R ELEVANCE OF THE T HESIS

To ensure the significance of the research, it is vital that the thesis has both theoretical and practical relevance. These are presented in the succeeding sections.

1.4.1 Theoretical Relevance

The concept of Lean embraces a broad variety of topics, but a central part of the concept is improved flows of material and information (Bicheno & Holweg, 2009;

Grunden & Hagood, 2012; Modig & Åhlström, 2014; Regattieri, Bartolini, Cima, Fanti, & Lauritano, 2018). However, when applied in healthcare, research primarily focuses on optimizing the patient flow. EY (2019, March), among others, emphasize that Lean in healthcare should be patient-centered. While this is natural, considering that the patients constitute the dominant flow in healthcare (Hicks, McGovern, Prior, & Smith, 2015), we perceive this as a gap in the literature regarding Lean. The flow of materials should be optimized in order to

achieve an efficient patient flow (Böhme et al., 2016). The literature covers waste and how it could be reduced, but not the actual flow of materials. Thus, we attempt to bridge this gap in our study.

Further, in addition to accounting for large portions of healthcare costs, hospital systems are highly complex. They have great variability and unpredictability of patient profile and care demand (Ageron, Benzidia, & Bourlakis, 2018). In fact, the hospital supply chain is perceived to be more complex than any other service supply chain (Mandal, 2017). It requires efficient coordination of many various processes and resources to deliver appropriate patient care (Rais, Alvelos, Figueiredo, & Nobre, 2018). There may be no other supply chain with a more urgent need of performance improvement (Dobrzykowski, 2019; Dobrzykowski, Deilami, Hong, & Kim, 2014; Smeltzer & Ramanathan, 2002). One of the main challenges identified in hospital supply chains is to ensure the availability of medical supplies to sustain quality and timely patient care, at the lowest inventory costs (Pinna, Carrus, & Marras, 2015). Despite this, compared to other industries, inventory management have not been given high priority in hospital management research until recently (Volland et al., 2017). Moreover, the search for managing the supply chain in a more efficient manner has only recently been recognized by hospital administrators as something of high impact potential (Nabelsi & Gagnon, 2017). By this, our study brings theoretical relevance through identifying how Lean methodology could improve inventory management at hospitals, and hospital supply chains in general.

In sum, we aim to contribute to the identified literature gap concerning the flow of materials and product availability at hospitals with regards to the concept of Lean.

Product availability is reliant on inventory management, while flow of materials is dependent upon supply chain management. The theoretical relevance is attempted ensured by a two-folded approach. First off, a conceptual framework for implementation of Lean at hospitals is developed based on the literature review.

Next, this framework is utilized in the analysis of two hospitals in the southeastern region of Norway to further secure the relevance of such a conceptual framework.

1.4.2 Practical Relevance

First, it is claimed that through improved supply chain management, hospitals can reduce costs. However, research reveal that the healthcare sector has been rather slow to embrace supply chain management practices (Regattieri et al., 2018).

Moreover, hospital managers have traditionally paid little attention to inventory management in general (De Vries, 2011; Nicholson, Vakharia, & Erenguc, 2004;

Rossetti, Buyurgan, & Pohl, 2012). If this still is the case, this thesis contributes with insights in areas of improvements and to some extent how hospital supply chain performance is affected by improved hospital supply chain management.

Second, Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation. Further, it has been decided by the largest regional health authority in Norway that all hospitals in their region are to implement and work Lean. This study aims identify the opportunities and challenges with implementing Lean philosophy at hospitals. Thus, our research could bring relevance to these Norwegian-based hospitals in their journey of implementing and continuously working Lean. In addition, it may be of relevance to the other regional health authorities and hospitals to consider implementing Lean. Perhaps abroad-based hospitals find the study of relevance when evaluating adoption of the concept.

Third, right now Norway experiences a deficit of 5 600 nurses (Aftenposten, 2019). The scarcity of nurses has become substantial across the country and the deficit is expected to increase to nearly 30 000 over the next sixteen years.

Working at a hospital is increasingly hectic, the employees run faster and faster.

Nurses express that they feel like they do not have enough colleagues at work.

This pressure is described to be so high at times, that some nurses are afraid that serious errors will occur. Further, one nurse expressed to Aftenposten (2019) “if you have eaten, visited the restroom or laughed during the day, it has been a good day”. The nurses claim that over the last two years, if has become fewer of those days, and more of the days where they are completely exhausted when the shift is over. Thus, we aim to identify opportunities for a more optimal material flow at the hospitals that may facilitate for a less hectic workday for the currently overworked nurses.