Leaning on leadership? Understanding how a lean implementation impacts hospital workers’ performance

This study examines the extent to which a Lean implementation impacts hospital work unit performance. It also explores the extent to which willingness to change and role clarity explain these relationships. The longitudinal data for this study were collected from a Lean implementation study conducted in a Dutch hospital and then analyzed using structural equation modelling. The results reveal that the practice of Lean Leadership behaviour positively affects performance, both directly and indirectly through role clarity. However, other Lean practices, involvement in continuous improvement and Lean techniques, did not enhance hospital performance. The inconsistent findings concerning Lean's soft practices suggest that major events (the COVID-19 pandemic in this case) can influence the implementation of Lean and the subsequent outcomes, potentially obstructing sustainable results. The novelty of this study is in its multi-wave design to evaluate the long-term effects of Lean and line managers' leadership behaviour in a hospital context. Furthermore, it enhances our understanding of the mechanisms explaining the relationship between Lean and its outcomes in healthcare.