A Phenomenological and Symbolic Interactionist Case Study into the Emotional Experience of Lean: as experienced through a Rapid Process Improvement Workshop in an English Foundation Trust Hospital

The aim of this study was to address the gap in the body of knowledge by exploring the human experience of Lean. A phenomenological and symbolic interactionist case study of a Lean tool known as a Rapid Process Improvement Workshop (RPIW) was undertaken within an English Foundation Trust hospital. Data related to the human, subjective, emotional experience of the RPIW was collected over one year through non-participant observation and semi-structured interviews. The data was analysed using Thematic Network Analysis (Attride-Stirling, 2001) and revealed that participation in an RPIW is much more than a technical process. It influences how people feel about themselves, is based on relationships with others, and requires mental, physical and emotional effort. All of these factors influence engagement with, initiation of, and sustainability of the RPIW.

Lean is a method of improving services in healthcare which aims to improve quality and productivity. The guidelines for implementing Lean in practice tend to focus on technical 'how to' elements. There is an absence of understanding where people, and their emotional experience, fits into the process. This case study addresses this gap in understanding and provides recommendations for implementing Lean which includes both the technical 'how to' alongside supporting the people involved.

A ‘Humanistic Framework for RPIWs’ is proposed which synthesises the published recommendations and research related to Lean and RPIWs with the study findings so that human, subjective and emotional experience is recognised in the implementation of an RPIW. Key recommendations include aligning Lean activities to personal and professional values; developing an explicit ‘psychological contract’; selecting RPIW participants based on emotional connection and personality-type; facilitating the formation of social bonds; providing psychological support including re-framing the ‘performativity’ of RPIWs; and shared accountability for sustaining the RPIW. The proposition is, that by recognising the humanistic elements of Lean in this way, appropriate practical and psychological support for RPIW participants may be provided, and longer-term impact and sustainability of RPIWs may be realised.