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Kiri Hider, MPH 2011


Lean thinking is a manufacturing tool, increasingly being applied to healthcare. The focus of this research is on midwives' perceptions of lean thinking in a tertiary birthing unit. Such a study is important, as there is a paucity of research into the realities and experiences of healthcare staff working in a lean environment. As well as lean impacting on what is already a high paced environment, lean has the ability to place extra demands on staff with the potential for negative health consequences. By giving voice to midwives' experiences and perceptions of lean, this dissertation may provide a valuable insight for hospital management when considering adopting lean methodologies or evaluating lean outcomes.

The research approach adopted in this dissertation was a qualitative methodology, as it sought to explore midwives' views and experiences of lean thinking. Information was gathered via in-depth interviews of six midwives who worked at Canterbury District Health Board's tertiary birthing unit. The interviews were audio taped, transcribed, and then analysed, using thematic analysis.

Three main findings emerged from the research. Firstly, the adoption of lean was piecemeal and not well understood by participants, which resulted in lean tools being utilised without an apparent whole system wide approach to lean. The second theme highlighted dissatisfaction with maternity service's management and an unsupportive culture that made lean unlikely to succeed. The third and final theme identified that post lean implementation, lean methodologies and staff input were not involved in designing the new recovery and acute observation room, which resulted in spaces that were unworkable, lacked flow and which participants felt were potentially unsafe.

The conclusions that can be drawn from this study are that division between management and staff were underpinned by management's non-engagement of workplace issues or the realities midwives faced. Birthing suite revealed a culture where lean initiatives were unlikely to thrive and had the potential to impact on employee health. Furthermore, this study recommends the addressing of the current culture in maternity services, as well as a whole organisation approach in adopting lean in accordance with all lean methodologies. Finally, that the Canterbury District Health Board carries out an evaluation of lean practices incorporating staff satisfaction. If these recommendations are taken, lean has the ability to make positive changes in maternity services both for the organisation and the midwives.

Supervisor:Gillian Abel

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