Institutionalizing Lean in a Norwegian Public Hospital - The same-day surgery process at SI Lillehammer
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In line with population growth, the need for public health services increases. In order to meet this increase in demand, greater financial support for public healthcare services is required. However, the economic frames are not increasing as rapidly as the demand for healthcare, and hospitals are therefore forced to spend less on more people. As a result, several Norwegian health organizations are trying to introduce methods of process improvement derived from industry, in order to increase efficiency and cut costs. One example of this is the same-day surgery process at SI Lillehammer, a Lean initiative. As one of very few Norwegian hospitals, SI Lillehammer has succeeded in institutionalizing the change, which is why we have chosen to conduct a qualitative, single case study of this particular process. By using a framework presented by Kuipers et al. s (2014), originally developed by Pettigrew (1985), we have studied how the context, content, process, leadership and the interaction between these factors have shaped the outcome of the change. The main findings of this study include that the external context in many ways has facilitated the same-day surgery process, and that the internal context of the surgical department at SI Lillehammer has been adjusted to fit with the change. At the same time, the concept of Lean has been adapted to fit with the internal context. Instead of relying on external consultants, they have had an internal consultant, with knowledge of both Lean and the healthcare sector, to assist the change. Furthermore, the leaders of same-day surgery process have facilitated employee involvement. The process has been implemented gradually, and the process leaders have stayed highly dedicated to Lean and the same-day surgery process over many years, despite employee resistance. Thus, the coherence between the framework factors have led to the successful institutionalization of this change. To our knowledge, no studies have been published that look at successful Lean processes in Norwegian public hospitals. We believe the findings in this study may be used as an instrument by other Norwegian public hospitals aiming to succeed with institutionalization of Lean initiatives, and hope this thesis will be a pointer for further research in the field.