Casting the lean spell: The promotion, dilution and erosion of lean management in the NHS

Abstract

Lean thinking has recently re-emerged as a fashionable management philosophy, especially in public services. A prescriptive or mainstream literature suggests that lean is rapidly diffusing into public sector environments, providing a much-needed rethink of traditional ways of working and stimulating performance improvements. Our study of the introduction of lean in a large UK public sector hospital challenges this argument. Based on a three-year ethnographic study of how employees make sense of lean ‘adoption’, we describe a process in which lean ideas were initially championed, later diluted and ultimately eroded. While initially functioning as a ‘mechanism of hope’ (Brunsson, 2006) around which legitimacy could be generated for tackling longstanding work problems, over time both ‘sellers’ and ‘buyers’ of the concept mobilized lean in ambiguous ways, to the extent that the notion was rendered somewhat meaningless. Ultimately, our analysis rejects current prescriptive or managerialist discourses on lean while offering support for prior positions that would explain such management fashions in terms of the ‘life cycle of a fad’.

How do managerial techniques evolve over time? The distortion of “facilitation” in healthcare service improvement

“…In our case study, the facilitated intervention progressed from transformation in the first phase of the Programme through customization and loose-coupling at the second phase (when the initial model started to be adapted but its core components were not yet completely lost) to corruption in the third phase, whereby the distorted facilitation approach failed to modify existing roles and power structures in the general practices and was co-opted for producing outcomes prioritized by the most powerful stakeholders. As highlighted by the second and third rounds of data collection, the evolution of a managerial technique is a gradual process, which can be hidden behind the rhetoric pertaining to the initial intervention (also see McCann et al 2015;Waring and Bishop 2010). For instance, the use of terms such as "facilitation", "facilitators" and "improvement teams" lasted well into the corruption stage, when these terms no longer adequately conveyed the essence of the distorted intervention.…”

“…These approaches are often viewed as rational, modern and progressive, enhancing the legitimacy of the adopting organization . Whilst managerial techniques are often enthusiastically embraced by managers and practitioners involved in service improvement, there is a growing body of critical research highlighting the difficulties and unintended consequences of their practical application (Bate and Robert 2002;Dixon-Woods, McNicol, and Martin 2012;Kislov, Wilson, and Boaden 2016;McCann et al 2015;Radnor, Holweg, and Waring 2012).…”

Management Knowledge and Learning in the UK Healthcare Context: Change and Continuity

“…Although a lot is known about how this affects relationships with clinicians (Currie, 1997(Currie, , 2006Davies & Harrison 2003;Hyde 2010), comparatively little is known about how managers in healthcare actually mobilize and utilize management knowledge and what this means for management learning (Ferlie et al, 2012). While some types of codified systems of knowledge do appear to influence management thinking and action Fischer et al, 2015), evidence of their impact on practice is often patchy, implicit and challenged (Hyde et al, 2016;McCann et al, 2015).…”

Sick Leave—A Signal of Unequal Work Organizations? Gender perspectives on work environment and work organizations in the health care sector: a knowledge review

“…From an overall perspective there has been a privatization trend in Swedish health care, with instability and changes to the ownership structures as a consequence, which has erased the borderlines between public and private sectors and affected the work conditions (Kamp et al 2013). On top of this economic recession and the associated demand for efficient, streamlined organizations have led to a constantly increasing pace of working, and in its pursuit of efficiency, the sector has turned to the manufacturing industry's established management concepts such as Lean production (Brännmark and Holden 2012, McCann et al 2015, Sederblad 2013). Health care is also a professional sector with clear hierarchies and a significant gender order (Lindgren 1999).…”