'Lean management', new technologies and employment in public health services: employees' experiences in the National Health Service

This article considers employees’ experiences of a major organisational redesign project, which sought to deploy robotics technologies to improve the performance of National Health Service pharmacy distribution in one part of the UK. The principles of Lean-type approaches partly informed the redesign project, with senior managers seeking to tap the benefits of new technologies to streamline processes, while also arguing that change would bring opportunities for upskilling and inter-professional collaboration. The project managed to avoid some of the negative consequences for job quality predicted by the critical literature on Lean-type approaches in public services. However, employees’ experiences varied, with some reporting new engagement in learning and collaborative service delivery ‘nearer the patient’, while others complained of fewer opportunities to rotate across a variety of job roles. More fundamentally, employees questioned management’s assumption that new technologies and Lean-type approaches are crucial to improved performance and better jobs. For many employees, both performance and job quality were compromised by the ‘leanness’ of staffing models, which limited opportunities for development and contributed to work intensification. This tension is likely to remain a key theme in employment relations in the UK and beyond for as long as the public sector faces financial austerity.