This article analyses a process improvement project based on Lean Six Sigma (LSS) techniques in the emergency department (ED) of a large Australian hospital. We consider perspectives of the clinical and managerial staff involved in the project implementation, its implications for empowerment and work intensification. We find that the project appeared to improve patient flow from the ED to the wards and to have positive implications for some staff. However, these achievements tended to be the result of senior staff using the project to leverage resources and create desirable outcomes, rather than the result of the use of LSS, in particular. We found some evidence of work intensification, but this was attributable to wider systemic issues and budget constraints, rather than being a direct consequence of the use of LSS. We argue that translating LSS from a manufacturing context into the politicised and professionalised context of healthcare changes the usual questions about empowerment or work intensification to questions about the influences of powerful stakeholders.

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This paper investigates the role of medical professionals in the success and longevity of the implementation of workplace innovation and organizational change in the Accident and Emergency (A&E) Departments of two large public hospitals, in Australia and Canada, during the introduction of process improvement using Lean Management (LM) methodologies. We ask why and how doctors resist, influence or enable LM initiatives in healthcare. Using a qualitative methodology, we contribute to institutional work theory by unpacking the complex forms of boundary and practice work undertaken by key actors who effectively use their professional status and power to enable practice changes to be embedded. Our findings lend support to the importance of the involvement and ownership of senior doctors in the design, introduction and implementation of successful workplace innovation and organizational change. Senior doctors use their professional expertise, positional and political power at the industry, organization and workplace levels to influence strategically the use of resources designated for workplace innovation to improve efficiencies, quality of patient care and maintain their dominance. The significant organizational change achieved reflected the ownership and leadership of the workplace innovation by senior doctors in ‘hybrid roles’ who captured the rhetoric and minimized adversarialism among key stakeholders.

PHYSICAL REVIEW LETTERS 21 FEBRUARY 1972 critical point. Several other related examples will be reported in a separate paper 6 with detailed arguments on the above models. [As should be the case, spin correlations obtained exactly in the model (1) satisfy Griffiths-Kelly-Sherman inequalities 7 for J k ^ 0 and J k ' ^ 0.] 1 R.The weak 0-delayed proton emitter 23 A1, with a half-life of 470±30 msec, was produced by the reaction 24 Mg(/>,2w) 23 Al. We observed delayed protons with a center-of-mass energy of 870 ± 30 keV and a maximum production cross section ^ 220 nb.

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