The lean paradox: Does applying Lean Management increase protocol deviations? A case study of cleaning staff in the hospital sector

Lean Management has been implemented for a number of years in the hospital sector. This
management strategy aims at improving hospitals’ operational processes essentially by
reducing unnecessary waste. One obvious question is what should be considered as
‘unnecessary waste’. The aim of this study is to illustrate the potential paradoxical effects of
the Lean Management on performance through a detailed analysis of a specific subset of
employees: hospital cleaners. The protocol for cleaning patients’ rooms was developed in
partnership with two team leaders as part of a Lean Management implementation process. It
consisted of 27 tasks to be performed within 15 minutes per room. Thirty-three hospital
cleaners agreed to take part in this study. We measured the time taken to clean the rooms
and identified deviations from the protocol and associated factors. On average, the staff
cleaned 6,4.4 rooms over a 2-hour period. Our results reveal that those cleaners who
respected the time criteria made fewer errors but more violations than those cleaners who
took an additional 5 minutes per cycle. These cleaners chose to respond to the contextual
demands for cooperation by deviating more frequently from the protocol.