Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading to lacking absorptive capacity (Cohen & Levinthal, 1990) by the professionals within healthcare. The third hypothesis states that the nature of work and work processes in some areas of healthcare represents a significant barrier to successful implementation of lean management in healthcare. The fourth and final hypothesis states that different mind sets and different rationalities between different types of healthcare professionals act as a major barrier for lean management in healthcare. The hypotheses are tested and discussed through four case studies.
Using empirical research from four case studies the paper will continue by discussing these four hypotheses. The cases where followed over a period of one year and the researchers gathered a substantial amount of data concerning the lean implementation processes. Based on an analysis of the case data hypotheses one is rejected whereas hypotheses two, three, and four are supported. The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy are respected, but the tools and concepts within the lean tool-box are adapted to the specific context of healthcare. Some concepts might even be considered inappropriate for healthcare. The key to harvest benefits from lean management lies in the ability to adopt lean in specific areas of healthcare organization where the prerequisites of lean can be satisfied. Finally, it is concluded that there are limits to lean management in healthcare as there are many situations and processes where lean is judged to be unsuited due to the reactive nature of the work.