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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.

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.

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.

Lean culture has been noted to be an underdeveloped concept. The purpose of this paper is to increase the understanding of Lean culture by determining its leading cultural clusters.

Content analysis was used to perform top relevant keywords exploration and qualitative analysis on main text of 33 reference books, 21 Lean generic and 12 Lean healthcare, consolidated as three cases (Lean general, Lean Liker et al. and Lean healthcare).

Four emergent Lean’s leading cultural clusters: operations, change, collectivity and humanity were identified inductively from ten 10 relevant keywords, namely, in order of importance: work, time, process, Lean, system, improvement, production, patient, people and team. Saliency of the word “time” is noteworthy. Cross-validation of these cultural clusters is demonstrated through sociotechnical systems theory.

Content analysis is shown to be an effective research method enabling inductive analysis. Identification of four leading clusters should support productive further research on Lean culture.

The four cultural clusters indicate to healthcare and other domains managers, who wish to improve their Lean cultural transformation success rate, to focus their attention to what their organization actually does (operations), to how improvement happens (change) and to how everything (collectivity) and everyone (humanity) work together in their organization.

This work applies innovative content analysis on Lean reference books. It highlights the importance of time as an underappreciated Lean culture element. It provides evidence and additional support for link between Lean and sociotechnical systems theory.

The purpose of this paper is to assess the level of pragmatic ambiguity (PA) lean culture has currently in the manufacturing and service literature.

A comprehensive systematic review of academic (journals, books and theses) and commercial literature was undertaken drawn from a six databases search of two keywords (“lean” and “culture”) and related citations.

A total sample of 1,066 references (678 academic papers, 121 books, 103 theses and 164 commercial documents) were analyzed. The authors found contributions from 67 countries but oddly, only two came from Japan. In total, 89 percent of citations were directly about lean culture. However, for 86 percent of them, lean culture was only discussed superficially. All four literature segments show an over 85 percent agreement on lean culture being an organizational aim. The authors encountered 103 definitions of organizational culture and found 13 definitions of lean culture. Issues of culture gap, leadership, human resource management, sustainability and innovation are found to amplify lean culture’s already high PA level.

Further research and development are needed to decrease lean culture’s PA level and improve understanding of lean from a cultural perspective.

Current lean culture’s high PA level has positive and negative effects on lean implementation. Taking lean implementation from a cultural perspective may facilitate an organization’s lean transformation journey.

This is the first systematic literature review on lean culture using a broad and inductive approach. An original evidence-based definition of organizational culture is proposed.