title: Has Lean improved organizational decision making?
abstract: Purpose - Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization's decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization's decision-making context, making it more amenable for QI initiatives. Design/methodology/approach - In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings - Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications - Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value - Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI's sustainability.
authors.affiliation: Department of Radiotherapy, MAASTRO Clinic, Maastricht, the Netherlands.
authors.forename: Pascale
authors.initials: P
authors.lastname: Simons
authors.affiliation: Centre for Sociological Research (CESO), KU Leuven, Leuven, Belgium.
authors.forename: Jos
authors.initials: J
authors.lastname: Benders
authors.affiliation: Faculty of Business Economics, Hasselt University, Hasselt, Belgium.
authors.forename: Jochen
authors.initials: J
authors.lastname: Bergs
authors.affiliation: Faculty of Business Economics, Hasselt University, Hasselt, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Marneffe
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vandijck
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration; D003659:Decision Making, Organizational; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009426:Netherlands; D015279:Organizational Culture; D058996:Quality Improvement / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*
keywords: Ambiguity; Lean management; Management decision making; Quality improvement