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Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

This paper aims to contribute to the debate concerning total quality management (TQM)–Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls.

Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM–Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals.

Results from the interviews show that there is a specific deployment path for TQM–Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers’ commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits.

The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry.

Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals.

The results of this research show that there is a specific, new deployment path for implementing TQM–Lean strategy in some public hospitals.

Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system.

This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors (n = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy.

Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy.

Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context.

This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.

Communities of Practice (CoPs) are increasingly being created to facilitate knowledge mobilization in organizations. This paper aims to elucidate an underexplored aspect of participation in mandated CoPs – identity reconciliation. Specifically, the authors explore how actors reconcile their existing identities with becoming members of new knowledge mobilization CoPs.

The authors conducted a longitudinal qualitative case study over a 12-month period to explore identity reconciliation practices during the formation of the “ED CoP” – mandated by policymakers to mobilize knowledge between process improvement advisors and clinicians from various hospitals. Observation and interviews allowed us to uncover “front stage” and “backstage” practices of identity reconciliation.

The findings reveal two key unexpected modes of identity reconciliation – “distancing” and “peripheral lurking”. These modes resulted in different trajectories of participation of two of the key participant groups – “veteran” improvement advisors and “veteran” clinicians.

Different modes of identity reconciliation of different participants impact the formation of CoPs and how knowledge mobilization occurs within them. This paper offers a sensitizing lens for practitioners creating CoPs which enhances awareness of hidden identity practices, and recommendations to enable practitioners to effectively facilitate CoP formation.

This study suggests that identity reconciliation is an integral aspect of CoP formation, and essential for knowledge mobilization within CoPs. Whereas studies on CoPs in the knowledge management literature have mostly assumed that collaboration produces beneficial knowledge mobilization outcomes, the findings build a more nuanced picture of the processes involved in producing these outcomes.