Organizational trials of valuation: insights from the work of leaning the patient distribution process at a children’s hospital

Management devices from industrial sectors are proliferating in the public sector, a trend now being accused of undermining the proper values of public organizations. A prominent example of such a management device is lean management, which is a set of principles and tools employed by contemporary management consultants to eliminate waste and promote value – often for the sake of efficiency. While lean management has been particularly welcomed in the healthcare sector, healthcare professionals are increasingly resisting attempts at leaning their work processes. Applying the notion of trials of valuation, this study empirically unfolds the conflicts arising when lean management is used to reorganize the task of distributing patients to beds in a children’s hospital. Following the turn to value and the pragmatic tenet of studying values as the outcome of work, this paper suggests that the effects of a management device on the values of an organization can fruitfully be investigated for its ability to organize. Further, the paper contributes to the field of valuation studies with a heuristic to undertake such an investigation, directing attention towards the object of valuation, the temporal and spatial dimensions of the valuation situation, and the knowledge used to inform that valuation.