Lean, with its origins at the Toyota Motor Company, is a concept that is known to increase effectiveness in manufacturing. The Lean concept is now argued to be relevant not only in manufacturing but in service and health-care delivery as well. The reported results of Lean implementation efforts are divided. There are reports that most of the Lean implementation efforts are not reaching the goal; on the other hand, there are reports of promising results. The divided results from Lean implementation efforts show how important it is to research and identify factors that are barriers to successful implementation of Lean. This thesis aims to contribute knowledge about barriers to Lean implementation by collecting empirical findings from manufacturing and health care and structuring the perceived barriers and difficulties to Lean implementation. My first study aimed to compare similarities and divergences in barriers to Lean described by key informants in manufacturing and health care. The data was collected via semi-structured interviews. Findings showed that the perceived difficulties and barriers are much the same in manufacturing and health care. The second study was a case study at a manufacturing firm, researching how the views on Lean of the managers implementing Lean influence its implementation. Data was collected via semi-structured interviews with 20 individuals and covered all hierarchical management levels in the company. Findings showed that managers' views on Lean influence the implementation but also that learning during the implementation process can alter managers' views of Lean. The third study aimed to research how management of Lean is described in the literature. This was done through a literature review. The findings showed that Lean management is a matter of dualism, consisting of two complementary systems of action, management and leadership, which are related to the two basic principles of Lean, continuous improvement and respect for the people.

The purpose of this thesis is to identify barriers to and supportive factors for Lean implementation and to investigate how application of the Sense of Coherence (SOC) theory combined with Lean philosophy may affect health and productivity. The thesis is based on five studies. The first study compared similarities and divergences in barriers to Lean described in interviews by informants in manufacturing and health care. The second study was a case study at a manufacturing firm. Interviews with managers implementing Lean revealed how their views on Lean influenced the implementation. In the third study, a literature analysis was used to conceptualize the concepts and roles of leadership and management in regard to Lean. In the fourth study it was explored how productivity, quality, work attendance and numbers of rehabilitation cases were influenced after implementation of sense of coherence theory based managerial behavior at three workplaces. The fifth study examined how the implementation of a new leadership approach based on the SOC theory combined with Lean philosophy relate to productivity, quality and levels of sick leave at a steel-producing company. The results from the studies show that the perceived difficulties and barriers are much the same in manufacturing and health care. Another finding was that managers' views on Lean influence the implementation but also that learning during the implementation process can alter their views. A third finding is that lean management is a matter of dualism, consisting of two complementary systems of action, management and leadership, which are related to the two basic principles of Lean, continuous improvement and respect for people. After application of the SOC theory combined with Lean as a basis for the managerial approach, there were improvements in productivity, quality, attendance at work and reduced levels of sick leave at all four studied workplaces, as well as fewer cases of rehabilitation at three workplaces. Several conclusions can be drawn. One is that Lean consultants with a limited approach to Lean, lack of a common organization-wide definition of Lean, and lack of supportive leadership are barriers to Lean implementation. Lean consultants with deep knowledge and capability to teach others Lean is a supportive factor. An organization-wide definition of Lean through an organization-specific Lean philosophy is another supportive factor. Managers that use both leadership and management to support people is a supportive factor to Lean. The study also shows that an application of SOC theory combined with Lean may be positively associated with health and productivity improvements. The overall conclusion is that people’s way of thinking and acting is the nucleus in Lean. To emphasize the importance of people, I suggest to call the approach of combining SOC and Lean “Human Lean.”

Syftet med denna avhandling är att identifiera hinder och stödjande faktorer för implementering av Lean och undersöka hur tillämpning av hälsoteorin Känsla av sammanhang (Kasam) kombinerad med Lean-filosofi påverkar hälsa och produktivitet. Avhandlingen baseras på fem studier. I den första studien studeras likheter och skillnader i beskrivna hinder från intervjuer av informanter verksamma i tillverkande industri och vårdsektorn. Den andra studien genomfördes i tillverkande industri. Genom intervjuer med chefer undersöktes hur deras syn på Lean påverkat implementeringen av Lean. I den tredje av studien studerades litteratur om Lean som bas för konceptualisering av ledarskap och management i relation till Lean. I den fjärde studien undersöktes hur produktivitet, kvalitet, närvaro på jobbet och antalet rehabiliteringsfall påverkades efter implementering av kasam orienterat ledarskap på tre arbetsplatser. I den femte studien undersöktes hur produktivitet, kvalitet och sjukskrivningar påverkats efter implementering av ett nytt ledarskapskoncept baserat på Kasam i kombination med Lean-filosofi i ett stålföretag. Resultaten visar att svårigheter och hinder beskrivs mycket lika i tillverkande industri och vårdsektorn. Ett annat resultat var att chefers syn på Lean påverkar implementationen, men också att denna syn kan förändras genom det lärande som sker under implementeringen. Ett tredje resultat var att ledarskap i Lean bör vara dualistisk. I praktiken behövs både management och ledarskap då dessa är komplementära och relaterar till de två huvudprinciperna i Lean, ständiga förbättringar och respekt för människan. Produktivitet, kvalitet och närvaro ökade samtidigt som sjukskrivningar minskade vid de fyra arbetsplatser som undersöktes. På de tre arbetsplatser där rehab-fall följdes upp konstaterades en minskning av antalet fall. En slutsats är att Leankonsulter med verktygsorienterad syn på Lean, brist på en organisationsövergripande definition av Lean och brist på stödjande ledarskap är tre faktorer som försvårar implementation av Lean. Konsulter med djup kunskap och förmåga att lära andra identifierades som stödjande faktorer vid implementering av Lean. En gemensam organisationsövergripande definition av Lean är också en stödjande faktor, liksom att chefer att praktiserar både management och ledarskap vid implementering av Lean. Studierna indikerar att kombinationen av Kasam och Lean kan ge positiva resultat på både hälsa och produktivitet. En övergripande slutsats är att människors sätt att tänka och handla är kärnan i Lean. För att betona människans betydelse i Lean, föreslår avhandlingen att kombinationen av kasam och Lean benämns Human Lean.