Impacto sobre la atmósfera

The nature of the research and environment that the study was conducted in provided some challenges to the study. These included:

• Conflicting priorities for both the researcher and the research participants.

• Changes across the organisation that impacted the study environment. Whilst many of these challenges were overcome through effective management of the research process and engagement with the various stakeholders, there were some that created limitations to the study.

Timeframe of Study to Gather Data

The timeframe of the study phase was one year, from the beginning of the ‘Pre- phase’ data collection, to the completion of the ‘Post-phase’ data collection. In between these phases was the ‘During phase’ in which the Lean Management System was implemented within the pharmacy department which lasted approximately nine months.

In reflection, this period was too short to gather reliable quantitative data (related to medication reconciliations) to be used in the ‘Post-phase’ analysis. As referred to previously, the internal data-collection methods were immature at the

commencement of the study but were more robust by study completion. As a result, the quantitative data was not used in the analysis and development of the findings. While it was agreed that quantitative data was not the primary focus for the research (as described in researcher reflections), it would have been interesting to see if there were any correlated changes observed, and this is the basis for future research. Furthermore, the level of established change achieved within the nine-month process was variable across the areas of pharmacy. Similar cases where change management was implemented in Auckland DHB indicated that it can take up to three years until the change associated with implementing a Lean Management System is fully embedded within a service (Winstone, 2015). The impact of this lack of embedded change was variation in the uptake of the different components of the Lean

Management System and therefore this produced some limitations to the depth of ‘Post-phase’ data collected. A recommendation would be to conduct further study groups, three years after the commencement of the Lean Management System to

determine if there are subsequent differences observed after a longer time to evaluate whether the change has been embedded as part of the pharmacy culture.

Changing Priorities within the Study Organisation

Change is constant and with this the focus in organisations change over time (Kotter, 2007). During the period that this research was conducted, Auckland DHB

continued to evolve and as a result the strategic priorities changed in the

organisation. One area where this was evident was in relation to the continuing focus to develop its Management Operating System (MOS) and therefore the allocation of resource to achieve this. There was a perception by a number of influential senior leaders that ‘we have done MOS’ and what was meant by this was that the tangible artefacts of MOS had been established in most areas across the organisation (for example issues and risks boards up on walls). As a result of this view, and continual competition for resource to support change, a decision was made to reduce the resource to assist teams in developing their Management Operating System.

The impact this had was significant in many areas, as while there was some level of tangible elements of MOS in practice, the framework was not embedded within the services and teams and it was reliant on key people and the support of resources for change in-order to keep the MOS functioning. An assessment was carried out (independently to this study) which indicated that less than half of teams across Auckland DHB had embedded MOS to the level where it was self-sustaining (Winstone, 2016). This meant that half of the teams either had not commenced the development of their MOS, or their MOS was at risk of deteriorating.

The outcome of this assessment and the changing priorities were that support resourcing to the development of MOS was reduced, but not removed all together. The implications of this change to the research was that the time available internally for the lead-researcher to focus on MOS was less than previously planned. This provided limitations as to the level of coaching support for the teams in Pharmacy,

6.5 Chapter Summary

This chapter has drawn on the key findings and related these findings to literature where it exists. In particular, these include:

• The level of connection to an overall purpose contributed to the level of engagement and involvement of change.

• Mapping a management system to cross-team (or social) networks may provide a greater level of alignment and engagement, although this can be more challenging to achieve than mapping the management system to an existing hierarchical structure.

• Tools and methods alone for a Lean Management System are not enough for it to be effective and sustainable. It requires leadership behaviours that enable the tools and methods to be effective and integrated across teams.

• Furthermore, an effective Lean Management System requires people to have work-practices for change, improvement and critical thinking.

• A Lean Management System is less likely to be sustained if it is imposed on a team or copied directly from another team (i.e. ‘paint by numbers’). It needs to be owned and developed by the team to meet their specific situation.

• Leaders need to be supported to build practice to focus on managing and maintaining their Lean Management System alongside their operational responsibility. Developing this practice as standard work is essential to ensure that leaders place the necessary focus where it is required on a daily basis.

A key part of this study has been reflexivity of both the change initiative per se and the findings as well as reflection over the research process itself. To aid others in replicating research such as this, reflections from the researcher have been shared in addition to challenges and limitations that occurred during this participatory action research. It is the researcher’s aim that others can learn from these reflections and contribute towards the design of future research.