‘Lean’, new technologies and employment in public health services: employees' experiences in the National Health Service

Abstract

This article considers employees' experiences of a major organisational redesign project, which sought to deploy robotics technologies to improve the performance of National Health Service pharmacy distribution in one part of the UK. The principles of Lean-type approaches partly informed the redesign project, with senior managers seeking to tap the benefits of new technologies to streamline processes, while also arguing that change would bring opportunities for up-skilling and inter-professional collaboration. The project managed to avoid some of the negative consequences for job quality predicted by the critical literature on Lean-type approaches in public services. However, employees' experiences varied, with some reporting new engagement in learning and collaborative service delivery 'nearer the patient', while others complained of fewer opportunities to rotate across a variety of job roles. More fundamentally, employees questioned management's assumption that new technologies and Lean-type approaches are crucial to improved performance and better jobs. For many employees, both performance and job quality were compromised by the 'leanness' of staffing models, which limited opportunities for development and contributed to work intensification. This tension is likely to remain a key theme in employment relations in the UK and beyond for as long as the public sector faces financial austerity.3

Collaborative Innovation, New Technologies, and Work Redesign

“…It is important to emphasize here that work intensification—and the associated stress—was seen as an outcome of inevitably tight deadlines and lean staffing but not as a side effect of inappropriate performance management systems. Deadlines and work targets (which often related to ensuring that the right medicines were prepared for patients upon discharge) were seen as appropriate and in line with the principles of high‐quality patient care (Lindsay et al ).…”

“…We have noted elsewhere that the claims made by managers at the outset of the redesign project—in terms of the inclusion of employees at all levels in decision making—were not fully realized, something acknowledged by managers themselves (Lindsay et al ). Accordingly, their role may be seen as more closely aligned with the principles of NPM‐driven innovation—applying technology‐driven solutions to drive down costs and seeking the compliance of “lean teams” within employee groups.…”

“…NPM themes around cost control and standardizing and quantifying performance were clearly reflected in the underlying business case for the redesign. Finally, the imposition of lean staffing and processes were a consistent source of tension between staff and managers involved in the redesign (Lindsay et al ). Nevertheless, as we see, many of the roles, behaviors, and practices that made the redesign project work digressed from NPM norms and were more representative of collaborative innovation as discussed earlier.…”

Analysis of the lean healthcare utilization in the context of pharmaceutical services

“…LH foi indicada como uma ajuda significativa para alcançar tais objetivos (Hlubocky et al, 2013). No Reino Unido, o Serviço Nacional de Saúde (NHS -National Health Service) incentiva a incorporação de ferramentas como o mapeamento do fluxo de valor (MFV) nas unidades do NHS, incluindo as farmácias (Lindsay et al, 2014;NHS, 2018) Dois estudos foram realizados no Brasil. O primeiro (Costa et al, 2015) avaliou cinco setores de dois hospitais brasileiros que implantaram os conceitos de LH em suas operações.…”

Teamworking and Lean revisited: a reply to Carter et al.

“…It also seems that our non-inclusion of these references comes as much more of a shock and an affront to Carter et al than (Cullinane et al, 2014) contained two, two articles (Bouville and Alis, 2014;Thirkell and Ashman, 2014) contained one each, and three (Lindsay et al, 2014;Sparrow and Otaye-Ebede, 2014;Stanton et al 2014 et al, 1999) is cited as many as three times, only one (Stewart et al, 2009) has two citations, two items (Mehri, 2006;Sprigg and Jackson, 2006) have just one citation each, and the other four (Danford, 1999;Delbridge, 1998;Lewchuk andRobertson, 1997, Sprigg et al, 2007) provide no real account of how consideration of the 'omitted' references might contribute to this. They describe the ways in which they claim that this literature portrays lean teams (Carter et al, 2015: 4), but provide no specific references to back this up.…”