The role of actor associations in understanding the implementation of Lean thinking in healthcare

Purpose - The importance of networks in effecting the outcomes of change processes is well-established in the literature. Whilst extant literature focuses predominantly on the structural properties of networks, our purpose is to explore the dynamics of network emergence that give rise to the outcomes of process improvement interventions. Through the use of actor-network theory (ANT), the purpose of this paper is to explore the dynamics in the implementation of a process improvement methodology in the complex organisational setting of a UK National Health Service Trust. The paper illustrates the utility of ANT in articulating the dynamic nature of networks underpinning socio-technical change, and our analysis provides insights for the management process change initiatives. Design/methodology/approach - This is a rich qualitative study in the Pathology Unit of a UK National Health Service Trust, using ANT as the theoretical lens for tracking the emergence and transformation of networks of individuals over the course of a management intervention to promote "Lean thinking" for process performance improvements. Findings - ANT is useful for explicitly tracking how organisational players shift their positions and network allegiances over time, and for identifying objects and actions that are effective in engaging individuals in networks which enable transition to a Lean process. It is important to attend to the dynamics of the process of change and devise appropriate timely interventions enabling actors to shift their own positions towards a desired outcome. Research limitations/implications - The paper makes the case for using theoretical frameworks developed outside the operations management to develop insights for designing process interventions. Originality/value - By understanding the role of shifting networks managers can use timely interventions during the process implementation to facilitate the transition to Lean processes, e.g. using demonstrable senior leadership commitment and visual communication.