IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i7p1332-1340.html
   My bibliography  Save this article

Lean healthcare: Rhetoric, ritual and resistance

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00525-3
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. W. Edwards Deming, 2000. "Out of the Crisis," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262541157, December.
    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.
    3. Nathan Proudlove & Claire Moxham & Ruth Boaden, 2008. "Lessons for Lean in Healthcare from Using Six Sigma in the NHS," Public Money & Management, Taylor & Francis Journals, vol. 28(1), pages 27-34, February.
    4. Zoe Radnor & Ruth Boaden, 2008. "Editorial: Lean in Public Services—Panacea or Paradox?," Public Money & Management, Taylor & Francis Journals, vol. 28(1), pages 3-7, February.
    5. Allen, Davina, 2009. "From boundary concept to boundary object: The practice and politics of care pathway development," Social Science & Medicine, Elsevier, vol. 69(3), pages 354-361, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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).
    10. Bromley, Elizabeth, 2012. "Building patient-centeredness: Hospital design as an interpretive act," Social Science & Medicine, Elsevier, vol. 75(6), pages 1057-1066.
    11. Stella Wright & Wilfred McSherry, 2014. "Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(13-14), pages 1866-1876, July.
    12. 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.
    13. 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.
    14. Radnor, Zoe J. & Holweg, Matthias & Waring, Justin, 2012. "Lean in healthcare: The unfilled promise?," Social Science & Medicine, Elsevier, vol. 74(3), pages 364-371.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. Assadej Vanichchinchai, 2021. "Assessing lean satisfaction and its enablers: a care provider perspective," Operations Management Research, Springer, vol. 14(1), pages 95-106, June.
    20. 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.
    21. 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.
    22. 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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Wright, Sarah & Porteous, Mary & Stirling, Diane & Young, Oliver & Gourley, Charlie & Hallowell, Nina, 2019. "Negotiating jurisdictional boundaries in response to new genetic possibilities in breast cancer care: The creation of an ‘oncogenetic taskscape’," Social Science & Medicine, Elsevier, vol. 225(C), pages 26-33.
    2. Malcolm, Dominic & Scott, Andrea, 2011. "Professional relations in sport healthcare: Workplace responses to organisational change," Social Science & Medicine, Elsevier, vol. 72(4), pages 513-520, February.
    3. Avner Engel & Shalom Shachar, 2006. "Measuring and optimizing systems' quality costs and project duration," Systems Engineering, John Wiley & Sons, vol. 9(3), pages 259-280, September.
    4. Jannis Angelis & Anna Häger Glenngård & Henrik Jordahl, 2021. "Management practices and the quality of primary care," Public Money & Management, Taylor & Francis Journals, vol. 41(3), pages 264-271, April.
    5. Iskra Panteleeva, 2013. "Changing roles and behaviour of human resources managers in the industrial businesses," Economic Thought journal, Bulgarian Academy of Sciences - Economic Research Institute, issue 3, pages 82-96.
    6. Scott Victor Valentine, 2010. "The Green Onion: a corporate environmental strategy framework," Corporate Social Responsibility and Environmental Management, John Wiley & Sons, vol. 17(5), pages 284-298, September.
    7. Cam Caldwell & Rolf Dixon & Larry Floyd & Joe Chaudoin & Jonathan Post & Gaynor Cheokas, 2012. "Transformative Leadership: Achieving Unparalleled Excellence," Journal of Business Ethics, Springer, vol. 109(2), pages 175-187, August.
    8. Cupit, Caroline, 2022. "Public health in the making: Dietary innovators and their on-the-job sociology," Social Science & Medicine, Elsevier, vol. 305(C).
    9. Hong Wan & Xiaowei Xu & Tian Ni, 2013. "The incentive effect of acceptance sampling plans in a supply chain with endogenous product quality," Naval Research Logistics (NRL), John Wiley & Sons, vol. 60(2), pages 111-124, March.
    10. Evans, Sarah & Scarbrough, Harry, 2014. "Supporting knowledge translation through collaborative translational research initiatives: ‘Bridging’ versus ‘blurring’ boundary-spanning approaches in the UK CLAHRC initiative," Social Science & Medicine, Elsevier, vol. 106(C), pages 119-127.
    11. Kyle J. Mayer & Jack A. Nickerson & Hideo Owan, 2004. "Are Supply and Plant Inspections Complements or Substitutes? A Strategic and Operational Assessment of Inspection Practices in Biotechnology," Management Science, INFORMS, vol. 50(8), pages 1064-1081, August.
    12. Per Magnus Mæhle & Ingrid Kristine Small Hanto & Sigbjørn Smeland, 2020. "Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz," IJERPH, MDPI, vol. 17(24), pages 1-32, December.
    13. T.A. Salimova & V.I. Makolov, 2016. "Unused Potential of Quality Management Systems of the Russian Companies: an Empirical Study," European Research Studies Journal, European Research Studies Journal, vol. 0(3A), pages 150-166.
    14. Sergey Sergeevich Skobkin & Yana Andreevna Belavina & Kalita Gleb Vadimovich, 2017. "Methodological Approaches to the Formation of the Quality Management System for Hotels in Russian Federation," International Review of Management and Marketing, Econjournals, vol. 7(1), pages 128-136.
    15. Engelseth, Per & Pujawan, I Nyoman & Ushada, Mirwan, 2018. "Continuous Handling of Uncertainty in Food Chains: Using the House of Risk Model in Ecosystems," 2018 International European Forum (163rd EAAE Seminar), February 5-9, 2018, Innsbruck-Igls, Austria 276882, International European Forum on System Dynamics and Innovation in Food Networks.
    16. Dag Øivind Madsen & Stig Risvik & Tonny Stenheim, 2017. "The diffusion of Lean in the Norwegian municipality sector: An exploratory survey," Cogent Business & Management, Taylor & Francis Journals, vol. 4(1), pages 1411067-141, January.
    17. Reményi, Christoph & Staudacher, Stephan, 2014. "Systematic simulation based approach for the identification and implementation of a scheduling rule in the aircraft engine maintenance," International Journal of Production Economics, Elsevier, vol. 147(PA), pages 94-107.
    18. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.
    19. Cam Caldwell & Larry Floyd & Ryan Atkins & Russell Holzgrefe, 2012. "Ethical Duties of Organizational Citizens: Obligations Owed by Highly Committed Employees," Journal of Business Ethics, Springer, vol. 110(3), pages 285-299, October.
    20. Gilbert, Patrick & Laporte, Marie-Eve, 2022. "War and peace in hospitals: Humans, objects and paradoxes," Journal of Business Research, Elsevier, vol. 141(C), pages 253-263.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:71:y:2010:i:7:p:1332-1340. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.