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A conceptual model of Lean culture adoption in healthcare

Marc Dorval (Nephrology, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, Canada)
Marie-Hélène Jobin (Logistics and Operations Management, Ecole des Hautes Etudes Commerciales, Montreal, Canada)

International Journal of Productivity and Performance Management

ISSN: 1741-0401

Article publication date: 3 May 2021




This work seeks to offer a greater understanding of Lean healthcare implementation challenges conceptually taking a situated cultural organizational change perspective.


A descriptive model of healthcare organizations’ Lean adoption trajectories is built using ripple and bridging modelization strategies from elements of three classic organizational change theories and knowledge from Lean, organizational culture, healthcare and operations management literature.


The “contingent Lean culture adoption” (CLCA) model suggests five theoretical trajectories the healthcare organizations may experience when conducting a Lean transformation. These trajectories evolve from a new concept of Lean cultural friction (LCF) which represents cultural friction that a healthcare organization encounters toward an ultimate Lean culture proficiency state through time. From high to low initial LCF, a healthcare organization may in its Lean proficiency course end up in three states: lower, similar or higher LCF situation.

Research limitations/implications

The CLCA model demonstrates the potential to be developed into a framework and possibly a Lean cultural friction theory pending further qualitative and quantitative validation.

Practical implications

The CLCA model may help healthcare managers to use more appropriate cultural change strategies during their organization’s Lean journey.


This work enriches the concept of Lean cultural change which may apply not only to healthcare organizations but also to other ones. It suggests the existence of a healthcare organization Lean culture proficiency archetype and introduces the notion of Lean cultural friction.



The authors would like to thank Dr Nicky Shaw for her insightful comments on work-in-progress versions of this manuscript.


Dorval, M. and Jobin, M.-H. (2021), "A conceptual model of Lean culture adoption in healthcare", International Journal of Productivity and Performance Management, Vol. ahead-of-print No. ahead-of-print.



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