Graduate School of Business


Doctor of Business Administration (DBA)


Brenda Palmore


Lean Management System, Healthcare, Improvement Culture, Leadership




Lean healthcare is a field of research that studies the use of effective goal setting and scientific thinking to drive improvements in the healthcare industry. Lean has been effectively applied in healthcare settings to improve efficiency, patient satisfaction, clinical outcomes, and safety. There have been, however, varying degrees of success achieved in healthcare organizations effectively implementing a lean management system. The problem addressed in this research is that many healthcare organizations in the United States that seek to improve quality and reduce costs by implementing a lean management system are unable to sustain the lean management system thereby missing out on achieving the long-term benefits of lean. There is a gap in the literature regarding the key factors and influences that might explain why some healthcare organizations are unable to achieve sustainable improvements with lean and why some are successful. The study utilized a flexible design using qualitative methods and multiple case studies of contemporary health systems in the United States. The goal of the study was to identify what cultural, leadership, or other systemic factors contribute to some organizations successfully achieving long-term success with lean. The researcher obtained lived experiences from 16 different lean leaders from 10 different healthcare institutions during individual interviews through a series of open-ended questions. The data obtained from the interviews was analyzed and coded. Common codes were identified across the inputs through triangulation from multiple sources and resulted in specific themes. The 10 key conclusions that resulted from these themes combine the contemporary experiences of lean leaders from health systems with successful lean management systems.

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