Emergent barriers to the lean healthcare journey: baronies, tribalism and scepticism

Healthcare systems are essential service organizations for citizens. However, the increasing demand for healthcare provisions and limited resources are challenging the public healthcare system to its limit. To respond to these constraints, healthcare managers and practitioners have worked together to adapt industrial practices of process improvements, such as lean production, to healthcare operations. Although the implementation of lean has gained considerable traction in the complex healthcare ecosystem and provided several benefits, its journey has been and continues to be challenged by contextual barriers not encountered in manufacturing settings. Amongst these barriers, the literature identifies professionalism, implementation fidelity, and the need for evidence-based research as being the most disruptive to lean implementation. These emergent barriers have impacted on the implementation and sustainability of lean in healthcare, and scholars have called for empirical studies to provide an in-depth understanding of these issues to fill this knowledge gap. This study responds to this call by empirically investigating the impact of these barriers in practice by using an exploratory case study in three emergency areas of a public healthcare system. Thirty-seven semi-structured interviews were conducted with nurses, physicians, coordinators, and lean management specialists involved in lean improvement projects. Two key concepts of value destruction and balanced centricity were identified as being crucial to understanding the impact of these emergent barriers. Research propositions are provided that identify baronies, tribalism and scepticism as being the main elements that constrain the implementation and sustainability of lean in healthcare.