Lean and professional autonomy at hospitals

Abstract

Hospitals are facing major challenges caused by growing expectations from both patients and the society. This is occurring at the same time that budgets are being limited alongside the introduction of new and expensive treatment possibilities. Lean has become one of the most important measures for management in their attempt to meet these challenges. However, lean originates from the manufacturing industry and its compatibility with the complexity of a hospital organisation should be questioned. These questions are studied during the introduction of lean into a cancer department at a university hospital. It proved more difficult than expected to implement lean, and the department experienced relatively limited sustainable results. For the employees the consequences seem to vary considerably. Lab technicians and nurses were the two main groups involved in lean activities, and they had quite different experiences. Lab technicians reported improvements to their psychosocial working environment, while the opposite was the case for nurses. A possible explanation for the positive results for the lab technicians could be that they had a relatively stand- ardised work, and the standardisation elements in their work was in accordance with professional norms in their work whereas the continuous improvement activities in lean opened for new ways of employee involvement. The nurses already experienced a work context marked by complexity and minimal standardisation. As such, they considered attempts to standardise elements of their work as limiting their autonomy and challenging their professional assessment of the patients’ care needs.