superficially and ritualistically (Waring and Bishop 2010). We add to the research base on lean adoption in the NHS by paying specific attention to the micro-details of how lean is conceptualized and in the hospital, and how and why staff ‘sold’ ‘buy’, use, ignore, or reject lean principles. Crucially, we extended our analysis over time and explored the case for a period of three years. This provided the opportunity to explore the pliability of lean in practice and the vulnerability of its at the ‘adoption’ hospital over time (Benders and van Veen 2001; Schofield 2001). Rather than explicitly promoting or denouncing lean itself, the paper builds on and extends the analysis of Waring and Bishop (2010) concerning the indeterminacy of lean take-up in the NHS, adopting an ethnographic approach similar to that of Watson (1994: 898) in exploring how employees may be value in much new thinking and language ‘seeing but hav[e] fears about what tends to be done with it in practice.’ Our case analysis thus explores the ways in which lean are in the hospital, how healthcare staff ‘sold’ are and it, and the longer-term outcomes, both for the hospital itself ‘buying’ ‘using’ and for the concept of lean in healthcare more broadly. The paper proceeds in five sections. We set the scene by providing a brief overview of lean literature. Secondly we discuss the literature on management fads and fashions, specifically focussing on the notion of fad arguing that this thread of ‘life-cycles’, literature remains highly pertinent to understanding the difficulties and uncertainties of planned organizational change. Thirdly, we offer a description of the research methods of the study. This is followed by analysis of our ethnographic data structured around three themes: (i) lean promotion, (ii) criticisms and scepticism around lean in healthcare, and (iii) the processes whereby lean starts to erode over time. Finally conclusions are drawn about the appropriateness of lean in healthcare, and about the
superficially and ritualistically (Waring and Bishop 2010). We add to the research base on lean adoption in the NHS by paying specific attention to the micro-details of how lean is conceptualized and ‘sold’ in the hospital, and how and why staff ‘buy’, use, ignore, or reject lean principles. Crucially, we extended our analysis over time and explored the case for a period of three years. This provided the opportunity to explore the pliability of lean in practice and the vulnerability of its ‘adoption’ at the hospital over time (Benders and van Veen 2001; Schofield 2001). Rather than explicitly promoting or denouncing lean itself, the paper builds on and extends the analysis of Waring and Bishop (2010) concerning the indeterminacy of lean take-up in the NHS, adopting an ethnographic approach similar to that of Watson (1994: 898) in exploring how employees may be ‘seeing value in much new thinking and language but hav[e] fears about what tends to be done with it in practice.’ Our case analysis thus explores the ways in which lean are ‘sold’ in the hospital, how healthcare staff are ‘buying’ and ‘using’ it, and the longer-term outcomes, both for the hospital itself and for the concept of lean in healthcare more broadly. The paper proceeds in five sections. We set the scene by providing a brief overview of lean literature. Secondly we discuss the literature on management fads and fashions, specifically focussing on the notion of fad ‘life-cycles’, arguing that this thread of literature remains highly pertinent to understanding the difficulties and uncertainties of planned organizational change. Thirdly, we offer a description of the research methods of the study. This is followed by analysis of our ethnographic data structured around three themes: (i) lean promotion, (ii) criticisms and scepticism around lean in healthcare, and (iii) the processes whereby lean starts to erode over time. Finally conclusions are drawn about the appropriateness of lean in healthcare, and about the
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