A socio-technical systems perspective of the operational delivery of secondary care in the NHS

Waiting has been widely acknowledged as a source o f patient dissatisfaction in the UK, especially the time spent in Hospitals waiting for safe, effective treatments and personal care. Comparison between healthcare systems in the UK and US informed managers, professionals and policy makers seeking to improve patient satisfaction with limited budgets. An emergence o f literature regarding Lean Thinking as a significant global influence in healthcare improvement has followed these comparison. Yet the NHS, with its unique history relating to policy shift, professional dominance and its sheer scale, has been portrayed as slow to change. What then, enables and inhibits healthcare organisations when implementing improvement strategies to reduce patient waiting? Taking an holistic approach, this study investigates the enablers and inhibitors for implementation o f premised high performance principles (Lean Thinking). Theoretically this study is significantly influenced by socio-technical systems theory and is argued from a realist stance. Using a single case, the research investigates major patient flows in secondary healthcare (NHS) to gain insight into the process and outcome o f implementation. Performance results were validated through comparison with two similar organisations. Primary analysis comprises a multi-method, triangulated approach o f interviews, questionnaires, process and performance measurement. The main limitations o f the study are a direct result o f the complexity and diversity o f the NHS. Findings show differences in implementation that arise from the degree o f closeness o f sub-systems related to patient contact. The importance o f middle managers on improvement implementation emerges. The impact o f Professionals and senior managers is greater at the extremes o f performance. The empirical findings from this study provide a contribution o f knowledge regarding the factors required for implementation o f improvement (Lean Thinking) to achieve high performance, culminating in models for practitioner and policy makers, derived from an original research procedure for theory buildin