Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

PurposeScale-ups have a crucial role in our society and economy, are known for their fast growth and high performance and undergo significant organizational change. Research on the organizational elements that ensure scale-ups sustaining high performance is limited. This empirical study aims to investigate the organizational culture in scale-ups using the Competing Values Framework, including the clan, adhocracy, the market, hierarchy cultures and its relation to performance.Design/methodology/approachQuantitative and qualitative data were collected in five scale-ups. Surveys provided data of 116 employees on organizational culture, assessed using the Organizational Culture Assessment Instrument (OCAI) and perceived performance. The aggregate outcomes and performance measures were analyzed using correlation analysis. Interviews were held with ten top managers and mirrored against the quantitative data.FindingsThe results show that top managers and employees have different perspectives on the culture scale-ups are supposed to have. Top managers perceive market culture as more and hierarchy culture as less present in their organizations than employees. The clan and adhocracy culture are positively correlated to performance and are preferred by employees. Market and hierarchy culture types are negatively correlated to performance and are least preferred by employees.Research limitations/implicationsIt enables scale-up leaders to specifically intervene when cultural elements are experienced by employees that will not drive performance and fit the high performance and fast-growing scale-up environment.Originality/valueThis study is the first that showed that organizational-wide surveys, combined with in-depth interviews, are suitable for top managers of scale-ups to diagnose the organizational culture and the effect on the organization's performance.

Purpose Following health-care organisations, many mental health-care organisations nowadays consider starting to work with self-managing teams as their organisation structure. Although the concept could be effective, the way of implementing self-managing teams in an organisation is crucial to achieve sustainable results. Therefore, this paper aims to examine how working with self-managing teams can be implemented successfully in the mental health-care sector where various factors for the successful implementation are distinguished. Design/methodology/approach This qualitative case study is executed by analysing 18 interviews within two self-managing teams in a mental health-care organisation located in the Netherlands. A coding process is executed in two steps. The first step is open coding, to make small summarising notes within each interview section. The second step is refocused coding, where the open codes were collected, categorised and summarised by searching for recurrence and significance. The coding process is made visible within a code tree. This code tree formed the basis for writing the findings. Findings Success factors for the implementation of a self-managing team that resulted from this research are a clear task portfolio division, good relationships within the team and a coaching trajectory with attention for a possible negative past. Originality/value By having used a specific change management model, the Change Competence Model, it can be concluded that a high change capacity will positively influence the success of a self-managing team in the context of a mental health-care organisation.