Conclusions about implementing the management concept lean in healthcare are contradictory and longitudinal studies are scarce. In particular, little is known of how working conditions contribute to the sustainability of lean in healthcare. The aim of this article is to identify to what extent lean tools (visual follow-up boards, standardised work, 5S [housekeeping], and value stream mapping [VSM]) promote working conditions for employees and managers in healthcare organisations (outcomes: engagement in development, job satisfaction and exhaustion), while considering the context (i.e., job resources and job demands) and aspects of the implementation process. A longitudinal quantitative study was conducted that involved employees and managers in two hospitals and one municipality (n = 448). Applying the job demands-resources model, multiple linear regression models were used. VSM, standardised work and 5S promoted employees and managers’ working conditions when supported by job resources. When no support was provided, visual follow-up boards were inhibiting employees and managers’ job satisfaction. VSM and standardised work were seen as central lean tools. In this sample, the application of lean cannot be considered sustainable as employees and managers’ working conditions deteriorated under the implementation of lean.
Purpose – This paper aims to identify conditions affecting sustainability of Lean implementations in Swedish psychiatric healthcare, from a socio-technical perspective. Design/methodology/approach – Longitudinal focus group interviews were conducted with 24 first-line managers within Swedish psychiatric healthcare. The analysis was made using Cherns’ ten socio-technical principles and a framework for sustainable development work in healthcare. Findings – The most critical socio-technical principles for a sustainable Lean implementation were boundary location; power and authority; and compatibility. At hospital level, socio-technical principles were inhibited by the weak ownership of the Lean implementation. However, strong ownership at division level meant the same principles were supported. Unclear goals made follow-ups difficult which had negative effects on the learning processes in the Lean implementation. The role and responsibility of first-line managers were unclear in that they perceived they lacked power and authority resulting in negative effects on the participation – an important sustainability concept. Originality/value – Empirically based papers assessing Lean implementations in psychiatry are rare. This study is a contribution to the research area of sustainable Lean implementations in healthcare. The practical implication of this study is that decision makers, senior managers, first-line managers and psychiatrists can be supported in reaching sustainable implementations of Lean.
Lean is a management concept that has been implemented in different sectors. This study expands upon lean tools and innovation enabling job resources. Three public sector entities in Sweden participated in a longitudinal quantitative study. Idea generation and idea implementation, as individual innovation, were analyzed. 5S and value stream mapping facilitated employee individual innovation. Hence, these lean tools are considered job resources for such innovation in the initial phase of implementing lean. After controlling for the lean context, job resources and job demands, visual follow‐up boards and standardized work had no significant influence upon individual innovation, while development resources and information as participation promoted individual innovation. These results add to the knowledge of methods and resources promoting individual innovation when initiating a lean implementation.
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