Hospital management in the Anthropocene: an international examination of lean-based management control systems and alienation of nurses in operating theatres

In the Anthropocene, healthcare systems face unprecendented challenges from increases in the aging population and expanding needs for acute and aged care services. To cope, hospitals are applying Lean-based management control systems (MCSs) to improve their efficiency and reliability by streamlining their existing processes. While literature shows the adoption of Lean-based MCSs in hospitals may lead to some significant productivity enhancements, the consequences of this new performance management approach for healthcare professionals in understudied. This thesis examines the impact of Lean-based MCSs on operating theatre nurses. Fieldwork was conducted between October 2016 and January 2019 in two countries, France, and Australia. It comprised 230 hours of non-participant observations and 47 semi-structured interviews. Findings revealed differences in how the MCSs were experienced - positively or negatively - between staff working at the two sites and the factors influencing such experiences. This research is the first to present an in-depth qualitative analysis of the ways Lean-based MCSs are implemented in operating theatres and how they are experienced by nursing staff. It is also the first international comparative study covering this subject and the first to provide a conceptual foundation for understanding the impacts of Lean-based MCSs in high acuity settings. This research not only contributes to the body of literature on the future of healthcare in the Anthropocene, it provides a theoretical foundation for future investigations of Lean and its consequences on healthcare staff.