Fools' Gold - Lean Management in the Health Sector

  • Bryan McIntosh Richmond University Queen's Road Richmond-upon-Thames TW10 6JP England
  • Ivan k Cohen Richmond University, The American International University in London, 16 Young Street, Kensington, London W8 5EH,
  • Bruce Sheppy Richmond University, The American International University in London, 17 Young Street, Kensington, London W8 5EH,
Keywords: Lean management, operational efficiency, patient outcomes, health care, health sector


Purpose: This paper provides a critical evaluation of the impact of lean practices in informing healthcare policy.

Methods: Review of primary and secondary literature.

Results: There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to address rising healthcare spending and disappointing patient safety indicators. This encompasses a number of practices in Operations Management and Human Resource Management, including Just-in-Time (JIT), Total Quality Management (TQM), Total Productive Maintenance (TPM), employee empowerment, and extensive training. Used together there is great potential to improve overall firm competitiveness. However, despite widespread enthusiasm about the potential of lean management processes, evidence about its contribution to higher organisational performance remains inconsistent.

Conclusion: Our paper contributes to the organisational management literature in healthcare by showing that even though lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

Author Biographies

Bryan McIntosh, Richmond University Queen's Road Richmond-upon-Thames TW10 6JP England

Dr McIntosh originally was employed as a political researcher at the House of Commons, and then in local and national Government prior to becoming an academic.

Dr McIntosh has researched many areas of Business and Management since 1987, this has been concerned with operational efficiency in the national and international context. Recently, his research has concentrated on Lean management approaches in small and large scale organisations.

He has lectured and worked in research at Edinburgh Napier, the University of Surrey, the University of Greenwich and latterly King's College London.

Dr McIntosh holds a PhD BA HONS (First) Sociology and History.

 Areas of Expertise

Health Economics, Leadership, Management, Marketing and Entrepreneurship.

Dr McIntosh is a member of the editorial board for British Journal of Healthcare Management dealing with commissioning and content.

PublicationsCommissioned reports
  • McIntosh B (2006) “The effectiveness of media projects upon social inclusion in deprived areas: ‘Young People Speak Out’ - a case study”, Report for the Unemployed and Volunteer Action Fund - Dunfermline.
  • Cohen, I, McIntosh, B & Richardson, M A (2011), “Fiscal and economic stability in the eurozone”, Adam Smith Institute – Working Paper 31st January 2012
Contributions to Edited Volumes
  • McIntosh, B (2008) “Sectarianism in the inter-war period” in Tatchell, P, A perspective in equality and diversity London: Kogan Page.
Papers in refereed journals
  • Chambers, D & McIntosh, B (2008) “Using authenticity to achieve competitive advantage in medical tourism in the English speaking Caribbean”, Third World Quarterly Volume 29(25), 919-937
  • McIntosh, B (2011), “Lean management in the NHS the hidden agenda” Health Service Journal, Issue 6286, 20
  • McIntosh, B (2012), “The future of Midwifery practice and roles”, British Journal of Midwifery, (20) 1, 69
  • McIntosh, B, Cookson, G & Sandall, J (2012), “A call to arms - the efficient use of the maternity workforce”, British Journal of Midwifery, (20) 1, 122-127
  • McIntosh, B (2012), “The future of mental health resource management”, British Journal of Healthcare Management, (18) 2, 7
  • McIntosh, B & Cookson, G (2012), “Lean management in the NHS – fad or panacea”, British Journal of Healthcare Management, (18) 3, 96-101
  • McIntosh, B, Cookson, G & Jones, S (2012) “Cancelled surgeries and payment by results in the English National Health Service”, Journal of Health Services Research & Policy, doi: 10.1258/jhsrp.2011.011053
  • McIntosh, B & Bewley, S (2012), “How far can a complex system with increased interventions be pushed? The way forward is to innovate”, British Journal of Midwifery, (20) 3, 170-172
  • Aiken, L, Sermeus, W, Van den Heede & McIntosh, B et al. (2012), “Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States”, British Medical Journal, 2012;344:e1717 doi: 10.1136/bmj.e1717
  • McIntosh, B & Voyer (2012), “A Perverse psychological contract”, British Journal of Healthcare Management, 18 (6), 290 – 291
  • McIntosh, B & Cohen, I & Sheppy, B (2012), “Heroes or villains – whistle blowing and the Poly Implant Scandal”, British Journal of Healthcare Management, 18 (7), 130-135
  • McIntosh, B (2012), “A necessary change: the transfer of care from hospital to community”, British Journal of Community Nursing, 17 (7), 325
  • McIntosh, B & Holland, A (2012), “Improving delivery - the need for empowered HCAs”, British Journal of Healthcare Assistants, 6 (7), 346-347
  • Cookson, G, Jones, S & McIntosh, B (2012), “Cancelled Procedures: Inequality, Inequity and the National Health Service Reforms”, Health Economics, First published online: DOI: 10.1002/hec.2860
  • McIntosh, B, McQuaid, R, Munro, A & Dabir- Alai, P (2012), “Motherhood and its impact on career progression – the case of Scottish nurses 2000-2008”, Gender in Management: an International Journal, 27 (5) 
  • Holland, A & McIntosh, B (2012), “Optimizing productivity, quality and efficiency in Community Nursing”, British Journal of Community Nursing, Volume 17, Issue 8, 258-261
  • McIntosh, B & Watt, S (2012), “Snakes and ladders - human resources in nursing”, British Journal of Nursing, 21 (15), 826
  • McIntosh, B & Smith, S (2012), “Skill mix – Healthcare Assistants and their role in quality healthcare”, British Journal of Healthcare Assistant, Volume 6, Issue 8, 396-399
  • Bruyneel, L, Li, B, Aiken, L, Emmanuel Lesaffre E, Van den Heede, K, Sermeus, W & McIntosh, B (2012), “A multi-country perspective on nurses’ tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries”, International Journal of Nursing Studies, DOI:
  • McIntosh, B & Watt, S (Forthcoming 2012), “A shadow on the future - the impact of gender perceptions upon women’s career progression in nursing”, Nursing Standard
  • Voyer, B & McIntosh, B (forthcoming 2012), “The Psychological Consequences of Power on the Self-perception of Leaders and Followers - Implications for Leadership Research”, Leadership & Organization Development Journal
  • McIntosh, B, Scotiabank Toronto, (16th April 2009), “Flexibility in the Labour market – Certain Gender Issues” – Speaker
  • McIntosh, B, 28th Annual International Labour Process Conference Rutgers University, (15 - 17, March 2010) “Special Interest Stream: Representations and Realities of Women’s Work” – Speaker.
  • McIntosh, B & Guest, D, Social Dimensions of Health Institute Conference, Saint Andrews University, (26-27 June 2011) “Lean Healthcare fad or panacea?” – Speaker.
Ivan k Cohen, Richmond University, The American International University in London, 16 Young Street, Kensington, London W8 5EH,

Ivan Cohen began his career at Richmond in 1999, working primarily on the MBA programme. His research specialty is pensions and pension funds, particularly those in the UK. As well as considering the optimal structure for the provision of pensions, Ivan is also working in the implications of pensions' provision on the corporate and financial sectors of the economy. He is a consultant to small self-administered pension funds.In 2004, Ivan appeared on CNN to discuss the 75th anniversary of the Wall Street Crash of 1929.

Before coming to Richmond, Ivan worked as Education and Publications executive for The Jewish Association for Business Ethics, an educational charity, where he produced a Jewish Business Ethics curriculum ("Money and Morals") for upper-level secondary school students.

During the 1990s Ivan spent his career working in the United States of America. While there he regularly undertook media interviews (particularly television), and also earned his USSF soccer coaching license. Ivan continues to have an abiding fascination with Association Football ("soccer"), particularly its financing. His research includes investigations into soccer's transfer fees, and he has regularly given media interviews on many aspects of football.

Ivan holds both a B.A. (Honours) and M.A. in Economics from the University of Essex, as well as a Ph.D. in Economics from the University of Sheffield. Prior to joining Richmond he taught at The University of North Carolina, Trinity College (Hartford, Connecticut), Imperial College, London, and The University of Notre Dame (London).

  • Focus on Financial Management (Winter 2004), Imperial College Press
  • "Pension Funds: Let the Shareholders Have A Say". Chapter 13 in N. Janahardan Rao (edited by). Financial Markets: Emerging Scenario. Hyderabad, India, ICFAI Books (ICFAI UNiversity Press), 2004.
  • "Pensions: The Way Ahead", The Analyst (December 2003), monthly magazine of The Institute of Chartered Financial Analysts of India (ICFAI).
  • "A Managerial-Based Model of the Investment Behaviour of the U.K. Pension Funds", (September 1994) British Academy of Management 1994 Conference, and Papers and Proceedings
  • "Reading Difficulties-The Economists' Paradigm", (1986 ) Reading Psychology 7(1)
  • Modelling the Investment Behaviour of the U. K. Pension Funds", (1981) Managerial Finance 7(3)
Bruce Sheppy, Richmond University, The American International University in London, 17 Young Street, Kensington, London W8 5EH,

Healthcare Management:
-Experienced senior manager and executive director with expertise in hospital management, medical insurance and TPA businesses having served on the boards of private and listed companies in emerging and developing economies
-Specific strategic and marketing management experience in health / medical insurance / re-insurance and risk management through managed care mechanisms in sub Saharan Africa and Asia
-Significant Non Executive director / trustee experience in profit and not for profit contexts - including Chair and Audit Committee roles
Education Management and Academic Services
-Served as Chair of Academic Exam Board and various education boards and participated in BAC and QAA REO events in London
MBA and MSc Post graduate programme design, validation and implementation at public and private educational institutions in England.
-A depth of academic lecturing, commercial training and guest speaking experience grounded in solid, successful business experience
-Authoring and mixed mode delivery of over 15 distance and e-learning modules (print and online through Moodle, Blackboard and Web CT )

Specialties: Non executive director / Trustee / Charity roles, visiting academic / lecturer, trainer / facilitator in strategy and marketing, education management, hospital management, medical insurance / medical aid / health / hospital / practice management, quality assurance


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