Calibrating Lean: beyond the silver bullet and untrue panacea: Examining the effects of Lean on hospital performance and hospital workers’ wellbeing, and exploring how these effects can be explained.

Healthcare systems are under increasing pressure due to demographic shifts and a growing shortage of healthcare personnel. Lean, originally developed in the manufacturing sector, is being adopted in hospitals as a method to better organise work processes. It focuses on customer value by eliminating waste, utilising specific techniques, and involving employees in continuous improvement efforts. This dissertation examines how Lean affects both performance and the well-being of healthcare workers within a hospital context, and explores the mechanisms that explain these effects. The study is a mixed-method case study conducted in a medium-sized Dutch hospital. It addresses three key knowledge gaps: the lack of context-specific research, limited insight into explanatory mechanisms, and uncertainty about the combined influence of Lean practices and leadership. Lean is approached as a socio-technical system centred on reducing variation and creating value. Team leaders play a crucial role in this system, particularly by influencing employees' perceptions and behaviors. Findings demonstrate the importance of distinguishing between different dimensions of Lean, as they have varied effects on hospital performance and staff well-being. Involvement in continuous improvement contributes to both outcomes, whereas Lean techniques primarily enhance efficiency. However, positive effects may coincide with increased job demands for staff. This implies that claims suggesting Lean can be implemented without additional burden on healthcare professionals may be more rhetorical than realistic. Leadership behaviour emerges as a decisive factor, with long-term outcomes driven by the conduct of team leaders. A notable paradox emerges in the mechanisms linking Lean to its outcomes. While increased guidance is often seen as incompatible with greater autonomy, this research shows that Lean in hospitals does not necessarily reduce autonomy. Instead, Lean promotes both role clarity and autonomy, offering structure and a sense of control in complex work environments. Rather than endorsing the common binary view of Lean as either a silver bullet or an untrue panacea, I argue that its effectiveness is better understood as a carefully calibrated alignment of interdependent elements—content, implementation process, semantics, and context. This highlights the need for researchers to adopt a nuanced and balanced approach to capture the intricacies of Lean implementation in healthcare settings fully.