Curing a meagre health care system by lean methods—translating ‘chains of care’ in the Swedish health care sector

The purpose of this article is to discuss what happens when work embedded in a ‘meagre’ † ‘Meagre’ is chosen as a term to describe a critical state in an organizational field where resources are relatively scarce, i.e. in relation to the prescribed task. ‘Lean’ is a term to describe an organizational concept in order to simultaneously rationalize and develop production. organizational context is changed by lean production‐related methods. The article is based on studies of seven lean production‐inspired projects in the Swedish health care sector, a sector already poor due to organizational slack. The projects were directed to develop ‘health care chains’, an organizational concept regarded as a way to rationalize health care organizations as well as to develop them, i.e. increase productivity, quality from a customer perspective and quality of working conditions. The article analyses the projects from an interpretative perspective and discusses how modern management models with ambitions to concurrently rationalize and develop organizations—e.g. lean production and health care chains—are used in a ‘meagre’ organizational field. As an outcome, a model is presented that explores what is beyond simple imitations and unique translations of ideas when a new concept is implemented in local organizations.