“…The hospital had worked with a system for quality improvement, kaizen, since 2009. Kaizen is one of the most commonly used approaches in lean methodology (Pettersen, 2009;Radnor, Holweg, & Waring, 2012) and is a structured and participatory approach for continuous improvement (Jacobson, McCoin, Lescallette, Russ, & Slovis, 2009). This approach engages employees in continuous improvement based on the assumption that employees, who are the ones closest to the work processes, are best suited to identify areas that need to be improved and to implement action plans (Ulhassan, von Thiele Schwarz, Westerlund, Sandahl, & Thor, 2015).…”