Stepping-back and stepping-in: conceptualizing collective reflection while implementing Lean Production in a hospital

How can we understand collective reflection in pluralistic organizations, which need to develop a shared understanding of their distributed value creation, especially in times of increased change? With this research interest, the present study addresses a key concern of management practice and research. Answering this question seems to be of particular relevance as the conditions for pluralism become more and more widespread.
To address this research interest, we empirically investigate a Lean Production change endeavour in a Swiss public hospital over a period of two years and seven months using a qualitative embedded single case study. Drawing on a practice perspective, we translate this general research interest into three research questions that build on each other: firstly, which collective, reflective activities can be observed in a pluralistic healthcare organization in times of increased change? Secondly, how do these observed collective, reflective activities change over time? And thirdly, how do these collective, reflective activities impact the pluralistic healthcare organization over time?
Taken together, this study proposes collective reflection in organizations as a way of organizing. As such, it enables joint reflection mainly from within routinized day-to-day work. In this sense, it is an active, joint and structured effort of coordinating. Over time, this way of organizing results in, what we call, “stepping-in” and “stepping-back”. Thus, collectively reflecting in organizations is about building the capacity for doing things in a way that increases the organizational observational capacity over time. Lean Production seems to be one such way of organizing: as a dynamic process in healthcare that gains value from its indefiniteness, it is a possibility to increase the observational capacity of pluralistic healthcare organizations over time and thereby especially requires an active effort of “stepping-back” to get at the ‘in-between’ value creation.
With these findings, we firstly contribute to the debate of collective reflection in organizations in further developing the theoretical concept of collective reflection in organizations. Particularly, we propose a process model that highlights collective reflection in its social and lasting notion in organizations. Secondly, we add to the debate of lean hospital by re-interpreting Lean Production for pluralistic healthcare organizations. Specifically, we propose re-interpreting Lean Production as a possibility for a joint and reflective further development of the hospital.