Lean paradox: Can lean influence healthcare?

This paper reports empirical findings concerning the nature of complexities of Lean implementation in two hospital Trusts in the UK. The research is part of a wider project that seeks to understand the extent that improvement methodologies such as Lean can and are being used within hospitals in order to streamline patient flow and overall hospital performance. Burgess et al (2009) reported the extensive use of Lean methodologies in English hospital Trusts but their findings signal the need for a degree of caution about the extent to which Lean is implemented in practice and the corresponding impact that a fragmented approach may have. A number of authors have referred to the pragmatic and fragmented approach to Lean implementation in healthcare resulting at best in pockets of best practice (Young and McClean, 2008; Radnor and Walley, 2008) and at worst having a dysfunctional consequence on the wider patient pathway (Towill and Christopher, 2005; Waldman and Schargel, 2006). This paper presents early findings from our first ‘matched pair’ case studies relating to the nature and complexities of Lean implementation in hospital Trusts. Key tensions of Lean implementation in these hospital Trusts are identified and discussed. Introduction – Context of English Healthcare The English National Health Service (NHS) in its macro context is a publicly funded organisation where there are few markets, customers or prices as would be conventionally understood (McNulty and Ferlie, 2004). Arguably the most universal and comprehensive of public services (Lister, 2008), the macro context of the NHS consists of multiple governance structures, independent monitoring bodies, multiple stakeholders and an abundance of stringent targets. Such high pressured environment against the onset of funding cuts gives rise to an unforgiving competitive environment in which annual performance ratings are freely accessible for all healthcare users to view and judge, with poor performing hospitals frequently persecuted in the popular press. Fillingham (2007)