Beyond the ostensible: an exploration of barriers to lean implementation and sustainability in healthcare

Abstract

The barriers to implement lean have been well researched and have generated consistent results; this study identifies these as ostensible barriers. There is a dearth of research that focuses on understanding the causes of these ostensible barriers. Thus, this study aims to empirically investigate the deeper causes that produce ostensible barriers to implement lean in emergency areas of healthcare. To achieve this aim, the paper draws on rich, qualitative data from four different sources of data, using exploratory case studies as the main approach. Undertaking thematic analysis, six main underlying barriers emerge as the root cause of ostensible barriers. The results suggest that addressing each of the underlying barriers in healthcare is likely to support lean implementation and sustainability, by reducing the impact of restraining forces that come from stakeholders and the public healthcare system.

Real-Time Data Utilization Barriers to Improving Production Performance: An In-depth Case Study Linking Lean Management and Industry 4.0 from a Learning Organization Perspective

“…At first glance, one would expect the existence of a supportive learning environment at the place of manufacture, since operators articulate the presence of psychological safety [58]. Operators feel they can speak up about what is on their mind.…”

Increasing Competitiveness through the Implementation of Lean Management in Healthcare

“…And Van Rossum et al argue that appropriate leadership styles and workforce flexibility are success factors in the transition from technical "lean tools" to the required transformation defined as a hospital culture characterised by increased patient and other stakeholder satisfaction through continuous improvement [59]. Finally, Leite et al analyses the deeper causes that influence the creation of ostensible barriers in healthcare, rather than just focusing on visible elements commonly related to a tools-based approach [60].…”

“…Therefore, these processes are key elements to take into account when offering greater customer satisfaction. In order to maximise value and eliminate waste, processes must be evaluated by accurately specifying the value desired by the user, identifying every step in the process and eliminating non-value-added activities, and making value flow from beginning to end based on the pull of the patient [60]; in the jargon of lean management and kaizen, this involves "Go to Gemba". In this context, the adoption of some Lean tools is useful, particularly, the value stream maps (VSM).…”

Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda

“…A tailored approach to Lean implementation may be necessary in the public sector, as public healthcare institutions are impacted by competing or even contradictory political, regulatory, and commissioning priorities [ 18 ]. Heavy bureaucracy, rigid policies, and regulations often reduce flexibility and complicate Lean implementation [ 13 , 19 ]. Despite these challenges, Lean management has been shown to be feasible in the public hospital settings in many countries across the world [ 21 – 29 ].…”