Beyond the toolbox: Lean production increases the observational capacity in a pluralistic organization

A common way to redesign healthcare organizations, which currently face pressure to improve their performance to remain affordable, accessible, safe, efficient and innovative, is to use managerial practices. Lean production is one such popular practice that aims to eliminate non-value adding activities. However, a critical consideration of lean production in healthcare beyond its toolbox understanding remains rare. We address this call with a study on how lean production is introduced in a hospital, and build on recent works that regard lean production not merely as a toolbox but as a way of learning-to-see and enhancing observational capacity. Particularly, we ask how lean production increases the observational capacity in pluralistic healthcare organizations. Drawing on a case study conducted in a medium-sized hospital in Switzerland, we will argue that the introduction of lean production involves and requires different activities that over time result in what we will call “stepping-in” and “stepping-back.” With these insights, we contribute to a more integrative perspective on lean production in healthcare beyond the widespread toolbox perspective.