Swedish healthcare lean(ing) towards efficiency -A case study of Swedish public health centres

Abstract: Background: The last three decades the Swedish public sector has undergone major changes. In Sweden, several municipalities, governmental authorities and hospitals, have tried to rapidly adopt the lean concept over the past five years, glancing at the private sector. At the same time as the lean concept spreads throughout the public sector, the basic rules for financing of the Swedish primary care have changed. Consequently, the free choice of healthcare, nationally introduced in 2010, has made the health centres compete in a new way. Lean has presented examples of successful results in Swedish healthcare. However, several authors question the possibility to use lean in a public service context as there is a question whether the financing model in combination with the embracement of lean, really allow the health centres to be governed by the patients’ needs. Purpose: The research questions is investigated from an accountability perspective with the purpose to increase the understanding of Swedish public health centres’ experience of lean, as well as examine the challenges of combining lean and the existing financing model. Methodology: The thesis is built on a case study of four health centres within VGR, Västra Götalandsregionen. The primary data has been collected through semi-structured interviews with directors and employees at the four health centres. Analysis and Conclusion: The health centres are subject to accountability to many different stakeholders, which creates a jumble of different accountability that employees need to take into consideration in their daily work, which may be hard to balance. The financing model sometimes affects strategic and operational decisions as accountability to the financing model, due to lack of resources, has been placed above accountability to lean. Lean seems to have potential to contribute to health centres, as many actions taken have led to positive outcome, but have come to focus on overall improvement such as improved meetings, communication and processes, rather than a more deeply rooted lean philosophy.