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Title: Lean in healthcare: the unfilled promise?
Authors: Radnor, Zoe J.
Holweg, Matthias
Waring, Justin
Issue Date: 2012
Publisher: © Elsevier
Citation: RADNOR, Z.J., HOLWEG, M. and WARING, J., 2012. Lean in healthcare: the unfilled promise? Social Science & Medicine, 74 (3), pp.364-371.
Abstract: In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. © 2011 Elsevier Ltd.
Description: This is the author’s version of a work that was accepted for publication in Social Science and Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published at: http://dx.doi.org/10.1016/j.socscimed.2011.02.011
Version: Accepted for publication
DOI: 10.1016/j.socscimed.2011.02.011
URI: https://dspace.lboro.ac.uk/2134/15864
Publisher Link: http://dx.doi.org/10.1016/j.socscimed.2011.02.011
ISSN: 0277-9536
Appears in Collections:Published Articles (Business School)

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