How to Learn Up from Lean Management in Health Services? HRM, Leadership and Relational Coordination

This chapter suggests that while the case for New Public Services rather than New Public Management is well grounded, some expositions of it have neglected the degree to which much can be learned for lean hospital management from the Toyota Production System. It distinguishes inflexible Fordist production based on economies of scale and Taylorist surveillance of performance from Post Fordist lean production based on economies of scope and continuous improvement in work methods. It highlights the contrast between top-down management and transactional leadership in Fordist-Weberian hierarchies with relational coordination through lower-level transformational leadership enhancing base-up learning in the Toyota Production System. It seeks to inform hitherto inconclusive debates on the effectiveness of strategic Human Resource Management by distinguishing institutional, organisational and operational logics and the case for recognising mutual advantage from psychological contract not only between individuals or within groups but also at organisational levels. The chapter gives examples of learning from lean in health reforms in the US and Sweden, contrasts this with not learning from lean in New Public Management in the UK and also draws implications for operationalising lean management within New Public Services paradigm.