‘Lean Dancing’: How Involvement in Continuous Improvement and Lean Techniques Relate to Hospital Performance and Workers’ Wellbeing Through Autonomy

This study examines Lean—conceptualized as Involvement in Continuous Improvement and Lean Techniques—in hospitals. Specifically, we aim to determine the extent to which hospital workers’ perceptions of Lean are related to perceptions of their performance and wellbeing, and to what extent these relationships are explained by autonomy. Our data (n = 754) come from a Lean implementation study in a Dutch hospital, and are analysed using structural equation modelling. First, our results indicate that Involvement in Continuous Improvement positively relates to hospital workers’ perceptions of several dimensions of hospital performance (quality, service, efficiency, and predictability) and their own wellbeing (burnout and engagement)—a mutual benefit for both employer and employees. However, we also show that the Lean Techniques do not significantly relate to wellbeing. Second, our study reveals that it is essential to distinguish between responsible autonomy and choice autonomy, as we found differing mediating effects. Based on these findings, we recommend HR executives to move away from approaches that focus on happy few and to move away from approaches that focus on techniques.