The lived reality and meaning of Lean Thinking for nurses and nursing at an NHS Hospitals Trust

Field-Richards, Sarah Elizabeth (2017) The lived reality and meaning of Lean Thinking for nurses and nursing at an NHS Hospitals Trust. PhD thesis, University of Nottingham.

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Lean Thinking (Lean) is a management philosophy originating from the Toyota automobile manufacturing company in Japan. Lean has been widely adopted in the United Kingdom (UK) National Health Service (NHS) as a panacea for addressing challenges that threaten its sustainability. Attempts to evaluate the outcomes of Lean implementation, in order to assess its claims to improve efficiency, quality and safety, have proved challenging owing to ambiguity surrounding the definition of Lean, differences in approaches to, and the poor quality of literature reporting, implementation. Lean continues to be adopted in healthcare regardless however, and a body of literature considering the consequences of Lean more broadly, is suggestive of implementation holding other, far-reaching implications.

In attempting to transform healthcare culture and the way in which work is physically and socially structured, managed, organised and delivered, Lean can be understood as a socio-cultural intervention, holding the potential to transform the socio-cultural milieu of healthcare practice. There is, however, a dearth of research considering the nature of this transformation, the interaction between Lean and the socio-cultural context of practice, healthcare professionals’ experiences, understandings and interpretations of implementation, and the implications that it holds for them. This is especially true in the context of Lean applied to nursing. Theoretically, owing to its managerialist associations, Lean presents challenges to essential facets of nursing as a profession, its socio-cultural foundations and identity. Other ‘empowering’ characteristics of Lean philosophy however, are congruent with increasing autonomy and control over practice, associated with nursing’s professional agenda. Lean implementation can therefore be conceived of as representing both a challenge to, and as proffering opportunities for, the nursing profession.

Underpinned by feminist philosophy and employing an ethnographic methodology, the thesis explores the lived reality of Lean implementation for nurses working in three settings at an NHS Hospitals Trust, and its meaning for nursing’s professional project, identity and mandate. The lived reality of Lean is conceptualised as a game played between the Trust and nurses, for power and control over nursing practice. The organisational rationale for, and mechanisms of, exercising power under the guise of Lean are explored, together with the nursing response, incorporating strategies to preserve the socio-cultural status quo and protect nursing knowledge, autonomy and practice.

The notions of ‘power’ and ‘holistic, person-centred theory’ are employed as conceptual vehicles, through which the lived reality of Lean and its meaning for nursing, are critically explored and understood. The traditional ‘powerless’ depiction and ‘project’ of nursing, are challenged in light of empirical findings. The positioning of Lean as a contemporary scapegoat for a theory-practice nexus, and the role of antagonising factors intrinsic to nursing itself, are considered. The utility and feasibility of the nursing project and identity, predicated on a holistic, person-centred model, is also questioned. In this context, the notion of ‘organisational collaboration work’ is introduced, and advanced as a recommendation of the thesis, as a potential means of extending nursing’s mandate, to better meet the needs of organisations, patients and nurses in contemporary healthcare.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Timmons, S.
Noke, H.
Keywords: Lean Thinking, Nursing, Organisational change management, Sociology of professions, Power, Holistic person-centred theory, Organisational collaboration work, Ethnography, Lived reality, Feminist philosophy
Subjects: W Medicine and related subjects (NLM Classification) > WY Nursing
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
UK Campuses > Faculty of Social Sciences, Law and Education > Nottingham University Business School
Item ID: 45825
Depositing User: Field-Richards, Sarah
Date Deposited: 18 Apr 2018 13:02
Last Modified: 14 Aug 2023 07:50

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