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dc.contributor.authorRøvik, Kjell Arne
dc.contributor.authorAndersen, Hege
dc.date.accessioned2016-03-08T12:41:41Z
dc.date.available2016-03-08T12:41:41Z
dc.date.issued2015-09-21
dc.description.abstractBackground: Lean thinking as a quality improvement approach is introduced in hospitals worldwide, although evidence for its impact is scarce. Lean initiatives are social, complex and context-dependent. This calls for a shift from cause–effect to conditional attributions to understand how lean works. In this study, we bring attention to the transformative power of local translation, which creates different versions of lean in different contexts, and thereby affect the evidence for lean as well as the success of lean initiatives within and among hospitals. <p>Methods: We explored the travel of lean within a hospital in Norway by identifying local actors’ perceptions of lean through their images of enablers for successful interventions. These attributions describe the characteristics of lean in use, i.e. the prevailing version of lean. Local actors’ perceptions of enablers for lean interventions were collected through focus group interviews with three groups of stakeholders: managers, internal consultants and staff. A questionnaire was used to reveal the enablers relative importance. <p>Results: The enablers known from the literature were retrieved at the case hospital. The only exception was that external expert change agents were not believed to promote lean. In addition, the stakeholders added a number of new and supplementary enablers. Two-thirds of the most important enablers for success were novel, local ones. Among these were a problem, not method focus, a bottom-up approach, the need of internal consultants, credibility, realism and patience. The local actors told different stories about local enablers and had different images of lean depending on their hierarchical level. <p>Discussion: By comparing and analyzing the findings from the literature review, the focus groups and the survey, we deduced that the travel of lean within the hospital was affected by three principles of translation: the practical, the pragmatic, and the sceptical. Further, three logics of translation were in play: translation as a funnel, a conscious sell-in, and a wash-out. This resulted in various local versions of lean. <p>Conclusions: We conclude that lean, introduced by the management, communicated by the internal consultants, and used by the staff, is transformed more than once within the hospital. Translation is part of the explanation for the lack of evidence for lean, and translation can be decisive for outcomes.en_US
dc.descriptionPublished version, also available at <a href=http://dx.doi.org/10.1186/s12913-015-1081-z> http://dx.doi.org/10.1186/s12913-015-1081-z</a>en_US
dc.identifier.citationBMC Health Services Research (2015) 15:401en_US
dc.identifier.cristinIDFRIDAID 1317236
dc.identifier.doi10.1186/s12913-015-1081-z
dc.identifier.issn1472-6963
dc.identifier.urihttps://hdl.handle.net/10037/8759
dc.identifier.urnURN:NBN:no-uit_munin_8320
dc.language.isoengen_US
dc.publisherBioMed Centralen_US
dc.rights.accessRightsopenAccess
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806en_US
dc.subjectQuality improvementen_US
dc.subjectLean thinkingen_US
dc.subjectHealthcareen_US
dc.subjectContexten_US
dc.subjectImplementationen_US
dc.subjectTranslationen_US
dc.subjectHospitalen_US
dc.subjectNorwayen_US
dc.titleLost in Translation: a case-study of the travel of lean thinking in a hospital.en_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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