Casting the lean spell: The promotion, dilution and erosion of lean management in the NHS

Leo McCann*, John S. Hassard, Edward Granter, Paula J. Hyde

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Citations (Scopus)


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’.

Original languageEnglish
Pages (from-to)1557-1577
Number of pages21
JournalHuman Relations
Issue number10
Early online date8 Apr 2015
Publication statusPublished - 1 Oct 2015


  • fad life cycles
  • fads and fashions
  • Foundation Trusts
  • healthcare management
  • lean healthcare
  • lean production
  • NHS restructuring

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • General Social Sciences
  • Strategy and Management
  • Management of Technology and Innovation


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