FRAM and LEAN as tools for describing and improving the referral process between outpatient clinics in a Danish Hospital: Complementary or conflicting?

•Functional Resonance Analysis Method and LEAN methods can be used synergistically in practice to support organisational changes.•Functional Resonance Analysis Method provides an in-depth understanding of work-as-done of the referral process in a hospital.•Value Stream Method provides baseline data such as processing time and lead time and quantifies value added and non-valued added activities.•One third of internal referrals can be averted by focusing on organsiational factors.