Lean implementation and ‘changing’

This research aims to explore and evaluate the phenomena of Lean and its implementation in a healthcare context, specifically English hospitals. The literature review presented in Chapter 2 Exploring Lean concludes that Lean is widespread but often fragmented and pragmatic in its implementation. Furthermore, the extant literature suggests that the phenomenon of Lean is rich in nuance and concerned with ‘change’: changes in the way operations and processes are managed from functional to process based work flows (or patient flows) and ultimately, changing mindsets (see Westwood and Silvester, 2006). Change of this order does not occur overnight; as discussed in Chapter 2, Lean is not a silver bullet solution it is best described as a journey. Thus any research design that seeks to evaluate Lean implementation needs to incorporate data collection methods that will facilitate a dynamic and holistic analysis of ‘changing’, allowing the change process to reveal itself temporally and contextually(Pettigrew et al, 1992).

‘The overriding aim of the process analyst … is to catch reality in flight’ (Pettigrew, 1997:338)

Describing the meaning of process as ‘a sequence of individual and collective events,

actions and activities evolving over time in context’, Pettigrew (1997:338) is portraying the essence of a processualist approach as one that is holistic and dynamic, where ‘human conduct is perpetually in a process of becoming’. In his early study of ICI, Pettigrew (1985) notes that the majority of studies of change tend to be a- historical, a-contextual and a-processual, regarding change as if it were a discrete occurrence that takes place independently of the multivariate context in which it is embedded. Pettigrew (1985) identifies the concept of changing as important and thus argues for a more holistic and dynamic analyses of organisational change.

Pettigrew’s (1985) seminal contribution is asserted through the author’s continuing work on organisations as systems and subsystems of political action, leading to a belief that ‘the possibilities and limitations of change in any organisation are

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outside of the firm, and by the mobilisation of support for a change within the power structure at any point in time’ (p.27).

In summary, Pettigrew and Whip (1991:268) articulate the following research attributes as necessary in view of ‘changing’:

 Processual – an emphasis on action as well as structure;

 Comparative – a range of studies;

 Pluralist – describe and analyse the often competing versions of reality seen by actors in change processes;

 Historical – take into account the historical evolution of ideas and actions for change as well as the constraints within which decision makers operate.

It follows that the selected data collection methods need to facilitate a dynamic view of the implementation of Lean methodology in the NHS. Table 3.3 below illustrates how the research methods align with a processual and contextualist perspective of change in accordance with the attributes outlined in Pettigrew et al (1991) outlined above.

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Table 3.3: Summary of data collection techniques aligned to Pettigrew et al (1991)

Research Attribute Method, description and rationale Processual (an emphasis on

action as well as structure)

Case Study

The case study method incorporates a series of semi- structured interviews with a cross section of staff in the

hospital who have experienced Lean (not necessarily as part of the observed ‘event’) to reveal the reality of Lean

implementation in a hospital Trust from the perspective of a range of hospital staff including members of the Executive team, consultant doctors, nurses and healthcare assistants. Where possible the researcher will also seek to observe Lean implementation to enrich the interview data and allow a rich documentation of how Lean is actually being implemented in a hospital environment.

Quantitative analysis of organisational performance

alongside Lean implementation. The aim is to explore whether there is any quantitative support for the impact of Lean

implementation in English hospital Trusts. Pluralist (describe and

analyse the often competing versions of reality seen by actors in change processes)

Semi-structured interviews (as above), interviews in four case study hospital Trusts with approximately 12 members of staff at different levels of the organisation.

Comparative (a range of studies)

Document analysis

A document analysis research method is used to analyse the annual reports of all NHS general acute hospitals in England in order to compare and contrast approaches to Lean

implementation by English hospitals in light of contextual data and performance data.

Cross Case analysis

To compare confirm and aid comprehension of the phenomena of Lean and its implementation. Historical (take into

account the historical evolution of ideas and actions for change as well as the constraints within which decision makers operate)

Document Analysis

Document analysis data is collected at two time intervals to evidence the occurrence of ‘changing’ in relation to Lean implementation in English hospital Trusts.

Case Studies

Semi-structured interviews will seek a narrative disclosure of the Lean journey in each of the four case studies from the multiple perspectives of interviewees.

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