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Abstract

Lean management has been widely adopted in public social and healthcare services, with a primary focus on value creation. However, value creation, destruction and co-destruction are interdependent processes shaped by the emotional and relational experiences of change. This study examines the factors that hinder value creation in Lean management within public social and healthcare organizations, and how these factors may lead to value destruction and co-destruction during transformation processes. Thematic interviews with 15 Lean-trained managers identified three key barriers: managerial change, managerial uncertainty and challenges related to information. These factors elicited negative emotions such as fear and shame, which in turn contributed to disengagement and diminished commitment. To address these challenges, we introduce the Lean Value Management (LVM) model, developed based on the Security–Inclusion–Success (SIS) framework. LVM extends the SIS model by explicitly incorporating value destruction and co-destruction as integral aspects of Lean management. Recognizing value destruction and co-destruction as part of value creation enables sustainable value generation, enhances employee well-being and improves service outcomes within complex public sector environments.

Keywords

Lean management public organization social and healthcare value destruction value co-destruction value creation

Introduction

Lean is a widely adopted management model in social and healthcare services, designed to address systemic challenges such as efficiency, quality and resource constraints (Leite & Quadros, 2024), aiming to generate customer value by embedding a culture of continuous improvement (Womack, 2003). It is not defined by isolated tools but rather represents a holistic cultural transformation requiring the commitment of top management (Kessy et al., 2023). It redefines organizational functioning through a people-centred management philosophy, wherein managers act as mentors and support employees in improving services and learning (Ballé et al., 2019). Without changes in culture and management, sustainable value creation—referring to long-term improvements in well-being while maintaining the ability to generate value in the future—remains unattainable (Gallarza & Sánchez-Fernández, 2023; Hurme & Liljeroos-Cork, 2024).

The goal of both Lean and public social and healthcare services is to create value (Ballé & Jones, 2017; Virtanen & Jalonen, 2024)—a subjective, context-dependent concept defined by individual needs and ultimately determined by the customer (Efe & Efe, 2016). Value can deteriorate either individually (value destruction) (Cui & Osborne, 2023) or through failed interactions (value co-destruction) when services do not meet expectations or needs. Value destruction may arise from structural misalignments or exclusion, while co-destruction often stems from ineffective or conflicting interactions (Lumivalo et al., 2024; Singhvi et al., 2016). Both can lead to a decline in well-being for individuals, organizations or society at large (Liljeroos-Cork & Luhtala, 2024). Faulty processes can also destroy value at multiple organizational levels (Leite & Quadros, 2024). Customers may be service users, citizens or other stakeholders who derive value (Chandler & Vargo, 2011). In this study, value is understood as a positive change in well-being.

In public organizations, Lean implementation can be particularly complex and may fail to deliver the desired outcomes (Leite & Quadros, 2024). Given the complexity of service processes, standardized Lean tools alone may not ensure value creation (Hurme & Liljeroos-Cork, 2024; Singhvi et al., 2016). Combined with Lean, public service logic can enhance value creation by emphasizing inclusion and individual experience (Domiciano Borota et al., 2023; Skarli, 2023). One example of this integration is the Security–Inclusion–Success (SIS) model, which operationalizes the principles of both approaches by promoting employee inclusion and psychological safety to support sustainable cultural change and achieve desired outcomes (Hurme & Liljeroos-Cork, 2024).

Most Lean research has focused on value creation (Costa & Godinho Filho, 2016; Leite & Quadros, 2024), while less attention has been paid to value destruction—particularly value co-destruction, where well-being deteriorates during service interactions. Although value co-destruction has been examined in relation to resources and practices (Echeverri & Skålén, 2021), little is known about its systemic and organizational dimensions, especially within public sector Lean contexts, where empirical and practical insights remain limited (Lindqvist & Westrup, 2020; Nicholas, 2023). As well-being is central to sustainable value creation, particularly in people-centred services, understanding these destructive dynamics is essential (Gallarza & Sánchez-Fernández, 2023).

This study integrates Lean management and value co-destruction theory to empirically identify managerial barriers to sustainable value creation in public social and healthcare organizations and proposes a Plan–Do–Check–Act (PDCA)-based solution model as a practical remedy. Drawing on interviews with 15 Lean-trained managers in a Finnish public social and healthcare organization, the study investigates the following research question: What factors hinder value creation in Lean management within public social and healthcare organizations? By exploring this relatively under-researched area, the article offers novel insights for both theory and practice into how the systemic characteristics of Lean management can simultaneously hinder and impede value creation within complex public service environments.

Backround

Lean Management

Lean is a human-centred management philosophy that emphasizes coaching, mentoring and developing employees as problem-solvers and active participants (Ballé et al., 2019). Its objective is to create customer value through a cultural shift towards continuous improvement (Womack, 2003). Value can be generated by eliminating waste—work that consumes resources but does not produce value—which is present in all processes (Liker, 2021). In social and healthcare services, Lean typically focuses on continuous improvement, customer value creation, respect for people, quality enhancement, employee well-being and the efficient use of resources (Maijala et al., 2020; Rosa et al., 2023).

The PDCA model supports continuous improvement by guiding data-driven problem-solving, fostering organizational learning and embedding systematic development (Liker, 2021). Its consistent application is vital for sustaining value (Frank & Rader, 2023), although support from public service logic may be required to ensure long-term sustainability (Hurme & Liljeroos-Cork, 2024). The A3 tool, based on PDCA (Schwagerman & Ulmer, 2013), standardizes problem-solving by addressing root causes rather than assumed problems (Harolds, 2023).

When implemented effectively, Lean can lead to positive outcomes in care quality, streamlined processes and employee well-being (Ballé et al., 2019; Nicholas, 2023). However, poor implementation may reduce these outcomes and adversely affect employee well-being (Lindsay et al., 2020). In public social and healthcare organizations, such challenges are amplified by fragmented responsibilities, complex service ecosystems and the need to balance efficiency with citizen well-being—highlighting the importance of understanding Lean’s contextual limitations and its potential for both value creation and destruction (Leite & Quadros, 2024; Radnor & Osborne, 2013).

Lean Management and Value Creation

Creating value for customers and society is central to both Lean and public healthcare organizations (Ballé & Jones, 2017; Virtanen & Jalonen, 2024). Value is a complex and widely studied concept, shaped by individual needs, expectations and roles (Höglund et al., 2021). It is often interpreted subjectively and inconsistently (Strokosch & Osborne, 2020), particularly when the customer may be any stakeholder who benefits from the interaction (Chandler & Vargo, 2011). Lean defines value from the customer’s perspective; however, in public social and healthcare services, the customer is not always the service user but may also be, for example, an employee in relation to a manager (McAdam et al., 2022). In social and healthcare contexts, organizations should focus not only on external value but also on intrinsic value—such as employees’ sense of safety and inclusion—as a foundation for sustainable value creation (Hurme & Liljeroos-Cork, 2024). This highlights long-term improvements in well-being while preserving the capacity to deliver value. In people-centred services, this requires identifying and addressing the dynamics that undermine value (Gallarza & Sánchez-Fernández, 2023). Value creation involves a variety of groups—politicians, civil servants, system users and frontline employees. The service experience is central, as understanding user needs, establishing shared societal goals and clarifying objectives all contribute to stronger value creation (Strokosch & Osborne, 2020).

In practice, competing goals influence how value is defined across service ecosystems, which are shaped by political, economic, legal and historical contexts (Voorberg et al., 2015). Complex systems such as social and healthcare services pose particular challenges to value creation, and especially value co-creation due to the involvement of multiple actors and outcomes that emerge through interconnected encounters. Yet these services may also offer the greatest potential for value creation (Keeling et al., 2021). Thus, in complex public service systems, value creation and destruction often occur simultaneously and are determined by the customer’s subjective experience—highlighting the need to examine both processes in order to fully understand sustainable value creation (Lumivalo et al., 2024). This underscores the importance of further research into how Lean management in public social and healthcare settings can both enable and undermine value.

Lean Management, Value Destruction and Value Co-destruction

Not all public services create value; some may destroy value and adversely affect customers’ lives. Studies have identified the exclusion of certain citizen groups, limited access to services and conflicts over the nature of public value as key factors contributing to public value destruction (Cui & Osborne, 2023). Value destruction can also reduce the value that has already been achieved and prevent services from reaching their full potential (Singhvi et al., 2016). However, the concept of value destruction remains insufficiently defined and requires further theoretical clarification (Cui & Osborne, 2023). Value destruction is experiential and context-dependent; value does not emerge uniformly for all customers. It results not only from service attributes but also from customers’ expectations and prior attitudes (Abid et al., 2022).

Value co-destruction, that is, the emergence of negative outcomes during interaction, has recently gained increased attention in Public Service Logic research as efforts focus on understanding how these outcomes arise (Lumivalo et al., 2024). In the context of public social and healthcare services, value co-destruction can be understood as the deterioration of well-being at the individual, organizational or societal level (Liljeroos-Cork & Luhtala, 2024). This often manifests as diminished customer well-being—or even reduced quality of life—due to inadequate service quality (Kaartemo & Känsäkoski, 2018). The diversity and complexity of service processes in social and healthcare, where the experience of value may unfold over time, further increase the risk of co-destruction (Keeling et al., 2021). Value co-destruction may also result from insufficient positive outcomes, rather than overtly negative effects. In such cases, although some benefits are evident, unmet expectations lead to co-destruction (Lumivalo et al., 2024). Within social and healthcare services, the interplay between value creation and value co-destruction hinges on a delicate interface where people, processes and resources interact in ways that can easily shift value creation into co-destruction (Leite & Quadros, 2024). Value co-destruction may occur at any stage of public service delivery (Rossi & Tuurnas, 2021). While value creation is hindered by organizational silos, rigid regulations, poor communication and skills gaps in the labour market, co-destruction may result from stakeholder conflicts and short-termism. Collectively, these factors reduce efficiency, hinder innovation and limit long-term impact (Skarli, 2023).

All processes contain waste (Liker, 2021), and eliminating it is a core objective of Lean (Womack, 2003). Public social and healthcare organizations must provide services that are transparent, comprehensible and tailored to customer needs, and must address any instances where value has been lost or eroded (Engen et al., 2021), as faulty processes destroy value at both the organizational and customer levels (Leite & Quadros, 2024). These phenomena highlight the need to investigate how Lean implementation may inadvertently contribute to value destruction and co-destruction in public social and healthcare—thus complementing existing research on Lean management.

Methodology

Data Collection

This study employed thematic interviews (n = 15) with Lean-trained managers from the Central Uusimaa Joint Municipal Authority in Finland in 2020. The managers represented a range of managerial levels, including frontline, middle and upper management, from both social and healthcare sectors. To protect participant confidentiality, no detailed demographic table is provided. The organization had recently undergone reform and aimed to become a Lean organization. Lean management training and A3 development assignments had just concluded, making the timing appropriate for this study. Research permission was granted by the organization.

Participants were recruited through an invitation sent to those who had completed the training. Participation was voluntary, and selection was based on the order of registration. Interviews were conducted via Teams, each lasting approximately 60 min. Participants had given written consent, and verbal consent was confirmed at the beginning of each interview after the study’s purpose, voluntary nature and confidentiality were outlined.

The interview themes were derived from the research question and structured around the A3 problem-solving tool (Schwagerman & Ulmer, 2013), which is based on the PDCA cycle. Subthemes included goal setting, current state assessment, root cause identification, countermeasure implementation and evaluation of results.

Data Analysis

All interviews were transcribed verbatim and analyzed using abductive content analysis (Saldana et al., 2011), combining theoretical and empirical insights. The analysis was conducted iteratively with the assistance of Atlas.ti, enabling systematic coding and memo writing. Codes were developed both deductively (from theory) and inductively (from data), and subsequently grouped into subthemes and overarching themes.

To ensure trustworthiness, the researcher maintained analytic notes to support transparency and reflexivity, acknowledging their dual role as both analyst and interpreter. Reflective memoing was employed to minimize bias. The interviews were conducted in Finnish. The quotations selected for the article were translated into English. All identifying information was removed to ensure anonymity and ethical integrity.

Results

The findings of this study demonstrate that value destruction occurs at various organizational levels and stages of Lean management. It is driven by managerial change, managerial uncertainty and issues related to information. These factors, in turn, triggered negative emotions among managers, which further weakened their commitment to the cultural transformation.

Managerial Change

Shift in Management Model

Implementing Lean was perceived as requiring a personal behavioural shift. This included a change in mindset, occasionally challenging personal values, learning new approaches and unlearning established habits. While generally welcomed, the change was experienced as demanding, as long-standing routines proved slow and difficult to alter.

According to the managers, customer-centricity is essential in social and healthcare services. However, in practice, management is frequently characterised by an employee-focused approach. The transition from an employee-centred perspective to a customer-oriented mindset, which lies at the heart of Lean management, was initially regarded as challenging to implement, prompting reflection on whether the value experienced by employees is of equal importance.

‘Often, people think, what does this mean for our team and how does it improve our team’s operations?’

Adoption of Lean Methods

During their training, managers practised using various Lean methods and tools. One of these was the A3 problem-solving tool, based on the PDCA model. This structured, fact-based development approach differed significantly from earlier practices. Learning to use A3 was challenging, but ultimately seen as beneficial. In particular, the root cause analysis component was experienced as difficult, slow and at times artificial. Managers found it hard to facilitate within their teams, and the reception was not always positive. The process consumed considerable time and did not always produce clear root causes.

‘The human mind tends to start solving things immediately. It doesn’t have the patience to go forward and forward again to find the right cause. It was challenging. Interesting, but challenging’.

Managerial Uncertainty

Unclear Objectives

Clear and measurable objectives are essential for effective management in Lean contexts. According to the managers, there were times when no objectives existed at all. This may have resulted from the novelty of the operations, but even long-standing processes suffered from vague or missing goals. Unclear objectives were seen as a particular challenge from a management perspective, as it was difficult to lead without knowing the intended direction.

‘And then, if you think about it, if there are no goals, the operations become quite erratic. For example, if employees don’t know why we are here, who we are working for’.

Lack of Control Over Work

Although Lean cultural transformation involves a shift towards a coaching-based management model, decision-making authority was not always transferred to the operational level. Managers found it challenging that neither they nor their employees had real influence over their work, as decisions continued to be made outside the processes.

‘One challenge has been the feeling that decisions from above interfere with their service delivery and their way of working’.

A lack of managerial control was also attributed to excessive spans of control. Managers reported that new supervisors were not always appointed to fill vacant roles, resulting in an unmanageable number of employees for those who remained. These large numbers further hindered the effective practice of genuine management.

Information

Inadequate Information

Lean management and continuous improvement rely on data to inform both managerial decisions and development efforts. According to the managers, although a significant amount of data was available within the organization, it did not always align with their actual needs. As a result, information often had to be collected manually, searched for or requested from elsewhere—circumstances that ultimately slowed both management and process development.

‘For example, I’ve been trying to find some cost information from organization X, and even running those reports feels challenging. Like, I need an employee from another organization to generate reports for us, to find out what our consumption has been, or similar data. And, well… The information doesn’t come immediately. For instance, I requested some information last Thursday or Friday, and I only got it today. It quickly diminishes the urgency or motivation to act when it takes several days to get the necessary data’.

Information Overload

Conversely, there was also an overabundance of information—some of which was collected about issues that were never revisited. In such cases, identifying the relevant information at the moment of need became difficult. Furthermore, the sheer accumulation of information could itself hinder development. For instance, when attempting to improve a small and clearly defined issue, the influx of data might reinforce the impression that the problem was part of a vast and complex system.

‘Or when you start development work on what seems like a small, simple issue, and as information increases, so does the frustration’.

Negative Emotions

The managers described a range of emotions experienced in the course of their managerial work and during shifts in managerial practices. These changes provoked both positive and negative emotions; however, this study focused on those perceived as destructive to value. The three factors outlined above—managerial change, managerial uncertainty and information—elicited emotions such as fear, shock, anxiety, insecurity and shame. These emotions contributed to the experience of value destruction.

‘Yes, I mean, how does our work even look? It’s not something we’d want to show to anyone’.

Lack of Commitment

Negative emotions were perceived as affecting managers’ commitment to cultural change. These emotions contributed to experiences of value destruction and were also described as at times fuelling resistance to change. Such resistance was seen to delay or obstruct progress—and in some cases, to halt or even terminate change altogether.

‘There’s been a lack of formal decisions about what we are actually aiming for, which makes it hard to commit to what’s been decided. For many managers, if there’s no decision, it means things can be influenced—and that includes opposing them’.

Discussion

Lean fails when people disengage. This study demonstrates that without intrinsic value and clear management, even well-intentioned reforms may provoke resistance, emotional strain and ultimately, value destruction. Our findings show that the implementation of Lean in public social and healthcare services is hindered not only by structural barriers, but also by psychological, relational and informational dynamics. Managers found the managerial change to be partly difficult and mentally demanding, which in some cases weakened their commitment to the cultural transformation.

The data highlight that value destruction is not merely a matter of process inefficiency but is deeply rooted in how change is experienced by individuals. Managerial uncertainty, unclear objectives, lack of autonomy and problematic access to information triggered negative emotions such as fear, shame and frustration. These findings resonate with prior research emphasizing the emotional dimension of change (Echeverri & Skålén, 2021; Hurme & Liljeroos-Cork, 2024) and suggest that much of the value loss observed in this context emerges through interaction. Value creation and destruction are interdependent and unfold in the same social processes, where individual experience ultimately shapes outcomes (Lumivalo et al., 2024). Rather than being one-sided, value destruction often took the form of value co-destruction—where relational disconnects, conflicting expectations or systemic ambiguity eroded value for multiple actors simultaneously (Kaartemo & Känsäkoski, 2018; Liljeroos-Cork & Luhtala, 2024). These challenges call for frameworks that guide not only structural change but also the emotional and relational dimensions of transformation. Intrinsic value is essential for sustainability and must be fostered through inclusion, psychological safety and meaningful engagement (Hurme & Liljeroos-Cork, 2024; Katsaitis & Zampetakis, 2024). To bridge the gap between strategic intent and emotional reality, this study introduces the Lean Value Management (LVM) model, building on the SIS framework by Hurme and Liljeroos-Cork. SIS emphasizes psychological safety, inclusion and success as drivers of change. LVM adds a critical dimension: it explicitly integrates value destruction and co-destruction into the understanding of change. While SIS supports value creation, LVM recognizes that value is also shaped—and often eroded—by emotional friction, relational disconnect and systemic ambiguity. This extension enables a more realistic and responsive Lean approach. Instead of focusing solely on tools and efficiency, LVM highlights the human experience of change and helps organizations detect early disengagement and address emotional resistance before it escalates. Figure 1 illustrates the LVM model, showing how emotional, relational and structural elements interact to influence value creation, destruction and co-destruction in Lean transformation.

Figure 1.

Lean Value Management (LVM) Model.

Recognizing value destruction as an integral part of Lean transformation challenges the dominant narrative of Lean as purely technical. Our findings underscore the need to view resistance and emotional strain not as signs of failure, but as feedback on misalignment between structure and experience. Addressing these human dynamics is essential for sustainable cultural change.

Conclusions

We argue that value destruction and co-destruction in Lean transformation are fundamentally tied to emotional experiences and relational dynamics—rather than merely technical or structural shortcomings. Negative experiences related to managerial change, uncertainty and challenges in information management can erode commitment and activate both individual-level value loss and collective co-destruction across actors. This positions human factors at the core of understanding both the success and failure of Lean initiatives.

Our main contribution is the LVM model, which expands upon the SIS framework by integrating psychological safety, inclusion and perceived success. Unlike the SIS model, which focuses on enabling value creation, LVM explicitly addresses what value means when it deteriorates or disappears. By recognizing the dynamics of both value creation and destruction, LVM offers a more realistic and sustainable approach to Lean transformation. It connects emotional experience to structural conditions and provides a practical tool for building resilience in public sector change contexts.

Theoretically, this study demonstrates how value is created and destroyed through interaction, and how emotional experience shapes strategic outcomes. Practically, we recommend applying LVM alongside traditional Lean tools such as the PDCA cycle to detect early signs of disengagement, strengthen trust and ensure clarity in goals and information access. A coaching-based management approach is essential for sustaining commitment and adaptability.

This study is limited to a single organizational context and reflects the perspectives of managerial actors. Future research should test the LVM model in diverse settings and examine how emotional and structural factors interact to either support or undermine the success of Lean transformation.

Consent to Participate

Participation in the interview was voluntary. Volunteers signed up with the interviewer and provided written consent for participating in the interview and for the use of the data in the dissertation research and related article.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,authorship and/or publication of this article.

Ethical Approval and Data Availability

Ethical approval for the study was obtained from the research organization,and the approval was granted. Permission for public availability of the data was not granted as part of the ethical approval process.

Funding

The authors received no financial support for the research,authorship and/or publication of this article.

ORCID iDs

Petra Hurme

Johanna Liljeroos-Cork

References

Abid

M. F.

, Shamim

, Khan

, & Khan

(2022). Value creation or value destruction: Conceptualizing the experiential nature of value-in-use. Journal of Consumer Behaviour , 21(3), 583–601. https://doi.org/10.1002/cb.2033

Ballé

, & Jones

(2017). Flow to learn. ISE; Industrial and Systems Engineering at Work , 49(5), 28–33.

Ballé

, Chaize

, & Jones

(2019). Lean as a learning system: What do organizations need to do to get the transformational benefits from Toyota’s method? Development and Learning in Organizations , 33(3), 1–4. https://doi.org/10.1108/DLO-11-2018-0147

Chandler

J. D.

, & Vargo

S. L.

(2011). Contextualization and value-in-context: How context frames exchange. Marketing Theory , 11(1), 35–49. https://doi.org/10.1177/1470593110393713

Costa

L. B. M.

, & Godinho Filho

(2016). Lean healthcare: Review, classification and analysis of literature. Production Planning & Control , 27(10), 823–836. https://doi.org/10.1080/09537287.2016.1143131

Cui

, & Osborne

S. P.

(2023). Unpacking value destruction at the intersection between public and private value. Public Administration (London) , 101(4), 1207–1226. https://doi.org/10.1111/padm.12850

Domiciano Borota

F. R.

, Bonamigo

, & de Souza Andrade

(2023). Implications of value co-creation in agro-industrial services [Implicaciones de co-creación de valor en servicios agroindustriales]. International Journal of Innovation (2318-9975) , 11(1), 1–36. https://doi.org/10.5585/2023.22014

Echeverri

, & Skålén

(2021). Value co-destruction: Review and conceptualization of interactive value formation. Marketing Theory , 21(2), 227–249. https://doi.org/10.1177/1470593120983390

Efe

, & Efe

Ö. F.

(2016). An application of value analysis for lean healthcare management in an emergency department. International Journal of Computational Intelligence Systems , 9(4), 689–697. https://doi.org/10.1080/18756891.2016.1204117

10.

Engen

, Fransson

, Quist

, & Skålén

(2021). Continuing the development of the public service logic: A study of value co-destruction in public services. Public Management Review , 23(6), 886–905. Scopus. https://doi.org/10.1080/14719037.2020.1720354

11.

Frank

, & Rader

(2023). Using lean healthcare techniques to reduce appointment times. The Journal for Nurse Practitioners , 19(3), 104508. https://doi.org/10.1016/j.nurpra.2022.11.018

12.

Gallarza

M. G.

, & Sánchez-Fernández

(2023). Defining and measuring customer value: Some reflections and new perspectives. Journal of Creating Value , 9(1), 27–45. https://doi.org/10.1177/23949643231163091

13.

Harolds

J. A.

(2023). Quality and safety in healthcare, Part XC: The A3 approach and lean in healthcare. Clinical Nuclear Medicine , 48(7), e358–e360. https://doi.org/10.1097/RLU.0000000000003851

14.

Höglund

, Mårtensson

, & Thomson

(2021). Strategic management, management control practices and public value creation: The strategic triangle in the Swedish public sector. Accounting, Auditing & Accountability Journal , 34(7), 1608–1634. https://doi.org/10.1108/AAAJ-11-2019-4284

15.

Hurme

, & Liljeroos-Cork

(2024). Factors promoting value creation in lean management within public social and healthcare organisation. International Journal of Services and Operations Management , 2024(49), 1–21. https://doi.org/10.1504/IJSOM.2024.10067492

16.

Kaartemo

, & Känsäkoski

(2018). Information and knowledge processes in health care value co-creation and co-destruction. Sage Open , 8(4). https://doi.org/10.1177/2158244018820482

17.

Katsaitis

, & Zampetakis

L. A.

(2024). What value do you bring to the company? Daily diary insights on the relationship between employees’ autonomy and value creation beliefs. Journal of Creating Value , 10(2), 220–234. https://doi.org/10.1177/23949643241248585

18.

Keeling

D. I.

, Keeling

, De Ruyter

, & Laing

(2021). How value co-creation and co-destruction unfolds: A longitudinal perspective on dialogic engagement in health services interactions. Journal of the Academy of Marketing Science , 49(2), 236–257. https://doi.org/10.1007/s11747-020-00737-z

19.

Kessy

S. S. A.

, Salema

G. L.

, & Simwita

(2023). Lean thinking in medical commodities supply chains: Applicability and success factors for Tanzanian health supply chains. Journal of Humanitarian Logistics and Supply Chain Management , 14(1), 105–117. https://doi.org/10.1108/JHLSCM-05-2022-0058

20.

Leite

, & Quadros

F. C.

(2024). Lean applications across the healthcare ecosystem: Value creation, destruction and a research agenda. Operations Management Research , 18, 24–47. https://doi.org/10.1007/s12063-024-00523-y

21.

Liker

J. K.

(2021). The Toyota way: 14 management principles from the world’s greatest manufacturer (2nd ed.). McGraw Hill.

22.

Liljeroos-Cork

, & Luhtala

(2024). Value co-destruction through misintegration of resources within a public service ecosystem. Public Management Review , 27(3), 722–745. https://doi-org.libproxy.tuni.fi/10.1080/14719037.2024.2366986

23.

Lindqvist

, & Westrup

(2020). Non-voluntary service interaction from a service logic perspective: Children and value co-creation. Public Management Review , 22(12), 1781–1798. https://doi.org/10.1080/14719037.2019.1648698

24.

Lindsay

C. F.

, Kumar

, & Juleff

(2020). Operationalising lean in healthcare: The impact of professionalism. Production Planning & Control , 31(8), 629–643. https://doi.org/10.1080/09537287.2019.1668577

25.

Lumivalo

, Tuunanen

, & Salo

(2024). Value co-destruction: A conceptual review and future research agenda. Journal of Service Research , 27(2), 159–176. https://doi.org/10.1177/10946705231177504

26.

Maijala

R. K.

, Eloranta

, & Ikonen

(2020). Lean-ajattelu ja lean-päivittäisjohtaminen yliopistosairaaloissa. Sosiaalilääketieteellinen Aikakauslehti , 57(1), Article 1. https://doi.org/10.23990/sa.78049

27.

McAdam

, Galbraith

, McComb

, Antony

, & Vijaya Sunder

(2022). Development of Sustainable Lean Patient Value in Healthcare: A Long-Term Condition Context. Total Quality Management & Business Excellence , 33(13–14), 1439–1471. https://doi.org/10.1080/14783363.2021.1964357

28.

Nicholas

(2023). Lean daily management in healthcare: Origins, practices, and associations with lean leadership and lean sustainability. Total Quality Management & Business Excellence , 34(11/12), 1526–1552. https://doi.org/10.1080/14783363.2023.2182677

29.

Radnor

, & Osborne

S. P.

(2013). Lean: A failed theory for public services? Public Management Review , 15(2), 265–287. https://doi.org/10.1080/14719037.2012.748820

30.

Rosa

, Marolla

, & McDermott

(2023). A cross-organizational Lean deployment in an Italian regional healthcare system. International Journal of Health Care Quality Assurance , 36(3/4), 17–36. https://doi.org/10.1108/IJHCQA-06-2023-0045

31.

Rossi

, & Tuurnas

(2021). Conflicts fostering understanding of value co-creation and service systems transformation in complex public service systems. Public Management Review , 23(2), 254–275. https://doi.org/10.1080/14719037.2019.1679231

32.

Saldana

, Leavy

, & Beretvas

(2011). Fundamentals of qualitative research . Oxford University Press, Incorporated. http://ebookcentral.proquest.com/lib/tampere/detail.action?docID=665394

33.

Schwagerman

W. C.

, & Ulmer

J. M.

(2013). The A3 lean management and leadership thought process. The Journal of Technology, Management, and Applied Engineering , 29(4), Article 4. https://www.iastatedigitalpress.com/jtmae/article/id/14149/

34.

Singhvi

, Balaji

, Wöhner

, Schupp

, & Durach

(2016). Value destruction: The new perspective_Beyond waste lies destruction .

35.

Skarli

J. B.

(2023). Responsibilization and value conflicts in healthcare co-creation: A public service logic perspective. Public Management Review , 25(7), 1238–1259. https://doi.org/10.1080/14719037.2021.2013070

36.

Strokosch

, & Osborne

S. P.

(2020). Co-experience, co-production and co-governance: An ecosystem approach to the analysis of value creation. Policy and Politics , 48(3), 425–442. https://doi.org/10.1332/030557320X15857337955214

37.

Virtanen

, & Jalonen

(2024). Public value creation mechanisms in the context of public service logic: An integrated conceptual framework. Public Management Review , 26(8), 2331–2354. https://doi.org/10.1080/14719037.2023.2268111

38.

Voorberg

W. H.

, Bekkers

V. J. J. M.

, & Tummers

L. G.

(2015). A systematic review of co-creation and co-production: Embarking on the social innovation journey. Public Management Review , 17(9), 1333–1357. https://doi.org/10.1080/14719037.2014.930505

39.

Womack

J. P.

(with Jones, T. D.). (2003). Lean thinking: Banish waste and create wealth in your corporation (rev. and updated). Free Press.