Contextual factors: assessing their influence on flow or resource efficiency orientations in healthcare lean projects

The outcomes of lean projects have been mixed, with some being successful while many others have not. An explanation for this is a paradox that can develop depending on the focus of the project. Ironically, in projects where the focus is on maximizing the efficiency of a resource (‘resource efficiency’), this focus might lead to worsening of the resource’s efficiency, thereby generating an ‘efficiency paradox’. This paradox does not usually arise in projects where the focus is on the subject of interest being processed through the system in the most efficient manner (‘flow efficiency’). The aim of this paper is to investigate the factors that give rise to either form of efficiency. We conducted a detailed study of eight lean projects in two large hospitals. In doing so, we advance the theory of lean service operations by identifying four key contextual factors that drive the orientation of a project to resource or flow efficiency. These are: service variety, interdependency, capital resource intensity, and service uniqueness. We propose a conceptual framework and four propositions that integrate the contextual factors to determine the dominant focus in lean projects. Through this, recommendations are made as to how the efficiency paradox can be avoided.