emerges in the creation of a suitable atmosphere and in participants’ cooperation during Lean training, we identify how in line with post-Fordist argumentation managing people’s social relations becomes a source of value. However, we look at how capital emerges not only as a social relation (Hardt & Negri, 2009, p. 136), but as a sociomaterial relation of bodies. Furthermore, we share the assumption that capitalist production relies on people’s collective activity (Hardt & Negri, 2009, p. viii). Thus, we see intellectual, communicative and affective (team)work as produced in loosely orchestrated human encounters, instead of through the top-down control of workers (Hardt & Negri, 2009). In today’s biocapitalism, value lies in ‘the relational resources of subjects, and in their ability to activate social links’ (Morini & Fumagalli, 2010, p. 236). In reference to these ideas about cooperation and social relations, we consider that current management trends such as Lean resonate with biocapitalist production in that they promote flat organisation, soft skills, and loose encounters between human and non-human actors, instead of hierarchical and siloed ways of managing people, organisations, spaces and materialities.

Investigating sociomaterial entanglements through ethnographic methods

The data analysed for this article is part of a larger Lean production in public services: New formations of work and gender in biocapitalism project. Our analysis is based on ethnographic fieldwork conducted at a two-day Lean workshop in 2019. The Lean workshop we attended was designed for healthcare professionals and middle managers in public and private healthcare organisations. While we were not the target group, the organisers welcomed us as paying participants in the workshop after we contacted them and introduced ourselves as working-life researchers exploring the implementation of Lean in healthcare services. The workshop organiser was a Finnish event management company whose business focuses on providing and organising various types of training, lectures and workshops concerning the ‘rapid changes’ in contemporary working life.

An experienced male and female consultant each led one day of the workshop. In addition to the four researchers and the Lean consultants, there were ten other participants. The healthcare sector is highly female-dominated. Consequently, most of the attendees were women aged between thirty and fifty-five years. The participants worked in mid-level managerial positions or in employee positions in private and public healthcare organisations. There were both differences and similarities among the attendees’ interests in the workshop. Two female nurses, for instance, had been sent by their supervisor to gain inspiration for a thesis about well-being at work. During a coffee break another attendee told us, ‘Finally I heard something that makes sense’, adding that her colleagues resisted all change. A woman from occupational health services said that while she had always been into development, her management was not committed to Lean. Therefore, she herself had asked to take part in the workshop, to pave the way for Lean in her workplace. A few others told us their workplaces were currently being ‘Leaned’ from top to bottom, so they wanted to learn more about it. Overall, the workshop seemed to be a ‘hot ticket’ for the attendees; they were not just learning the basics of Lean but were also expected to share their embodied Lean experience in their workplaces afterwards, and to help their organisations implement the Lean philosophy.

Our own position as researchers doubtless generated various thoughts and feelings among the other workshop participants. At the beginning of the workshop, one of us introduced our group as (academic) working-life researchers who were investigating the introduction and implementation of Lean in social and healthcare services. The consultant said: ‘It is nice to have researchers here […]. There are numerous good examples about Lean, but their effectiveness has not necessarily been confirmed by science’. We received similar comments from him during a break, when the attendees and consultant alike asked curiously when they would be able read our results. They seemed a little disappointed when we explained the slowness of the academic publication process. Thus, to some extent we felt that our presence as researchers at the workshop was expected to sanction Lean in some way. Moreover, although the consultants were polite to us, our relationship with one of them was somewhat strained and uncertain. For instance, when he asked whether anyone was familiar with the Lean literature or the concepts he introduced, we often raised our hands, which he acknowledged with humorous remarks about academic learning. Thus, our presence might have placed his professional authority at risk, although we did not actively question his viewpoint during the workshop. Our relationship with the other attendees was friendlier and chattier. When we asked about their work and previous Lean experience during the breaks, they were very willing to share their thoughts and feelings. We pondered whether our position as working-life researchers fostered this dialogue and encouraged them to talk openly about ‘how things really were’. Since there was no rivalry – professional or otherwise – between the other attendees and us, neither side had to worry about saving face in front of the other – unlike our position with the consultants. Moreover, the easy-going atmosphere among the participants was due not least to the compelling practical exercise we carried out at the beginning of the first day (discussed below).

While affects are the main theoretical underpinning of our conceptual approach to Lean, the ambivalences we detected in how affects were put to work during the workshop further increased our interest in them during the analysis (see also Katila et al., 2019; Kolehmainen, 2019). Our discussions and field notes from the training course indicated that the consultants had tried to create a positive atmosphere and a hopeful feeling around the new management model (see Thedvall, 2017). They did this by repeatedly emphasising that the application of Lean thinking was not ‘rocket science’ and that anyone could apply ‘common-sense’ solutions to (re)organise their own work. We became interested in mapping the ways in which affects occurred in the sociomaterial setting and how they were mobilised through the idea of Lean as common sense.

Because we took the role of active participants in the workshop (Wadel, 2015), the data and knowledge production process foregrounded our own bodily doings, our responses, and the embodied experiences of affecting and being affected as researchers (see also Kolehmainen, 2019). In line with Kolehmainen (2019), we think that by engaging in field practices a researcher can sense and experience affects on-site through the entanglement of their body with other non-human or human bodies. In this regard, our methodological choice to perform the role of active participants took inspiration from affective ethnography, which Gherardi (2019) defines as ‘a style of performative ethnographic process that relies on the researcher’s capacity to affect and be affected in order to produce interpretations that may transform the things that they interpret’ (p. 742). Affective ethnography shifts the locus of knowledge production from after-the-event narratives to ‘the social as it happens’, which enables an exploration of affective enactments themselves rather than their descriptions (Kolehmainen, 2019, p. 46). While there is nothing new per se in using the researcher’s body and embodied experience as a resource for ‘knowing’ in the ethnographic research process (Coffey, 1999; Ortner, 2006), feeling the atmosphere in the field in affective ethnography shifts the focus from ethnographic ‘knowing’ to relating and experiencing (Kolehmainen, 2019, p. 46).

Our empirical analysis is based on ethnographic field notes produced by four researchers. Our conduct while making field notes was guided by the question of how affects occurred: how they were mobilised and co-produced within and through the sociomaterial entanglements of the Lean workshop to legitimate the necessity of Lean thinking. When making field notes, we paid attention to how human actions and materiality were entangled, and how affective sensations were evoked by those entanglements. In practice this meant that we focused on the material aspects of the workshop venue and the embodied activities, feelings, moods, gestures and body movements of the workshop participants, including ourselves. We also paid attention to how sociomaterial entanglements and affective sensations intensified attendees’ attachment to Lean. In terms of our analytical focus on common sense, it is critical to stress that most of the workshop attendees were at the beginning of their ‘Lean journey’, given that their prior knowledge of Lean was scarce. The fact that this workshop focused on the basics of Lean might be one reason why the theme of common sense emerged so pervasively.

Making Lean common-sensible

We present the results of our analysis in two subsections. In the first subsection, we demonstrate how affective atmosphere emerged through sociomaterial settings, and how collective (common) sense-making was applied during the workshop. In the second subsection, we focus on a specific Lean exercise (the tennis ball game), and we show how affects became capitalised through the entanglement of sensing human bodies, material equipment, space, social norms, and ideological and cultural discourses while we played the game.

Collective (common) sense-making of Lean

The workshop began with the consultant telling us that Lean had been applied in several fields, including theatre and even nature conservation, after which he encouraged us to ‘ponder throughout the workshop whether Lean makes sense’. Lean was introduced less as an extraordinary management model and more as a means to do things in a common-sense way. In this subsection, we show how the consultants, participants, affects and sociomateriality assembled in a collective (common) sense-making of Lean during the workshop.

Firstly, since the participants were unfamiliar to each other, an easy-going and comfortable affective atmosphere was required to help them adapt, accept challenges, and prepare to play Lean games. As the attendees did not all share the same profession or position, it also made sense to use the general notion of sense-making as a starting point for them to learn Lean. The affective atmosphere of common sense was contained and produced by the specific materiality and space surrounding us, which came to circulate the social practices and encounters situated within the Lean workshop (cf. Gherardi, 2019). In line with grand start-up entrepreneur events such as Slush (cf. Katila et al., 2019), visually we had expected something extraordinary, or at least some pizzazz around the Lean workshop. However, the workshop was arranged in an ordinary seminar room appropriate to the size of the group: the room was about sixty square metres, and there were only as many chairs and desks as there were attendees. The result was that participants were forced to sit close to each other. The tables in the seminar room were grouped together to invite us to form teams. The workshop began with a round of introductions, to break the ice and help us gel. Thus, the space became an active force that generated affects through its sociomateriality, which transformed us from individuals into a group (Beyes & Steyaert, 2011, p. 56). Moreover, the lunch and coffee breaks were held just outside the seminar room, keeping us together throughout the whole two days.

Secondly, the consultants and their chosen styles played a crucial role in making Lean common-sensible. This is in line with observations by Kantola (2014, p. 261), who states that in congruence with structural changes, management consultants have become central mediators in the circuit of contemporary capitalism. In particular, the male consultant who started the workshop softened the ‘new’ doctrines by explaining that the idea was not to challenge the participants’ professional knowledge. Instead, he emphasised that Lean was a way to demolish hierarchies between professions, thus influencing relations between professional groups rather than individual workers’ knowledge per se. Moreover, the common sense and ordinariness of the examples used, sprinkled with the low-key humour of both consultants, made for a relaxed atmosphere where the benefits of Lean could be introduced. However, since many Lean textbooks emphasise the scientific thinking behind Lean, this common-sense tone came as a surprise to us. The tone was highlighted when Lean methods were introduced with reference to everyday life outside the work environment. The following example shows how Lean was visualised as common-sensible through the consultant’s (claimed) personal photograph of his messy garage. The photograph was used to demonstrate a popular Lean method called ‘5S’ (Sort, Set in Order, Shine, Standardise, Sustain).

He shows us photos of his cluttered garage full of all kinds of stuff. He then includes a joke which describes people’s bad habit of hoarding belongings: ‘People take anything if they can get it for free, even an enema’. I cannot stop laughing. He then explains how he started cleaning and sorting by taking everything out. He demonstrates this to us by showing different items, such as a golf bag, while asking us with a twinkle in his eye if he needs this or that item. He continues by explaining where most of the stuff went: some he sold, some old Lego he gave to his grandchildren, etc. One person in the audience notes that this reminds her of Konmari. ‘Yeah, there are many similar elements, the Japanese [organizing consultant Marie] Kondo took advantage of the 5S’, the consultant responds. However, he quickly adds that 5S is not a cleaning programme, but 5S is used to get rid of waste, and one should apply it constantly. (Field notes, 2019)

The photographs of the consultant’s personal items represented familiarity, thereby acting as ‘a concrete anchor’ to everyday life (Herranen & Vaden, 2017, p. 49), and as a mediator between the consultant, the participants and the ‘new’ management model – and even the fashionable Konmari method of lifestyle organising. This was crucial in maintaining an active, excited affective atmosphere (see also Thedvall, 2017). By responding to and supporting the flow orchestrated by the consultant, participants not only verified the idea of Lean as common-sensible but also began to look at their own everyday lives through Lean lenses. This example demonstrates that participants’ embodied knowledge and experience of the mundane were evoked through visualised anchors of common sense that had little to do with the workshop’s mission of healthcare management reform. Moreover, in Finnish debates about the value of public goods such as health services, modes of argumentation and justification often highlight efficiency and technical expertise. According to Ylä-Anttila and Luhtakallio (2016), this matter-of-fact, hands-on notion of worth is widely culturally shared in Finland. In this light, it is understandable that an order of worth that values planning that leads to efficiency – as in the example of ‘Leaning up’ one’s garage using the 5S method – would be attractive to an audience of Finnish healthcare professionals.

In some cases, as with the enema joke mentioned earlier, the references to everyday life were so unsophisticated and racy that the consultant was probably taking a risk in terms of keeping the atmosphere pleasant. However, the humour he intertwined with his stories, and the laughter that came out of it, made the examples memorable and powerful in an affective sense. Participants’ spontaneous and positive responses to the jokes intensified and supported the collective sense-making of Lean. Furthermore, the jokes revealed that affect works not only as a force (Seigworth & Gregg, 2010, p. 2), but also as an ‘excess to the practices of the ‘speaking subject’’ (Blackman & Venn, 2010, p. 15).

However, there were moments when one of the consultants did not reply to attendees’ questions or critical remarks but quickly diverted the focus elsewhere. We began to wonder whether the atmosphere was actually too easy-going and uncritical, leaving health and social care professionals without proper answers to their important questions. This kept the Lean consultants and their expertise intact, enabling them to orchestrate an atmosphere where we felt we were making sense of Lean together as a collective, without an explicit authority figure. It demonstrated the Lean idea of team-based leadership in practice; it also demonstrated the capitalist mode of production that relies on the collective activity of people (Hardt & Negri, 2009, p. viii). The somewhat peculiar collective endeavour of affirming Lean’s common-sensibility was put to the test in a more intense way in the exercise discussed below.

Common sense put to work: Feeling, sensing and learning through sociomaterial cooperation

After showing us a few introductory slides on ‘why Lean?’, ‘what is Lean?’ and ‘the Lean success story’, the consultant asked us to move on to the first practical Lean exercise of the day. The exercise dealt with the streamlining of workflow, which is the underlying idea in Lean thinking. First, we were randomly divided into two teams. To generate a sense of togetherness, we were asked to devise our own names for the teams. In one team, a researcher suggested ‘Waste Remover’, but this was rejected: ‘No, Lint Remover is better’, said one woman. People in the group laughed. We interpret this counterproposal as an attempt to translate an abstract Lean concept, ‘waste’, into a common-sense conceptual form: ‘Lint Remover’ (LR) connotes cleaning, which makes it concrete and tangible, closer to participants’ everyday lives. ‘Light’ (L) was the name chosen by the other team. The consultant then picked one woman as an observer whose job was to measure and record L’s performance. The consultant picked himself as the observer for LR. While giving the instructions, the consultant reminded us to ‘be playful and open in the exercise’.

The exercise was meant to illustrate the phases, flows and fluencies of the healthcare service path, and to familiarise participants with the idea of constant improvement. Learning to cooperate as a self-regulating team, however, was probably the most important objective, given that process development and problem-solving are always conceived as collective endeavours in Lean philosophy (Womack & Jones, 1996). The consultant set out the rules and explained the logic of the game. At the beginning of the exercise, each team was given three tennis balls. A tennis ball represented a patient (customer) who was progressing through the service process; each team member represented one function in the healthcare service path. The teams’ task was to figure out how customers’ progress along the healthcare service path could remain as smooth as possible while demand for the service grew. The consultant explained that team members were not allowed to give or throw balls to the person next to them. Every person in the team had to touch each of the three balls at least once before the process was completed. If anyone dropped a ball, this indicated a quality defect, and the whole process of circulating the balls had to restart. We played three rounds altogether, with the lead time (objective) set tighter in each round.

The relational understanding of affect emphasises the importance of intercorporeal relations (Blackman & Venn, 2010; Seyfert, 2012). This directs attention not only to relations between bodies, but also to encounters between bodies, things, technologies, spaces and infrastructures in different configurations (Katila et al., 2019; Kolehmainen & Juvonen, 2018, p. 5). We could sense the excitement in our bodies, and consequently in the seminar room atmosphere, as we transformed from relatively passive observers sitting behind desks into competitive team players who had to get fully involved. To play the game successfully, team members had to find the appropriate distance between each other’s bodies. The tennis balls were not just passive tools to be used in the game after the bodies were assembled; through their ‘inscripted’ design (Akrich, 1992), the balls were constitutive of the appropriate distance (cf. Orlikowski & Scott, 2008, p. 445). If team members’ bodies were too far apart, the circulation of the three balls became relatively slow; if too close, the pace of circulation accelerated, increasing the risk of dropping or fumbling a ball. The teams effectively formed a sociomaterial organism in which the movements of participants’ bodies and minds, the tennis balls, the given rules, and the shared cultural understanding of a ‘game’ were synchronised together.

Playing the game was an effective way to produce a sense of intimacy and affinity among people who were unknown to each other. Unlike when we were observing each other from behind our desks, during the game we had no time to assess one another based on our professional positions, titles or backgrounds; instead, we became acquainted through our immediate intercorporeal and sociomaterial relatedness. We could sense in and through our excited bodies how tension was released and energy started to flow from the moment we formed a circle and began to throw and catch the balls: people began to smile, made comments on their throws, swore or laughed if they failed to catch the ball, and spurred and guided each other about how to throw. As one researcher wrote immediately before and after the exercise: ‘I am so nervous already because I cannot perceive these kinds of things. […] Well, this was more fun than I thought, and there is a good bonding effect as well’. Although we were supposed to imagine that we were improving processes in healthcare, playing the game did not require any specific occupational expertise or profound analytical understanding of healthcare processes. On the contrary, adopting too analytical a form of context-based thinking would have hindered the spontaneous joy and playfulness. The substance of healthcare vanished; having an able body and adopting a playful, social and cooperative attitude was enough to practice Lean.

To imitate Lean practices, the results – the time to completion and the number of defects – were written on a whiteboard after every round, so the performances of both teams became visible and comparable. Affective intensity subsided in the seminar room and suspense increased just before the consultant announced the results. Everyone awaited the verdict in silence. In the first two rounds, L was faster but had more defects (dropped more balls). The consultant went through the results: ‘As you can see, the more time pressure grows, the more stress and defects in terms of quality’. People nodded in agreement: the numbers confirmed our embodied experience. While the members of LR had complimented each other on their ‘good job’ immediately after the performance (they had dropped a ball only once), their good humour gave way to seriousness when they realised they had lost in terms of lead time. One woman, the most talkative member of LR, complained that they should have stood closer to each other; another blamed herself for fumbling the balls. The measurement of the practices and the visualisation of the results not only changed the experience of the performance (cf. Espeland & Sauder, 2007), but also oriented LR’s attitude and energy towards the next round. The most talkative LR member lifted the mood by grinning at a member of L (apparently they knew each other), while others urged each other on with phrases such as ‘now we have to focus’ and ‘let’s beat them’.

For the final round, the consultant increased the intensity even further. He brought some ‘hard economic realism’ into the game by drawing on popular beliefs about the workings of the (neoliberal) capitalist system: ‘[A] rival company perform the process in two seconds, and employees are worrying if they [will] have jobs in the future at all […]. There must be something wrong in the work process, you know your work, fix this’. For a moment, participants in both teams looked stumped, since the objective sounded impossible. However, LR quickly figured out that although the objective could not be reached by using tennis balls in a conventional way, the balls – as one woman suggested – could be set on an empty table in the seminar room. The next problem was that the tennis balls did not remain still but started to roll; the woman realised she could use her scarf as a prop to tie the balls together on the table. Then we transcended the boundaries of our individual bodies by coming so close to the table and the balls that we all touched. We leaned forwards on our elbows so that everyone could touch the tennis balls at the same time. After we had practised a few times, the consultant came to measure our performance, and we managed to perform the task in under two seconds. Hearing the words ‘one point six seconds’ felt so good that we almost hugged each other. This peak in our affective sensation was thanks largely to the consultant’s orchestration of the exercise through the competitive practices of measuring and recording our performance. Sensing the presence of the observer, and seeing the results displayed on a whiteboard for comparison after each round, increased the intensity and evoked a sense of goal-oriented teamwork, effectiveness, competition and ambition to improve the team’s performance in the next round.

The scenario just discussed illustrates how the social meaning and affordance of a single ordinary material object, such as a tennis ball or a scarf, varies with and depends upon the whole sociomaterial configuration in which it is employed. While non-humans have agential power (Barad, 2003), they do not determine the course of action in any straightforward way, because there is considerable scope for interpretative flexibility in every situation (Pinch & Bijker, 1987, p. 40). People were creative during the tennis ball game, but this creativity did not emerge through an encounter with expert knowledge; rather, it emerged through a spontaneous common-sense perception of the situation. Both teams’ discoveries of practical solutions were structured by common-sense thinking, albeit differently: while LR were able to use their bodies, the tennis balls, a table and a scarf – ‘concrete anchors’ of the common sense (Herranen & Vaden, 2017, p. 49) – in a new and creative manner, L could not get beyond a common-sense understanding of the use of the tennis balls. When the solution was demonstrated to L, they appeared a little puzzled. As one researcher who was an L team member wrote in her field notes: ‘While the exercise was compelling, I was annoyed by the unclarity of the rules’. This comment underlines the affective sensations evoked by the sociomaterial entanglement of a silly game.

After the practical part of exercise, we returned to our seats. The consultant unpacked the exercise by asking about the preconditions for success in the game. ‘Experiment in practice’ was his response. He explained that LR would not have accomplished the task if they had simply discussed it; they had succeeded because they had the courage to experiment. ‘What else, what motivates you?’ he continued. ‘We had a goal’, one person answered. ‘Yes!’ the consultant said enthusiastically, and he explained that there is often a lot of juggling of tasks in the public (healthcare) sector because the actors do not have a goal. Affective power was mobilised here through the common-sense discourse and ideological belief that the inefficient public sector needs a Lean solution. Then the consultant introduced a third condition: he remarked that it is impossible to improve a performance and move in the right direction unless one measures that performance. All of the points the consultant made were hard to resist, as they resonated extremely well with our embodied experiences from the game. Most of the participants, including us, just nodded and wrote down his points. Thus, we see that the strategy for introducing and promoting Lean was affective and impressively constructed: our embodied affective experiences, which had emerged through sociomaterial cooperation and common-sense perceptions while we played the game, were exploited by the consultant to legitimate his argument for Lean and its necessity in healthcare. However, the arguments that promoted Lean were very general, and made no contextual references other than popular discourses about queues and inefficiency in public healthcare. To position Lean in the context of the complex workings of (public) healthcare, or to problematise the credibility of the exercise from the perspective of healthcare professionals, would have been an absolute killjoy in this situation, which hinged on the spontaneous use of general human capabilities and the finding of common-sense solutions to play the game efficiently. The service process we were supposed to be imitating could have been taken from almost any occupational sector, and the healthcare professionals who participated could have been substituted by participants from almost any other profession.

Concluding remarks

In this article, we have shown that Lean training exemplifies a complex mechanism of biocapitalist production in which people’s cognition, feelings, sensitivities and experiences are transformed into tools of labour and put to work through affective sociomaterialities. Previous studies on the atmospheres of training courses and events have demonstrated how affective intensities are created through extravagant performances of affects (Kolehmainen & Mäkinen, 2019, p. 455), by using flamboyant and splashy effects (Katila et al., 2019), or by creating an atmosphere of hope (Thedvall, 2017). In contrast to these studies, our case shows that Lean methods were introduced in the workshop as ordinary and folksy (see also McCann et al., 2015), and were practised in a common-sense manner tied to sociomateriality, the affectivity of common sense and the banality of the everyday.

The first part of our analysis showed that the consultants’ styles, the sociomaterial setting, the role of participants and the affective atmosphere surrounding the workshop all participated in the collective (common) sense-making of Lean. The feeling of confidence that anyone can learn and use Lean was created by the avoidance of any specific contextualisation in healthcare. Instead, the consultants directed attendees’ senses and feelings towards everyday life, using simple but affective examples that everyone could relate to, and by employing a culturally shared mode of argumentation that highlighted matter-of-fact, hands-on worth and efficiency (Ylä-Anttila & Luhtakallio, 2016). As a consequence, the participants were left to ponder the more specific and complex question of Lean’s applicability to healthcare by themselves. Responsibility for making sense of Lean was distributed to all of us, thereby manifesting both the idea of Lean as a team effort and the nature of biocapitalist production as a collective endeavour.

The second part of our analysis showed how the role of the participants – not as individuals, but as a collective body – became crucial in making Lean common-sensible. We examined how affective flows emerged through participants’ cooperation in the sociomaterial setting of the tennis ball game. We found that the game proved to be particularly efficient in making Lean common-sensible because it took advantage of general human capabilities, such as the abilities to feel and to cooperate with others. The game showed that workshop participants were not passive objects who were simply caught in pre-orchestrated affective practices (Seyfert, 2012). Instead, in and through different embodied configurations with other human and non-human actors, participants actively took part in producing the affective flows and intensities they experienced (see also Kolehmainen & Mäkinen, 2019).

On a more general level, the way people were put to work and found creative solutions through cooperation is a paradigmatic example of the workings of production in contemporary biocapitalism. As Hardt and Negri (2009) put it, ‘intellectual, communicative, and affective means of cooperation are generally created in the productive encounters themselves and cannot be directed from the outside’ (p. 140). However, our analysis showed that productivity and creativity were generated not only through human-to-human relations, but also as a result of more-than-human relations. Thus, the result of our empirical analysis illustrates how capital(ization) emerges not only as a social relation (Hardt & Negri, 2009, p. 136), but in fact as a sociomaterial relation of bodies. In addition, the professional skills and context of healthcare were given less attention in the tennis ball game, leading to a situation where everyone – including we researchers – was encouraged to learn and play as equals. It was precisely this decontextualization – an affective trick – that made Lean feel common-sensible to everyone that participated in the game. References to complex, realistic and context-bound examples might have spoiled the affective atmosphere of common sense, which encouraged participants to be creative with mundane and simple items such as tennis balls and a scarf (see also Thedvall, 2017).

Although at first the visual elements and banal examples used in the workshop to make Lean common-sensible seemed simple and somewhat neutral, the affects became socially and economically charged through figures and popular ideological narratives about the inefficiency of the healthcare sector. The consultants framed Lean as a common-sense solution to avoid the further deterioration of the healthcare sector as a public good. The mode of justification they used to do so rested largely on the culturally shared value attached to rational-functional argumentation that highlights technical expertise and efficiency. This may offer a partial explanation for the widespread popularity that Lean has recently gained in the Finnish public-service sector.

Capturing and operationalising affect is considered to be difficult from a methodological point of view (see Mazzei & McCoy, 2010). By applying affective ethnography (Gherardi, 2019), our study has demonstrated how it is possible to do so. As we did not conduct in-depth interviews with the other participants in the workshop, but instead relied on our own feelings and capacities to affect and become affected by others, we acknowledge that this may have led to an emphasis on the affective approach rather than on the detailed feelings and reflections of the professionals who attended the workshop. However, from a workers’ point of view, our study hints that in consultancy-driven biocapitalism – as Hardt and Negri (2009) put it – ‘workers do not feel they own their capacities for thinking, loving and caring when they are on the job’ (p. 140). Following this line of thought, we argue that in Lean training, participants are persuaded to feel, think and use their capacities, but with the attendant risk that they might become alienated from their professional capacities if their work is discussed through common-sense arguments and banal everyday examples. Nevertheless, by becoming part of corporeal, material and affective entanglements, workers come to learn and embody new ways of managing themselves and maintaining their productive skills.

Finally, because we approached the notion of common sense as an affective source of justification, our focus has not been on ideological debates about common sense (cf. Herranen & Vaden, 2017). Only time will tell whether Lean will replace other management models and modify the way health and social and care workers perceive their everyday work practices by becoming the common-sense way to arrange health and social and care in Finland.

Acknowledgments

The authors would like to thank the two anonymous reviewers for their sophisticated, encouraging and constructive feedback.

Disclosure statement

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

Additional information

Funding

This work was supported by Academy of Finland [grant no SA314935].