Engineering Medicine: The Deployment of Lean Production in Health Care

• In Event: 413 - Section on Organizations, Occupations and Work Refereed Roundtable Session. Table 01. Culture and Organizations
  In Refereed Roundtable 100min: Table 12. Making Markets

Abstract

Lean production is a management philosophy originally developed by the Japanese automobile firm Toyota to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of transplanting a management model from its site of origin to a new and alien context. How do actors attempt to overcome barriers to model implementation, and what insights might this provide regarding processes of institutional transformation? Recent institutionalist literature has highlighted how skilled agents of change, or “institutional entrepreneurs,” promote profound transformations through the artful and strategic manipulation of symbols. In contrast, our research highlights the barriers institutional entrepreneurs face in attempting to bring about institutional change. In both cases, the model encountered considerable obstacles to implementation, but the nature of these obstacles was somewhat different in each case. We use these cases to illustrate how actors operate within institutionally specific material and discursive opportunity structures that impose a collective logic of action that is both enabling and constraining.

Authors

• Will Attwood-Charles, Boston College

• Sarah Louise Babb, Boston College