Casting the lean spell: The promotion, dilution and erosion of lean management in the NHS
基于对英国一家大型公立医院三年的民族志研究，发现精益管理最初被作为希望机制推广，但随后被模糊化、稀释并最终侵蚀，挑战了精益在公共部门快速扩散的主流观点。
Lean thinking has recently re-emerged as a fashionable management philosophy, especially in public services. A prescriptive or mainstream literature suggests that lean is rapidly diffusing into public sector environments, providing a much-needed rethink of traditional ways of working and stimulating performance improvements. Our study of the introduction of lean in a large UK public sector hospital challenges this argument. Based on a three-year ethnographic study of how employees make sense of lean ‘adoption’, we describe a process in which lean ideas were initially championed, later diluted and ultimately eroded. While initially functioning as a ‘mechanism of hope’ (Brunsson, 2006) around which legitimacy could be generated for tackling longstanding work problems, over time both ‘sellers’ and ‘buyers’ of the concept mobilized lean in ambiguous ways, to the extent that the notion was rendered somewhat meaningless. Ultimately, our analysis rejects current prescriptive or managerialist discourses on lean while offering support for prior positions that would explain such management fashions in terms of the ‘life cycle of a fad’.