Conclusions

The primary objective of this research was to engage with a team who were implementing a Lean Management System, to explore and aim to answer the question:

‘How does the introduction of a Lean Management System affect managing and sustaining change in a healthcare environment’?

It has been demonstrated through this research that a Lean Management System has positive effects on managing and sustaining change in a healthcare environment, however a Lean Management System alone is not enough for long lasting, sustained change. In addition to the framework and principles provided by a Lean

Management System, a team requires effective leadership that can lead through the Lean Management System on a daily basis, in addition to a team who have

developed work practices (such as problem-solving skills) that enable them to act on change.

The findings through this study related to two main themes, Relevance and

Reactivity. These concepts were adopted as they align with the two primary focuses of Lean Management systems: Deploying and aligning strategy and purpose; and the operational decision making and daily improvement.

Relevance

For the purposes of this study, Relevance has been defined as the degree to which staff feel that what they do is relevant to the department or organisation. The findings indicated that there were improvements in the factors associated with Relevance such as: the connectivity and alignment of senior managers, and improvement of clarity of purpose within teams. There were limitations to the extent that a Lean Management System improved Relevance across teams, in particular outside of the Pharmacy Leadership Team. It emerged that whilst leaders across the Pharmacy service had the tools and methods for deploying strategy, they were not taking the action, or developing the standard work, to discuss this with their teams on a regular basis and develop the level of Relevance with team members. The literature went some way to explaining this issue in that standard work for leaders is required as the ‘engine’ to drive a Lean Management System (Lancaster, 2017, Mann 2005). Furthermore, it was discussed that some of the leaders who were responsible for deploying and communicating strategy with their teams did not exhibit the leadership behaviours required to be effective at this. Some leaders lacked confidence in communicating strategy, or didn’t see it as a priority.

In summary, a Lean Management System goes some way to improving Relevance in the pharmacy department under study, however to have the greatest impact it needs to be coupled with standard work, that ensures strategy deployment is a routine activity, and the effective behavioural competencies of the leaders who are responsible for this activity.

Reactivity

For the purposes of this study Reactivity has been defined as the degree to which staff and teams are prepared for emergent issues and risks that often invoke corrective action, post an event. The findings indicate that the introduction of the Lean Management System improved decision making within Pharmacy teams through greater team involvement and that there was a greater emphasis on action through ownership of decisions by team members. Also, the speed of decision making and management of priorities improved with the Lean Management System.

All of these factors in combination led to a reduction in Reactivity within the pharmacy department as teams were taking ownership of issues and taking action much sooner.

The improvement in decision making also enabled team members to feel more involved in their teams, however it was found that cross-team collaboration was sub- optimal and remains a challenge despite implementing a Lean Management System. The level of collaboration impacts how future Lean Management Systems might be deployed in this case. Mapping a management system to cross-function (or social) networks as opposed to an existing hierarchical structure may be more effective to build on these connections and this is an area recommended for future research.

Strong Links to Leadership

Through this study there were a number of emergent findings that were outside of the main themes (Relevance and Reactivity). One theme that came through very strongly was the alignment to leadership development that emerged through the introduction of the Lean Management System. Primarily this was seen through those people responsible for leading change and managing people. These people found they were reflecting on their leadership style and in many cases changing how they lead and engaged their teams. Examples of these changes included a greater ownership of the change process, distribution of responsibilities and increased professionalism.

The implication of showing the importance of leadership is that not only can the introduction of a Lean Management System benefit in improving the management and sustainability of change in this hospital pharmacy, it can also offer an experience and framework in which leaders develop their behaviours and are challenged to think and act in different ways. The impact of this is likely to be two-fold: improvements in team performance and also improved leadership capabilities.