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Discursive practice – lean thinking, nurses’ responsibilities and the cost to care

Clare Lynette Harvey (School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, Australia)
Christophe Baret (The Institute of Labour Economics and Industrial Sociology (LEST – CNRS), Aix-Marseille University, Aix en Provence, France)
Christian M. Rochefort (School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada) (Research Centre, University Hospital Center of Sherbrooke (CHUS), Sherbrooke, Canada) (Research Centre, Charles-LeMoyne Hospital, Longueuil, Canada)
Alannah Meyer (School of Nursing, Eastern Institute of Technology, Taradale, New Zealand)
Dietmar Ausserhofer (State College of Health Professions “Claudiana”, Bolzano, Italy)
Ruta Ciutene (Faculty of Social Sciences, Kaunas University of Technology, Kaunas, Lithuania)
Maria Schubert (University of Basel, Basel, Switzerland)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 24 September 2018

Issue publication date: 9 October 2018

1505

Abstract

Purpose

The purpose of this paper is to explore the literature regarding work intensification that is being experienced by nurses, to examine the effects this is having on their capacity to complete care. The authors contend that nurses’ inability to provide all the care patients require, has negative implications on their professional responsibility.

Design/methodology/approach

The authors used institutional ethnography to review the discourse in the literature. This approach supports inquiry through the review of text in order to uncover activities that remain institutionally accepted but unquestioned and hidden.

Findings

What the authors found was that the quality and risk management forms an important part of lean thinking, with the organisational culture influencing outcomes; however, the professional cost to nurses has not been fully explored.

Research limitations/implications

The text uncovered inconsistency between what organisations accepted as successful cost savings, and what nurses were experiencing in their attempts to achieve the care in the face of reduced time and human resources. Nurses’ attempts at completing care were done at the risk of their own professional accountability.

Practical implications

Nurses are working in lean and stressful environments and are struggling to complete care within reduced resource allocations. This leads to care rationing, which negatively impacts on nurses’ professional practice, and quality of care provision.

Originality/value

This approach is a departure from the standard qualitative review because the focus is on the textual relationships between what is being advocated by organisations directing cost reduction and what is actioned by the nurses working at the coalface. The discordant standpoints between these two juxtapositions are identified.

Keywords

Acknowledgements

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this paper. This paper is based upon work from COST Action RANCARE CA15208, supported by COST (European Cooperation in Science and Technology).

Citation

Harvey, C.L., Baret, C., Rochefort, C.M., Meyer, A., Ausserhofer, D., Ciutene, R. and Schubert, M. (2018), "Discursive practice – lean thinking, nurses’ responsibilities and the cost to care", Journal of Health Organization and Management, Vol. 32 No. 6, pp. 762-778. https://doi.org/10.1108/JHOM-12-2017-0316

Publisher

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Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited

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