A Balanced Approach Involving Hard and Soft Factors for Internalizing Lean Management and Six Sigma in Hospitals

PurposeThis study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.Design/methodology/approachA cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units,N = 218 supervisors,N = 1,668 employees), and multivariate multilevel regression analyses were performed.FindingsA systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (βis 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (bothβs are 0.33). We did not find that a climate for LM&SS had a mediating effect.Research limitations/implicationsThis study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.Practical implicationsIn their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.Originality/valueThis is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.