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Lean healthcare: Rhetoric, ritual and resistance

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  • Waring, Justin J.
  • Bishop, Simon

Abstract

This paper presents an ethnographic account of the implementation of Lean service redesign methodologies in one UK NHS hospital operating department. It is suggested that this popular management 'technology', with its emphasis on creating value streams and reducing waste, has the potential to transform the social organisation of healthcare work. The paper locates Lean healthcare within wider debates related to the standardisation of clinical practice, the re-configuration of occupational boundaries and the stratification of clinical communities. Drawing on the 'technologies-in-practice' perspective the study is attentive to the interaction of both the intent to transform work and the response of clinicians to this intent as an ongoing and situated social practice. In developing this analysis this article explores three dimensions of social practice to consider the way Lean is interpreted and articulated (rhetoric), enacted in social practice (ritual), and experienced in the context of prevailing lines of power (resistance). Through these interlinked analytical lenses the paper suggests the interaction of Lean and clinical practice remains contingent and open to negotiation. In particular, Lean follows in a line of service improvements that bring to the fore tensions between clinicians and service leaders around the social organisation of healthcare work. The paper concludes that Lean might not be the easy remedy for making both efficiency and effectiveness improvements in healthcare.

Suggested Citation

  • Waring, Justin J. & Bishop, Simon, 2010. "Lean healthcare: Rhetoric, ritual and resistance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1332-1340, October.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:7:p:1332-1340
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    References listed on IDEAS

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    2. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
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    Cited by:

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    2. Carlotta Patrone & Lucia Cassettari & Francesca Giovannini & Isabella Cevasco, 2018. "La realizzazione di una metodologia per la misurazione delle performance dei coordinatori infermieristici in un ospedale per intensit? di cura di alta specializzazione attraverso l?approccio del PDCA," MECOSAN, FrancoAngeli Editore, vol. 2018(106), pages 111-127.
    3. Lukas D. Filser & Fábio Francisco Silva & Otávio José Oliveira, 2017. "State of research and future research tendencies in lean healthcare: a bibliometric analysis," Scientometrics, Springer;Akadémiai Kiadó, vol. 112(2), pages 799-816, August.
    4. Sara A. Kreindler, 2016. "What if implementation is not the problem? Exploring the missing links between knowledge and action," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(2), pages 208-226, April.
    5. Radnor, Zoe J. & Holweg, Matthias & Waring, Justin, 2012. "Lean in healthcare: The unfilled promise?," Social Science & Medicine, Elsevier, vol. 74(3), pages 364-371.
    6. Luana Bonome Message Costa & Moacir Godinho Filho & Antonio Freitas Rentes & Thiago Moreno Bertani & Ronaldo Mardegan, 2017. "Lean healthcare in developing countries: evidence from Brazilian hospitals," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 99-120, January.
    7. Jacopo Guercini & Vincenzo Mezzatesta & Andrea Chiarini & Caterina Bianciardi & Lucia Bellandi & Sara Moi & Pasquale Biandolino, 2016. "Applicazione della metodologia SMED per il miglioramento delle operations nelle sale operatorie. Il caso Azienda Ospedaliera Universitaria Senese," MECOSAN, FrancoAngeli Editore, vol. 2016(98), pages 83-103.
    8. Federica Centauri & Marta Marsilio & Stefano Villa & Francesco Nicosia, 2016. "Implementare il modello Lean nelle organizzazioni sanitarie: il caso dell?Ospedale Galliera," MECOSAN, FrancoAngeli Editore, vol. 2016(100), pages 27-55.
    9. MacIntosh, Robert & Beech, Nic & Martin, Graeme, 2012. "Dialogues and dialetics: Limits to clinician–manager interaction in healthcare organizations," Social Science & Medicine, Elsevier, vol. 74(3), pages 332-339.
    10. Douglas Martin, 2018. "Lean in a cold fiscal climate: the public sector in an age of reduced resources," Public Money & Management, Taylor & Francis Journals, vol. 38(1), pages 29-36, January.
    11. Anand Chand & Suwastika Naidu, 2017. "Health Care Service Quality and Availability of Skilled Health Workforce: A Panel Data Modelling of the UK, USA and Israel," Modern Applied Science, Canadian Center of Science and Education, vol. 11(10), pages 152-152, October.
    12. Elizabeth Quinlan & Susan Robertson & Ann-Marie Urban & Isobel M Findlay & Beth Bilson, 2020. "Ameliorating Workplace Harassment among Direct Caregivers in Canada’s Healthcare System: A Theatre-Based Intervention," Work, Employment & Society, British Sociological Association, vol. 34(4), pages 626-643, August.
    13. Svensson, Peter O. & Hartmann, Rasmus Koss, 2018. "Policies to promote user innovation: Makerspaces and clinician innovation in Swedish hospitals," Research Policy, Elsevier, vol. 47(1), pages 277-288.
    14. Cynthia Hardy & Vikram Bhakoo & Steve Maguire, 2020. "A New Methodology for Supply Chain Management: Discourse Analysis and its Potential for Theoretical Advancement," Journal of Supply Chain Management, Institute for Supply Management, vol. 56(2), pages 19-35, April.
    15. Jacob DAMMAND & Mads HORLYCK & Thomas Lyngholm JACOBSEN & Rainer LUEG & Rasmus Laygardt RÖCK, 2014. "Lean management in hospitals: Evidence from Denmark," REVISTA ADMINISTRATIE SI MANAGEMENT PUBLIC, Faculty of Administration and Public Management, Academy of Economic Studies, Bucharest, Romania, vol. 2014(23), pages 19-35, December.
    16. Assadej Vanichchinchai, 2021. "Assessing lean satisfaction and its enablers: a care provider perspective," Operations Management Research, Springer, vol. 14(1), pages 95-106, June.
    17. Huay Ling Tay & Prakash J. Singh & Vikram Bhakoo & Shahid Al-Balushi, 2017. "Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects," Operations Management Research, Springer, vol. 10(3), pages 118-136, December.
    18. Pedersen, Kirstine Zinck & Roelsgaard Obling, Anne, 2020. "‘It's all about time’: Temporal effects of cancer pathway introduction in treatment and care," Social Science & Medicine, Elsevier, vol. 246(C).
    19. Nurul Fadly Habidin & Nurul Aifaa Shazali & Naimah Ali & Nur Afni Khaidir & Osman Jusoh, 2016. "The impact of lean healthcare practice on healthcare performance: the mediating role of supply chain innovation in Malaysian healthcare industry," International Journal of Critical Accounting, Inderscience Enterprises Ltd, vol. 8(1), pages 79-93.
    20. Sandra G. Leggat & Pauline Stanton & Greg J. Bamber & Timothy Bartram & Richard Gough & Ruth Ballardie & Kathy GermAnn & Amrik Sohal, 2018. ": 4P recommendations for implementing change, from research in hospitals," Public Money & Management, Taylor & Francis Journals, vol. 38(1), pages 45-50, January.
    21. Akmal, Adeel & Podgorodnichenko, Nataliya & Foote, Jeff & Greatbanks, Richard & Stokes, Tim & Gauld, Robin, 2021. "Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers," Health Policy, Elsevier, vol. 125(5), pages 658-664.
    22. Bromley, Elizabeth, 2012. "Building patient-centeredness: Hospital design as an interpretive act," Social Science & Medicine, Elsevier, vol. 75(6), pages 1057-1066.

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