Since the dawn of New Public Management (NPM) the healthcare sector has been the target for several concepts imported from the private sector. This study takes its departure in the widely spread management concept Lean. Originally developed in the Japanese auto-industry the concept has diffused globally. During the past decade, interest in Lean has grown significantly in the healthcare sector in Sweden. Lean is used to achieve a process oriented care beyond NPM.
The purpose of the study is to explore and investigate Lean in this particular context. We analyze the development of Lean to situate the state of institutionalization. We draw upon the ideas of management concepts as fashions to problematize and contrast the potential legitimacy gains of adaptation in relation to their diffusion and representation. The study covers Lean efforts in the healthcare sector by using a rhetorical text analysis of annual reports in which we track the development of the discourse of Lean.
Our contribution is related the observed evolution where reasons to adapting Lean has surpassed a turning point, from legitimacy towards institutionalization where operationalization of Lean thoughts are approaching a state of becoming taken-for-granted.