Abstract

Purpose - The purpose of this paper is to understand the barriers and enablers to Lean
implementation as part of an imaging quality improvement programme, from a socio-cultural
perspective.
Design/methodology/approach – An in-depth 33 month ethnographic study, using observation and
qualitative interviews, examined the process of Lean implementation as part of an improvement
programme.
Findings - Implementation of Lean was more successful compared with other reports of Lean in
healthcare settings. Key enablers of Lean were high levels of multidisciplinary staff involvement and
engagement; the professional credibility of facilitators; clinicians as early adopters; all within a wider
culture of relatively strong inter-professional relationships in the imaging department. These
enablers combined with the more routinised and standardised nature of imaging pathways
compared to some other acute specialties, suggest that imaging is fertile ground for Lean, linked to
the manufacturing origins of Lean.
Practical implications - When introducing Lean within healthcare settings special attention needs to
be paid to the specific healthcare context and the existing cultures of inter-professional
relationships. Fostering an improvement culture and engagement with training, together with
adequate financial resource, are key to contributing to the level of acceptability of an improvement
tool such as Lean.
Originality/value- This ethnographic study, bringing together rich multi-source data, has provided a
detailed insight into the cultural workings of the process of Lean implementation within a complex
healthcare system.