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

Abstract

Lean is a philosophy applied within organisations through associated principles and tools to reduce inefficiencies. The ‘promise’ of Lean is that organisations will be enabled to increase productivity whilst maintaining quality. It has been widely adopted in healthcare to address the financial and quality challenges that face healthcare organisations across the world. Lean principles and tools are central to quality improvement strategy in the English National Health Service and there are a plethora of books and publications aimed at healthcare staff promoting Lean principles and guiding the application of Lean tools. In terms of empirical research, Lean in healthcare has been extensively studied but the dominant approach is positivist/post-positivist with prevailing assumptions of determinism and linear causality. There are no studies that consider the humanistic elements of Lean; that is those that consider human agency, individuality and subjective experience.

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.

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.

Date of Award	17 Oct 2019
Original language	English
Awarding Institution	Teesside University
Supervisor	Susy Cook (Supervisor), Robert McSherry (Supervisor) & Emma Giles (Supervisor)