Examining nurses’ work experiences in Lean operating theatres

Introduction: Hospitals around the world are faced with unprecedented demographic, budgetary and epidemiological challenges. To cope, many are adopting managerial approaches inspired by the Japanese Lean Manufacturing philosophy. While Lean has been shown to help hospitals improve their efficiency, reduce costs and increase their capacity, little is known about its consequences on their medical, nursing, and allied health staff. This study aims to address this gap by examining the links between the use of lean and experiences of alienation amongst operating theatres (OT) nurses.

Methods: Underpinned in a critical realist epistemology and using a qualitative methodology, the research was conducted at a publicly funded hospital in France. Data was collected through non-participant observations in an OT (90 hours), semi-structured interviews (n=19) and document analysis. Participants were OT nurses. Theoretically, the research draws on Blauner’s (1964) taxonomy of alienation.

Results: Findings of the study revealed that Lean practices were seen as alienating by the nurses who described an increased sense of powerlessness, meaninglessness, and social isolation. Participants chiefly viewed their work as a worthy goal in itself and signs of self-estrangement were only apparent in instances where Lean negatively impacted patient care. Resistance strategies were identified and will be discussed in this presentation.

Conclusion: While no direct links can be drawn between Lean and experiences of alienation, this study reveals the ways in which Lean can create an alienating environment and lead to negative work experiences. Broadly, this study contributes to the discussion on the future of health services management as hospitals operate in an era of unprecedented challenges. The research argues that along with efficiency, the wellbeing of staff and patients needs to be at the forefront of managerial priorities.