City Research Online

Lean in healthcare: The unfilled promise?

Radnor, Z. J., Holweg, M. and Waring, J. (2012). Lean in healthcare: The unfilled promise?. Social Science & Medicine, 74(3), pp. 364-371. doi: 10.1016/j.socscimed.2011.02.011

Abstract

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean ‘tools’, such as ‘kaizen blitz’ and ‘rapid improvement events’, which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the ‘tool level’. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining ‘customer value’ that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily ‘professional’ in origin but actually more ‘organisational’ and ‘managerial’ and, if not addressed could severely constrain Lean’s impact on healthcare productivity at the systems level.

Publication Type: Article
Additional Information: © 2011 Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Publisher Keywords: Efficiency, Lean thinking, Process improvement, Context-dependence
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
R Medicine
R Medicine > RA Public aspects of medicine
Departments: Presidents's Portfolio
URI: http://openaccess.city.ac.uk/id/eprint/20646
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