Academic journal article Nordic Journal of Working Life Studies

A Case Study of Three Swedish Hospitals' Strategies for Implementing Lean Production

Academic journal article Nordic Journal of Working Life Studies

A Case Study of Three Swedish Hospitals' Strategies for Implementing Lean Production

Article excerpt


Many hospitals have recently developed strategies for implementing the management concept lean production (LP), and previous research has shown that a variety of different implementation strategies are applied (Mazzocato et al. 2010; Poksinska 2010). We know, from extensive previous research, that the participation of different organizational key actors, including managers and different professional groups, is critical for successful implementation of strategies for organizational development (OD) like LP (Easterby-Smith et al. 2000; Oreg et al. 2011). There are, however, limited research and a lack of studies on how and why hospitals actually choose different strategies for implementing LP (Brandao de Souza 2009). This case study investigated the strategy choices three Swedish hospitals made for implementing LP in different ways and examined the contexts and conditions behind their distinct LP implementation strategies, including how managers, professional groups, and other organizational key actors participated in the implementation of strategies. In conclusion, the aim of this study was to learn how and why three Swedish hospitals selected and developed their hospital-wide LP strategies. This meant that we were studying the content of the hospitals' selected implementation strategies, and conditions and rationales behind the selection of strategies including how different organizational actors participated in the chosen implementation strategies. The analysis focused on the overall implementation of LP strategies at the hospital level.

Research questions

1. What different strategies for implementing LP were applied?

2. What contextual factors were described to impact the strategy selection?

3. What were the described rationales behind the selection of LP strategies?

4. How did indicators of participation in LP among employees develop over time?

Based on the results of this study, discussions will be held concerning implications for choosing hospital-wide LP strategies that contribute to sustainable participation in LP.


LP in health care

Sweden's health care sector has for many decades been under pressure to reduce costs and increase the efficiency of care processes, while simultaneously sustaining or improving the quality of care. Major top-down structural changes, such as merging hospitals with a centralized administration or applying systems for debiting internal costs, have had limited success (Anell 2005) and coincided with increased health problems among health care staff(Arbetsmiljöverket 2012; Dellve et al. 2011; Elstad and Vabo 2008). More recent attempts to improve Swedish health care have focused on mandating, but not prescribing the nature of, intraorganizational redesign, including the use of new OD concepts (Kollberg et al. 2006; SKL 2009). Lately, LP has become the most dominant concept for OD and over the last 7 years, 85% of the Swedish hospitals have implemented LP (Weimarsson 2011).

LP is an approach to developing organizational processes, with roots in the car industry (Womack et al. 1990). Although there are different views on how to define LP, a common goal of LP in practice is to maximize customer value by eliminating waste, defined as nonvalue-adding processes or tasks (Womack and Jones 2003). Subgoals often include improving or 'smoothing' process flow and reducing errors (Womack and Jones 2003). Another common characteristic of LP is the use of a systematic, scientific approach to identifying and solving problems occurring in work. Frontline employees are often empowered to participate in or even lead problem identification, problem solving, and improvement efforts (Mazzocato et al. 2010). Reviews of the literature on LP in health care show that LP has been applied in several different ways, although most applications focus on process improvements and continuous flows (Poksinska 2010), and frequently involve value stream mapping of patient flow (Brandao de Souza 2009; Holden 2011; Poksinska 2010). …

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