The future of lean construction: a brave new world

Lean construction is considered from a human resource management (HRM) perspective. It is contended that the UK construction sector is characterised by an institutionalised regressive approach to HRM. In the face of rapidly declining recruitment rates for built environment courses, the dominant HRM philosophy of utilitarian instrumentalism does little to attract the intelligent and creative young people that the industry so badly needs. Given this broader context, there is a danger that an uncritical acceptance of lean construction will exacerbate the industry's reputation for unrewarding jobs. Construction academics have strangely ignored the extensive literature that equates lean production to a HRM regime of control, exploitation and surveillance. The emphasis of lean thinking on eliminating waste and improving efficiency makes it easy to absorb into the best practice agenda because it conforms to the existing dominant way of thinking. 'Best practice' is seemingly judged by the extent to which it serves the interests of the industry's technocratic elite. Hence it acts as a conservative force in favour of maintaining the status quo. In this respect, lean construction is the latest manifestation of a long established trend. In common with countless other improvement initiatives, the rhetoric is heavy in the machine metaphor whilst exhorting others to be more efficient. If current trends in lean construction are extrapolated into the future the ultimate destination may be uncomfortably close to Aldous Huxley's apocalyptic vision of a Brave New World. In the face of these trends, the lean construction research community pleads neutrality whilst confining its attention to the rational high ground. The future of lean construction is not yet predetermined. Many choices remain to be made. The challenge for the research community is to improve practice whilst avoiding the dehumanising tendencies of high utilitarianism.

Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.