Problem-solving behaviour of nurses in a lean environment

J Nurs Manag. 2019 Jan;27(1):35-41. doi: 10.1111/jonm.12646. Epub 2018 Aug 6.


Aim: To investigate how the extensiveness of a lean implementation-that is, the extent to which lean as a new practice is adopted across nursing departments-relates to second-order problem solving behaviour of nurses.

Background: Lean implementation is expected to stimulate nurses' second-order problem-solving behaviour.

Method: We used a vignette-based survey to look for differences in second-order problem-solving behaviour in early-adopter and late-adopter departments at two hospitals with differing degrees of extensiveness of lean implementation.

Results: At the hospital with an extensive lean implementation, nurses at the early-adopter department showed 71 second-order problem-solving responses from 50 problem scenarios, as compared with 39 responses from 37 scenarios in the late-adopter department. At the hospital with a less extensive lean implementation, these numbers were 16 from 23 compared with 18 from 19.

Conclusions: The nurses in the hospital with an extensive lean implementation show more second-order problem-solving behaviour than those in the hospital with a stand-alone approach in a single department.

Implications for nursing management: Extensive lean implementation where management clearly shows its belief in lean is a more favourable environment for changing the problem-solving behaviour of nurses.

Keywords: implementation; lean health care; nursing; problem-solving behaviour.

MeSH terms

  • Health Resources / supply & distribution*
  • Humans
  • Nurses / psychology*
  • Nurses / standards
  • Nurses / statistics & numerical data
  • Problem Solving*
  • Surveys and Questionnaires
  • Total Quality Management