Continuously stepping-back and stepping-in when incorporating lean management in emergency care - advancing a practice view on organizational reflexivity

Despite its increasing importance reflection in its collective notion has mainly been studied as a temporary way of actors stepping back to question their daily work and its underlying assumptions. Drawing on recent studies, we ask how reflexive practices become enduring, and integral to the ongoing organizing. Using a practice studies lens, we draw on a longitudinal case study of introducing lean management to a hospital’s pluralistic emergency care unit. Our results show the emergence of different practices of stepping-back (formalizing, empowering and listening to others) and of stepping-in (demonstrating, adding and exploring) that become part of daily organizing at the emergency care unit. As these practices form a duality over time we conceptualize organizational reflexivity as an iterative process of collectively stepping-back and stepping-in. This insight contributes to the existing debate on reflection as a collective, dialogical practice.