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3. Review of Literature

3.1 Overview / History of Lean

3.1.1. Lean Manufacturing

This first section aims to give an overview of both the history of Lean and the development of the concept. The term "Lean" was first adopted in the 1980s (66) as it was claimed that the implementation of Lean practices resulted in using less of everything ( e.g. raw materials, labour, time, etc) compared to mass production. The Lean concept was based on the Toyota Production System, which was developed in the 1950s after World War 2 (10, 38, 66). It was introduced as an alternative to mass production techniques in the Toyota factory and led to raised productivity and quality levels by allowing the flexibility of "skilled" production with the volume efficiencies of "mass" manufacturing. The core characteristics of the Lean Manufacturing can be described as (38):

• Team-based organisation involving flexible, multi-skilled operators taking a high degree of responsibility for work within their areas.
• Active shop floor problem solving structures, central to continuous improvement activities.

• Lean operations, which force problems to be surfaced and corrected.
• High commitment human resource policies, which encourage a sense of shared destiny.
• Close, shared destiny relations with suppliers, typically in the context of much smaller supply bases.
• Cross-functional development teams.
• Close links to the customer.

Studies into the adoption of Lean practices in Japanese vehicle manufacturers have concluded that these companies have superior performance in terms of productivity and quality when compared to their European or North American counterparts (38, 39, 66). However, even though European and North American manufacturing companies have taken on board some of the principles (39, 49, 50, 66) very few have evidence of all aspects of the Lean Manufacturing model.

3.1.2 Lean Service

There has been literature with evidence of the transfer of manufacturing concepts to the service sector since the 1970s arguing that service characteristics are not an excuse for avoiding manufacturing methodologies as a means of efficiency gains (6, 29). Some studies argue that any organisation can gain substantial benefits including improved quality, reduction in costs and increase responsiveness from at least some new practices (57). Indeed supermarkets have been adopting Lean techniques for improving the flow of customers for many years (51). There are strong benefits that can be gained from implementing Lean whatever the size or sector of the organisation (19, 41, 50, 51).

3.1.3 Lean Enterprise

During the 1990s, the Lean debate moved away from best practice production techniques in automotive to other techniques / approaches and sectors. The Lean concept was extended to develop the "Lean Enterprise" which is defined as a group of individuals, functions, and legally separate but operationally synchronized companies (65). Lean Enterprises join together all the 'value-creating' activities from all the organisations and use Lean technologies and techniques. It is also claimed that the development of a Lean Enterprise aids the stimulation to innovate (48).

3.1.4 Lean Thinking

From Lean Enterprise came the idea of "Lean Thinking", which took the Lean idea further and is described as having five principles (64):

• Specifying value by specific products.
• Identifying the value stream for each product.
• Making value flow without interruptions.
• Letting the customer pull value from the producer.
• Pursuing perfection.

The five principles of Lean Thinking have become the foundation to Lean and can be used in relation to all notions of Lean, Leanness and Lean principles. However, some writings focus on the organisation (as in Lean Manufacturing or Lean Service), the supplier (Lean Supply) or customer end (Lean Consumption).

3.1.5 Lean Supply and Lean Consumption

"Lean Supply" literature focuses on the need for closer relationships between customers and a small base of suppliers as a key characteristic (27). Lean Supply considers the entire flow from raw materials to consumer, recognising that there is a cost associated with any departure from perfection in undertaking the tasks necessary to provide long-term customer satisfaction (27). "Lean Consumption" requires the integration and streamlining of the process of provision and consumption (63). The challenge is for service providers to consider total cost from the standpoint of the customer and to work with customers to optimise the process of consuming.

3.1.6 Leanness

Considering the fundamental ideas of Lean Manufacturing and Lean Thinking it is possible to develop the concept of Lean ways of working or Leanness, which can be equally well applied to a number of other 1990s management doctrines like BPR and TQM (52). There are three common reasons for introducing Lean ways of working; to cut costs, to promote efficiency and to support growth and innovation (52). Using the muscle, fat, etc, connotations of the Leanness concept, it has been suggested that what is needed is "fitness" or "strive to be fit" (52). Some organisations have embraced the notion of Leanness by adopting new working practices, including teamworking, project leadership, self-directed teams, empowerment, outsourcing, flexible working and the learning organisation.

3.2 Lean in the Public Sector

3.2.1 Lean Evidence in the Public Sector

This section particularly focuses on the evidence of Lean in the public sector, drawing on relevant ideas based on Lean Service. This evidence outlines how there are substantial efficiency gains to be made from the introduction of Lean practices and techniques in the public sector with improved customer service, quality and reduction unit costs (42, 30) as well as better planning of service operations (28). The public sector should look to manufacturing to learn about Lean, and although Lean will have to be modified to suit the peculiarities of these sectors, the principles are the same as are the lessons regarding the configurations of systems (21). However, some argue against this suitability of Lean practices outside of high volume manufacturing (17). In addition, other writers have stated that Lean ways of working are affected by the organisational context into which they are introduced ( i.e. size, sector, union presence or absence, greenfield/ brownfield site and legal framework) so Lean or Leanness is not a homogeneous or invariable concept but a context-dependent process (44).

3.2.2 Lean Application in the Public Sector

Lean principles have been adopted in various public sector organisations, although the way that they have been implemented differs depending on the organisation. This includes for example, the use of Lean production, flow, kaizen, process and value stream mapping, standardising systems and root cause analysis in hospitals to improve emergency care services, intensive care units and operating units and to reduce waiting times (1, 47, 55, 67). However there are still few empirical studies on the implementation of Lean in the public sector within both academic and practitioner literature. Some studies have been undertaken in the US on related Lean principles, which have concluded:

• There is a lack of empirical research documenting the JIT experience in the public sector. This can be attributed to the lack of such experience and its relatively new adoption (69).
• That the public sector appears to be behind manufacturing and service organisations in terms of utilising innovative operational practices such as JIT, TQM and automation (70).
• That where hospitals are trying techniques first used in manufacturing as a means of improving performance, there are no examples of a hospital that has achieved comparable large-scale transformation (71).

A study assessing the suitability of Lean Thinking in the UK health service looked at how a performance measurement system called the "flow model" was designed to identify key performance indicators that measure changes towards Lean Thinking (26). The study concluded that Lean Thinking is applicable in health care settings, and that the flow model is a suitable tool for following up these initiatives. This has practical implications for health care practitioners, who may use the findings to develop measurements of the outcome of Lean Thinking initiatives on existing care processes. However, it is argued that the flow model needs to be balanced with other measurements in order to receive a complete picture of Lean Thinking performance (26). The same study also reported similar findings in a study of the Swedish health care system (26).

In the UK, there are organisations aiming to develop and introduce the principles and practices of system thinking in the public sector. These organisations specialise in the translation of these ideas into service organisations, and have developed the term "Lean Service" (46). Using the experience and knowledge gained in local authorities, police forces, fire services and housing associations, the improvement of one particular system may be used to improve systems in other processes and departments. Every local authority has similar administration processes across different departments. If the time to make decisions can be halved and the service improved in one department, the same principles might be used to improve others.

A recent study [73] of the use of Lean Thinking to improve Social Housing revealed 80% reductions in the time taken to process repairs, a 40% reduction in the time taken to collect first rental payments, a 50% reduction in the number of steps needed to re-house and a 50% reduction in void time. This was all achieved with both significant cost reduction and improvement to the customer experience. The main caveat of this approach is that it took a "systems" approach to the implementation of Lean, which some people may regard to be a significantly different version of the approach conventionally applied.

3.2.3 Relevance of Lean in the Public Sector

Despite the lack of concrete empirical examples of successful implementations in the public sector, some researchers do believe that non-manufacturing organisations can reap rewards from Lean approaches if they look past the manufacturing-associated labels and utilise the underlying concepts (2). The essential requirements of any organisation, which might want to take advantage of these techniques, are patience, support from top management, and the presence of a change agent/champion.

However, again others have questioned the application of the Lean philosophy within the service industry. Some key criticisms have included (17):

• Human aspects: Lean systems can be seen as exploitative and high pressure to the shop floor workers. The long-term sustainability of any Lean programme is dependent on the human dimensions of motivation, empowerment and respect for people.
• Scope and lack of strategic perspective: There is a lack of discussion of strategic level thinking in Lean programmes leading to a lack of sustainability of many Lean transformation programmes.
• Lack of contingency: Lean thinking may encourage organisations to remove buffers which may not always be in use but are necessary for occasional or unforeseen factors.
• Coping with variability: Various Lean approaches manage variability and create capacity by utilising assets more effectively. In many sectors however, as demand varies the ability of Lean production systems and supply chains to cope can become the main inhibitor to the implementation of Lean.
• Over-standardisation: Service organisations are under pressure to meet individual customer needs and standardisation of services to fit the Lean model can lead to accusations of "McDonaldlisation".
• Inflexible and fragile: A truly Lean system lacks flexibility in terms of `space to experiment' and `time to think'.
• Unable to deal with uncertainties: Higher levels of Lean can remove essential levels of organisational slack, which are required to deal with uncertainty. It gives preference to efficiency over robustness and system reliability.

In some respects the evidence that critiques Lean is probably greater than the evidence that proclaims the scale of improvements using Lean, mainly due to the lower levels of vested interest by those generating the criticism. However, the evidence tends to be case-based and does not involve extensive empirical data.

3.3 Outcomes of a Lean Approach

This section presents the possible outputs and outcomes that have been and can be achieved through the implementation of Lean. Due to the majority of writings and studies to date being in manufacturing organisations then the initial material presented in this section relates to manufacturing. However, as indicated in various sections above and some evidence below some writers indicate that equal, if not more benefit, can be gained in the public sector. By presenting the outputs and outcomes of Lean in manufacturing and service it can become a useful benchmark of possible achievement that can be attained. Although, of course, it should be noted that other writers claim that a like for like comparison should not be made due to issues of context and customer requirements. From an academic perspective, the standard of the direct evidence is quite poor, with carefully selected case studies being used to promote benefits without a balanced view of the negative aspects. The work has never really established whether other factors, such as the advances in IT capability, have made a difference.

3.3.1 Successful Lean Implementation Programmes in Manufacturing

Common themes running through successful Lean implementation programmes in manufacturing are (32):

• Receiving assistance to prioritise, select and define the focus and boundary of the improvement programme.
• A high level of expertise in delivering implementation programmes using Lean practitioners with hands on process improvement expertise and relevant production management experience.
• Going for quick wins is popular and does actually work.
• Integrating accredited training and workforce development, change management and rapid improvement techniques.
• Organisations use operational measures to quantify the success of their Lean programme, with an investment of £20,000, report it delivering benefits of £100,000.
• Networks and sharing of learning has been an important way of gaining information and knowledge on Lean.

The main qualitative results from surveys of manufacturing companies are (32):

• Vastly improved customer focus was the main legacy of Lean implementation and of the new organisation created.
• Successful companies conceived and executed a strategy for change to support the adoption of Lean.
• The initial implementation of Lean was usually piloted on a smaller scale prior to the investment in training being made to expand Lean outside of the pilot area.
• One methodology does not fit all applications of Lean and methodologies and tools need to be flexible enough to fit a variety of programmes.
• The Lean toolbox is extensive with a very broad range of tools being used. Much of the support delivered to companies involves training in these tools and techniques.
• Support provided by specialist consultancies, public sector support agencies and FE/ HE was seen as effective.
• The most common areas for the application of Lean was in the production function, production planning, maintenance, supply chain management and purchasing/procurement.
• Improvements in quality reduce process cycle time, cut production costs and were likely to improve delivery performance and customer satisfaction.
• Companies found it very difficult to report on the level of investment that they had made in order to secure the cost savings they were reporting.

3.3.2 Lean Outcomes in Public Service Organisations

Within service organisations as they go Lean, there is strong evidence suggesting that costs fall, service improves and waste is reduced. In addition, because the people who do the work have been engaged in understanding it from a different point of view and changing it, morale improves. And finally, because the system has been changed (in particular roles and measures) there is the means for continuous improvement (46). The following are quoted as examples of efficiency gains in the UK public sector where Lean principles have been applied:

• Halving the end-to-end time for planning applications.
• Halving the time for voids in council houses.
• Cutting end-to-end processing time for high demand adaptations from disabled people from over 200 days to 12 days.
• Payroll errors reduced from 75% to 2%.
• Reducing backlog in lost and found departments by 80%.
• Reducing the time taken in report production from 77 to 6 days in the Justice system (46).

There is also evidence of other benefits in the public sector (67). Using the Lean approach, some hospitals have traced problematic infections in some patients to their source, prompting changes in the way that intensive-care units inserted intravenous lines. The result was a 90% drop in the number of infections after just 90 days of using the new procedures. It also made good business because the fall in infections led to savings of almost half a million dollars a year in intensive-care-unit costs.

Reported outcomes from a kaizen blitz in another hospital case study include dramatic performance improvements by capitalising on many hands and minds working together with a common focus. This includes 97% reductions in throughput time and 50% reduction in space required (34). The process, often led by practitioners, gives other benefits which help to demonstrate employee empowerment, development of cross-team synergies and provide lessons in best practice by actual use - e.g. process mapping.

A range of benefits were also listed in a study on initiatives, in which JIT approaches were used with the implementation of new Information Technology systems ( e.g. Enterprise Resource Management) to improve business processes in a large public sector organisation (11):

Accessibility:

• 39% decrease in reference to others for information
• 56% increase in respondents indicating "frequent" or "constant" use of electronic resources

Productivity:

• 60% increase in respondents indicating a 75% or greater reduction in time required for accessing information
• 61% increase in respondents indicating a 75% or greater reduction in time required for taking action on information

Customer satisfaction:

• 95% increase in respondents indicating satisfaction with the new processes
• 94% increase in respondents indicating preference for the re-engineered electronic processes.

3.4 Lean Thinking in Practice

3.4.1 The Five Principles of Lean Thinking

This section builds on the five main principles of Lean Thinking outlined in section 3.1 to highlight the other key concepts and the content of Lean Thinking within literature. These include (20, 61):

• Managing the business from the customer definition of value.
• Creating end-to-end primary processes to design, deliver and support this value, with minimum waste, together with the appropriate support processes.
• Building a management system to develop, sustain and improve these processes over time.
• Being clear about the customer purpose before designing the processes; and then organising the people to sustain this.

3.4.2 Lean Techniques

In order to apply Lean Thinking in the public sector, the literature builds on the definition of the Lean business system and the challenge of obtaining value from each process (20, 61, 62). However due to the specific nature of the public sector, the Lean concepts may need to be transferred into a more user-friendly language (42). The standard Lean techniques and their applicability in the public service could be:

• Value. Organisations need to determine what aspects of the service are critical to quality and what are the key characteristics. It may also be useful to identify who the real customer is and better understand their requirements.
• Value Stream. Identifying the value stream and measuring how and when value is added helps to identify and remove waste. In services it can be hard to see waste, work in progress and problems.

• Flow. Adopting standard operations and identifying best practice can achieve the maintenance of a high rate of flow and quality through value chains. This allows the routine to run more smoothly, freeing up time for creativity and innovation.
• Pull. This focuses upon the customer demand and trigger events backwards through the value chain. Thereby linking activity to customer needs. However, customer demand is not always clear in a service environment and effort is required early to understand this area (42).
• Perfection. Striving for perfection is an important element of Lean embedding continuous improvement in the culture. Continuous improvement ensures that non-value adding activities are removed from the value chain.

3.4.3 Lean Measurement in Health Care

In an evaluation of Lean Thinking in health care, some writers (26) have used the five elements of the Womack and Jones Lean model to discuss how applicable Lean is to health care and, in particular, how measurement can be used to reflect this application:

• Specify Value - putting the patient at the centre means measures such as medical quality, waiting times and patient satisfaction are key.
• Identify Value Stream (to eliminate "wasteful" activities) - they suggest process mapping is key and the degree to which this happens is a key measure, as is the amount of time spent by medical staff on patient contact, and waste in the referral process.
• Flow - measurement might include the number of times demand for care can be matched with capacity, the ability to smooth demand by scheduling, improving flow through the use of multi-skilled teams, and transparency through information;
• Pull - waiting times and delays are key measurements of the effectiveness of this element.
• Perfection - policy deployment is key, with measures feeding into a balanced scorecard.

This study examines how well the "flow model" used in the Swedish health care system provides measures which support all five Lean principles. The study found that additional measures e.g. policy deployment, patient satisfaction and continuous improvement are needed in order to fully capture the changes towards Lean thinking. The study also suggests that designing a performance measurement system that reflects Lean initiatives is one important phase in implementing Lean Thinking in the entire organisation (26).

3.5 Organisational Readiness

3.5.1 Defining Organisational Readiness

The readiness of an organisation to take on board change, and particular concepts like Lean, are critical in allowing successful implementation. Organisational readiness is concerned with the ability of an organisation to take on board change, together with deciding which concepts to implement. It is related to organisational barriers (see section 3.7), although readiness could be considered as the point before implementation and so before the barriers may appear.

This section considers studies on organisational readiness, drawing mainly on associated concepts such as Just In Time ( JIT) and benchmarking. Lean has the potential to increase the operational efficiency, service quality and organisational effectiveness of the public sector, but there are several prerequisites for gaining such benefits. Therefore, this section will describe some ways for this potential to be achieved, related to how public sector organisations must modify their operating procedures, production systems and organisational culture. A study of the application of JIT into the public sector suggested the consideration of the following issues in order to enhance its potential success (69):

• Training of management and employees in order to create an organisational culture, which is consistent with the JIT organisational philosophy.
• Establishment of new procedures for dealing with suppliers. These procedures should define the criteria for suppliers based on quality, cost and timing.
• Analysis of operations to identify areas where standardisation, simplifications and automation are needed. Operational processes and procedures should be re-engineered based on this analysis prior to the implementation of JIT.

3.5.2 Benchmarking to aid Organisational Readiness

Benchmarking is the process of learning from others. It involves a comparison of one's own performance and/ or methods with those of others. Empirical studies provide actions that can be used by manufacturing, service and public sector organisations to reduce implementation problems and improve their chances of a successful benchmarking implementation. As the operating systems of these organisations share fundamental similarities, they can all gain significantly from cooperative benchmarking. The following conclusions are drawn (68):

• System-wide pre- JIT modifications appear to reduce the potential for JIT implementation problems. This is especially the case for public sector organisations, which should learn the lessons from the manufacturing experience.
• Pre- JIT modifications appear to enhance JIT success, especially for public sector organisations where both operations- and procedures-related modifications are associated with JIT success.
• Top management should champion the initiation of the JIT effort, while leaving involvement in the details of the implementation process to other internal constituents and external partners such as customers and suppliers.
• Organisations that follow a differentiation business strategy appear to have more success with JIT.
• Industry leaders tend to have more success with JIT than others in their industries.

A benchmarking study by a public sector organisation looked at the contribution business management systems make to achieving organisational objectives (37). The aim of the study was to improve the architecture, management, control, communication and deployment of the organisation by reviewing current best practice. The study concluded that benchmarking was not about just visiting other people but of the need to align management systems and Lean improvement programmes with business strategy (37).

3.5.3 Public Sector Experience

Drawing upon experiences in local government, the evidence suggests a need to drive continuous change through performance management through a bottom up approach (45).

There is literature on how higher education institutes can be supported towards making the transition to managing and behaving commercially while continuing to focus on the provision and continuous improvement of an effective service (7). Education of those within the organisation is proposed as a means of moving the organisation towards managing and behaving commercially without adversely effecting political ties and while continuing to focus on the provision of an effective service. However this is recognised as not being an easy task. There is also the need for the workforce within higher education institutes to trust their managers to help them understand their own organisational culture, its political frameworks and work practices, to work with them in order to build new relationships.

3.5.4 Recognition and Consideration

There has been a study looking at the standards of quality that can be expected from public services (72). This has highlighted a number of factors in improving quality where customer and suppliers influence the limiting factors. The fact that there are in-built limits can provide an excuse for doing nothing about quality. However the development of quality is an incremental and continuous process, which needs to be undertaken. Recognising and accepting these limitations means that expectations by service provider and customer can be realistic and shortcomings more readily accepted.

Other considerations that should be taken into account when implementing Lean include (40):

• The need to ensure that Lean does not mean a loss in humane aspects of work i.e. over standardisation of the process so that little human ability is required.
• Lean should be appropriate to the organisational strategy and teamwork but should also take into account the productive capacity of the organisation as well as the non-productive capacity.
• Lean should be associated with fitness for purpose.
• Lean means having the optimal amount of particular resource for the circumstance in question.

3.6 Prerequisites for Lean

In this section we explore and describe the prerequisites for Lean both in terms of implementation process and the technical content of organisation change. Section 3.6.1 focuses upon the commonly cited implementation success factors. Sections 3.6.2 - 3.6.5 consider tools, techniques and concepts that may be implemented in advance of full Lean implementation, either as prerequisites or as approaches used to test the validity of Lean in a new context.

3.6.1 Key Elements for Change Programmes

The implementation and embedding process of Lean can be considered as another critical element of the whole approach in order for the benefits to be realised. This section presents the elements that need to be considered when embarking on Lean. However, in general it has been stated that the key lessons that have been derived from implementing change programmes, which include Lean, include (49):

• Need to change existing attitudes, behaviours and practices.
• Full and ongoing support from top management.
• Need for a champion to drive the change initiatives and maintain momentum.
• Realisation by everyone that it will take a long time
• Engaging employees as much as possible in the planning, implementation and evaluation of changes (31).
• Developing an environment of openness and trust through communication and sharing information.

3.6.2 Value Stream Mapping

Value Stream Analysis or Mapping is often cited as a technique that can be used in order to decide which tools to use to reduce waste in specific circumstances (18). This involves:

1. Identifying the specific value stream to be reviewed.
2. Interviewing managers to identify the various wastes that should be removed.
3. Obtaining views regarding the complete industry structure.

Further discussion on Value Stream Mapping and Analysis is in section 4.1. However, the model claims to have a practical and research use. For research, the model can be used to operationalise Lean production to study the change process properly. In practice the model can be used to assess the developments taking place in an effort to become Lean and as a checklist for what to aim at when implementing Lean (23).

3.6.3 Kaizen Blitz

Another study has demonstrated how to implement a "kaizen blitz", which in turn implements Lean ideas in an organisation, within two days and described how to achieve dramatic performance improvement with employee buy-in through this process (34). A kaizen blitz is a rapid improvement effort that emphasises teamwork and innovation to increase employee ownership and productivity in both traditional and just-in-time cellular flow process. The process is best carried out by a cross-functional team of six to ten people - including suppliers, customers, and at least one person from outside the area under study to encourage out of the box thinking. The process includes freeing participants of any other responsibilities during the blitz and informing those working around them that it is about to happen. This is followed by:

• Recording the as-is process performance.
• Evaluating the process as it is now.
• Developing a new work combination (workflow).
• Redesigning the process flow.
• Implementing the new process flow.
• Re-measuring the new flow.
• Reviewing the results.

3.6.4 Developing a Process Understanding

A complex health care system considered the implementation of a cellular approach, where 'families' of services are grouped together, in order to re design the tasks and make their impact more visible. Therefore, the design and implementation process undertaken was a series of stages (56):

• Understanding the nature of demand volumes and seasonality
• Assessing the actual process sequence for the systematic sample of patients
• Clustering patients in segments of similar processes
• Identifying the process flow of each patient
• Designing the process flow
• Testing new flow for delays
• Assessing results and implementing improved processes

A project was undertaken using this approach to help reach the target for an Accident and Emergency department to treat, discharge or transfer 90% of patient arrivals within 4 hrs. Relating this to Lean the project was undertaken with the objective to improve care, staff satisfaction and variability in the treatment process (56).

3.6.5 Developing Relevant Training and Involvement

For successful implementation Lean practice implies a pre requisite is having the right employee in the right position. This means Human Resource practitioners need to review the reliability of their selection programmes for every level of the organisation (14). As a result, amended training needs implies:

• Replacing managerial development programmes with individual continuous development, competence based programmes, focusing on the skills individuals need as they climb the organisation.
• Broadening the training available to team members to include different processes and techniques, training in continuous improvement allowing individuals to alter their workplace and solve their own problems.
• Industrial relations may become strained through the changes and improvements caused by Lean practices. There is need for managers to create trusting and open communication with trade unions (14).

Developing a culture that creates the involvement of everyone in the organisation is a critical element of the Lean philosophy (66). Everyone in the organisation needs to be trained in the Lean philosophy concepts as well as the planning, design, implementation and evaluation of the changes so that Lean is driven by all the people, usually through teams, in the organisation not just the senior management (19, 49, 50).

However, this development of teamworking and involving everyone in the Lean approach needs to be handled carefully as it can lead to teamworking characterised by significant responsibility being given to the team leader, rather than team members, and the use of continuous improvement techniques that make marginal improvement in standard operating procedures. A set of case studies looked at the introduction of team working in the Inland Revenue in the UK (8), where teamworking was implemented to facilitate the introduction of a new tax regime in the face of reduced numbers of middle managers and clerical employees. In this study certain human resource policies and practices had an effect upon its implementation. The study concluded that because the primary motivation for introducing teamworking was economic, the scope for increasing the autonomy of team members was limited. However, the change in management style that came with the implementation meant that there was increased autonomy, but that this resided with team leaders.

3.7 Organisational Barriers

3.7.1 Summary of the Barriers to Change and Improvement in the Public Sector

Having discussed Lean in terms of its history and content this section outlines the studies of the public sector in the UK that have highlighted various organisational barriers to the successful implementation of 'Lean principles' and associated techniques. These studies have concluded that barriers to continuous improvement and increasing business excellence include (16, 47):

• Public sector culture.
• Lack of clear customer focus.
• Too many procedures.
• People working in silos.
• Too many targets.
• Lack of awareness of strategic direction.
• Lack of 'buy-in' by staff
• General belief that staff are overworked and underpaid.
• Domination by stakeholders.
• A lack of understanding of the effect of variation, systems thinking and process flow.

The studies presented in the articles in the literature review referred to many of these barriers. However, some were mentioned more than others, related to the public sector, and so are discussed a little further.

3.7.2 Lack of Understanding of Variation, Systems Thinking and Process Flow

In the literature there are debates between the role of variation reduction in the service sector in contrast to that of manufacturing (33), claiming that there is a need to accept greater variability in service outcomes and a need to develop ways of achieving necessary flexibility. A study evaluating lean techniques in the health sector examined the causes of excessive queuing in the NHS, which results in patient backlogs and long waiting times (47), suggesting that the variation between demand and capacity is the major issue. Poor understanding of this leads to ineffective capacity planning. However these studies propose to eradicate queues in the NHS by advanced access systems, which emphasise the need to properly understand and manage patient flow. Many hundreds of NHS teams are already using these principles with promising results. Given concerted leadership action, staff capability building and new systems to match demand and capacity on a daily basis, it would be possible to develop 'low wait' or even 'no wait' services across the NHS.

Under the concept of "Lean Service", system thinking requires understanding work as a system. This leads to managing flow rather than function. It requires the development of different measures and methods. If this understanding does not exist it may cause a potential barrier to full implementation and the realising of benefits which can lead to a reduction in the number of steps, in end-to-end time, in waste, and cost but, overall an improvement of service (46).

3.7.3 Lack of 'buy-in' from Staff

For the public sector similar barriers to the adoption of Lean tools and techniques exist due to the lack of the necessary skills, capability, experience and understanding (42). In studies looking at the adoption of Lean techniques in US hospitals, the following problems were highlighted (67):

• Hospitals are not factories.
• Doctors, nurses and other hospital staffers do not think of themselves as assembly-line workers or their patients as a product under construction.
• There is a clash between the culture of efficiency and the culture of caring.
• Doctors are sceptical and do not want to be told how to do things.

There have also been attempts to develop more effective public management and more efficient public services through continuous improvement, business excellence and other change management practices in Northern Ireland (16). This has highlighted:

• Public sector management context: sector is heterogeneous, concept of customer is contestable, issues relating to the provision of services rather than goods; and the political dimension especially around definition of quality.
• Performance measurement: although attempts had been made through the Business Excellence ( EFQM) model, the difficulties of measuring performance ( e.g. the lack of an overall measure such as profit) have led to a lack of effective performance measurement.

3.7.4 Public Sector Culture

Specific employee-related barriers that organisations can come across when implementing change programmes, including continuous improvement and Lean principles, include the following (49):

• Making employees aware that there were better ways of performing the tasks they had been doing for years
• Changing attitudes of people in the shop floor and making them realise that waste means lost time and money.
• Developing and maintaining discipline especially getting operators to produce only the required quantities.

Educating the employees is cited as being critical in overcoming these problems.

There are particular people issues that surround Lean techniques (59), which have been mentioned in the literature. Unions see Lean techniques as intensifying the work effort, increasing management control and undermining the independence of trade unions. Kaizen is seen as appropriating workers' knowledge and employees will not work for improvements to which they fall victim. Therefore, any change needs to be non-threatening. The way to gain higher efficiency and higher quality of work and jobs is through "teamwork" and giving responsibility for standard operations to the production people. Also, eliminating waste does stretch the system and can create pressures. Therefore, the aim must be to create Lean "people-centred" production.

3.7.4 Improvement Implementation Issues in Higher Education

Studies looking into the adoption of TQM have had similar conclusions. A study into the implementation of TQM in three higher education institutions in the UK and the US, highlighted a need to develop more market-based approaches in higher education. The professional (specialist) nature of employment within universities was also seen as a challenge for team-based working (53). A survey of the practice of TQM within UK higher education institutions provides evidence of low adoption with some differences across colleges, new and old universities (22). Some organisations did not fill in the questionnaire, explaining that they lacked the quality management processes. TQM was only adopted in academic functions only. The specific results were:

• Only 4 organisations practice TQM.
• 72.5% of organisations define quality as "fitness for purpose".
• 5.9% of organisations show "customer awareness".
• 31% of organisations benchmark.
• 32 reasons for quality management identified.

3.7.5 Improvement Implementation Issues in Government Departments

A case study of quality restructuring in local government and the trade union response highlighted that quality is essentially managerially driven and must be understood as part of the process of local government restructuring (13). There is no neutrality of quality management, nor can trade unions simply adopt it for their own purposes. Public sector managers and staff may have a joint desire for quality outcomes for service users but they do not share the same language of quality in relation to process. Workers' responses to quality initiatives may contain important contradictions. There may be confusion between process and outcome, which can lead to support for quality as an undifferentiated "good thing". The actual experience of managerial quality strategies may be very different as they are often used to challenge traditional systems of job regulation.

Case studies of implementing TQM in government departments show that quality initiatives in HM Customs and Excise were coupled to a delayering strategy (reduction of management layers and so, managers) and in the Benefits Agency, to efficiency gains (36). This had an immediate benefit to empowerment by saving staff costs and budget-driven efficiency gains. However quality changes are part of a continuous process, and with empowerment initiatives pushed through alongside cost control measures, there remains the possibility that these improvements were driven by fear rather than by a genuine commitment to improve.

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