The Lean paradox: Does applying Lean Management increase protocol deviations? A case study of cleaning staff in the hospital sector

Abstract

ABSTRACT Lean Management has been implemented for a number of years in the hospital sector. This management strategy aims at improving hospitals’ operational processes essentially by reducing unnecessary waste. One obvious question is what should be considered as ‘unnecessary waste’. The aim of this study is to illustrate the potential paradoxical effects of the Lean Management on performance through a detailed analysis of a specific subset of employees: hospital cleaners. The protocol for cleaning patients’ rooms was developed in partnership with two team leaders as part of a Lean Management implementation process. It consisted of 27 tasks to be performed within 15 minutes per room. Thirty-three hospital cleaners agreed to take part in this study. We measured the time taken to clean the rooms and identified deviations from the protocol and associated factors.⁠ On average, the staff cleaned 6,4.4 rooms over a 2-hour period. Our results reveal that those cleaners who respected the time criteria made fewer errors but more violations than those cleaners who took an additional 5 minutes per cycle. These cleaners chose to respond to the contextual demands for cooperation by deviating more frequently from the protocol.