Derived from studies of the Toyota Production System, the concept of Lean has been credited with universal applicability across all sectors from manufacturing to service, and in public and private sectors. Since 2001, Lean has progressively been adopted by healthcare organisations in various ways, for various reasons and to various degrees of success. Despite the promise of Lean to enhance quality of products and services through the elimination of non-value-adding activity, and thereby a reduction of overall cost, many organisations who attempt to adopt Lean, fail to successfully implement and subsequently fail to sustain Lean practices across the organisation.
In healthcare, many reasons for implementation failure exist, from an expectation that Lean will ‘plug the financial gap’ to a lack of engagement from middle managers… ‘A manager’s focus is compliance’ ‘are we hitting our targets; are we doing what is expected of us?’, and resistance from clinical professionals: ‘we’re not Toyota and we don’t make cars’ and ‘we’ve been doing this for years, if there was a better way don’t you think we would have done it by now?’
A few healthcare organisations have been successful at implementing Lean across the organisation and even reaching beyond the organisational boundaries to primary and tertiary services. Sustainability, however, appears vulnerable to shifts in the political and financial context. My recent research (2016) reveals how sudden changes in the political and/or financial context of healthcare organisations can quickly derail even the most prolific of Lean implementations. So, how can organisations adopting Lean sustain implementation and mitigate the effects of a fast moving political and fiscal context?
At a more micro level, the power base of professional workers remains a crucial factor in the adoption of new management practice and the implementation of new ways of working. The capacity of professionals to influence the fate of implementing change programmes per se is significant and presents an important area for research. Research is needed to understand how we might mitigate such barriers to Lean implementation and sustainability of Lean within professional contexts to realise an organisation-wide service improvement effect.