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Lean Service: A literature analysis and

classification
a

Manuel F. Surez-Barraza , Tricia Smith & Su Mi Dahlgaard-Park

c
a

EGADE Business School Mxico, Tecnolgico de Monterrey ,

Mxico, D.F. , Mxico
b

ESADE Business School, Member of GRACO Research Group ,

Barcelona , Spain
c

Institute for Service Management, Lund University ,

Helsingborg , Sweden
Published online: 10 Jan 2012.

To cite this article: Manuel F. Surez-Barraza , Tricia Smith & Su Mi Dahlgaard-Park (2012) Lean
Service: A literature analysis and classification, Total Quality Management & Business Excellence,
23:3-4, 359-380, DOI: 10.1080/14783363.2011.637777
To link to this article: http://dx.doi.org/10.1080/14783363.2011.637777

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Total Quality Management

Vol. 23, No. 4, April 2012, 359 380

Lean Service: A literature analysis and classification

Manuel F. Suarez-Barrazaa , Tricia Smithb and Su Mi Dahlgaard-Parkc
EGADE Business School Mexico, Tecnologico de Monterrey, Mexico, D.F., Mexico; bESADE
Business School, Member of GRACO Research Group, Barcelona, Spain; cInstitute for Service
Management, Lund University, Helsingborg, Sweden

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The service sector in the USA accounts for 80% of gross domestic product. However, in
spite of the pivotal role of the service sector in the US economy and its impact on daily
life, the level of productivity in this sector has been much lower than that of the
manufacturing area. This situation has been in existence for some time, but in the
current context, there are growing external pressures to reduce costs, increase
flexibility, improve quality and cut down on lead times. Companies are thus turning
their attention to the manufacturing sector with the aim of implementing their
techniques and methods which encourage a lean approach. The purpose of this
article is to review the extant literature on the subject that goes under the umbrellatitle of Lean Service, analyse it, classify it into preliminary categories and suggest
possible gaps in the research literature from the point of view of researchers and
practitioners. The paper systematically categorises the published literature where
the term Lean Service appears, including the early publications on the subject. Then,
the categories are revised and analysed methodically. The research found that the
literature referring to Lean Service can vary widely from the exploration of the
meaning of the concept, its applications (case studies), the setting up of theoretical
concepts (models) to the generation of new definitions. Within each category, certain
gaps have been identified and possible future lines of research which clarify and
distinguish the concept of Lean Service. In addition, within the category of
applications, sub-categories have been identified such as banks and financial
institutions, the health sector, education, the airline industry, and hotels and
restaurants. The paper aspires to be of interest as much to researchers as to
professionals in the service industry, whether they have middle management
responsibilities, or are service managers, and also to all those employees whose
work is related to this sector, with the object of understanding the management of
service organisations from the Lean Service perspective.
Keywords: Lean Thinking; Lean Service; literature review; analysis; classification

1.

Introduction

Due to the extraordinary growth in the service sector during the last two decades many
service organisations now pay attention to the efficiency and effectiveness of their operations (Cavaness & Mannochehri, 1993). However, despite the key role of the service
sector in the American and worldwide economy and society, the productivity of this
sector has been far lower than that of manufacturing. In fact, between 1981 and 1990,
the growth rate in the service sector was only 0.1% a year compared with 3% in the manufacturing sector in the USA (US Bureau of Labour Statistics, 1990, 1991, 1992). This low

Corresponding author. Email: manuelfrancisco.suarez@itesm.mx

ISSN 1478-3363 print/ISSN 1478-3371 online

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360 M.F. Suarez-Barraza et al.

rate has continued until today but given the increasing external pressures to reduce costs,
increase flexibility, improve quality and reduce lead times, organisations in the service
sector now look to the manufacturing sector in order to learn and implement their techniques and methods so as to become more lean and thus focus their service activities
from a lean perspective (Kinnie et al., 1996.)
Various researchers agree that we are now in the post-modern era in which quality of
life is the guiding principle in society. Because of this, services like health, education,
transport, financial services (banks, financial institutions) and even public services have
come to form the integrated basis of the life of citizens who are the clients of these
organisations in this new post-industrial era (Fitzsimmons & Fitzsimmons, 1994;
Suarez-Barraza, Smith, & Dahlgaard-Park, 2009). So a growing pressure to improve
efficiency and effectiveness of services seems to be one of the most constant features
that face the post-industrial organisation which now also finds itself in a full global recession. In this context, the research literature on service organisations seeking improvements
has reported certain cases that serve to illustrate and to refine the term Lean Service. But
what does research say about this term? The objectives of this article are the following:
(1) To investigate and to suggest a classification of the existing literature in the field of
Lean Service.
(2) To identify some critical observations about each classification.
(3) To identify what points there are in common so as to profile what we mean by Lean
Service.
(4) Based on the above, to propose further paths and directions for researchers in this
field.
(5) As far as possible, to try to consolidate the existing literature, centring mainly on
academic articles but extending the range to include relevant practitioner
contributions.
The structure of the article is the following:
(1) A short introduction leads on to a section that explains the methodology adopted in
the literature review; then the results of the surveyed literature will be shown,
dividing it into categories and sub-categories of Lean Service.
(2) There will be an analysis and detailed discussion of each category and subcategory, each of which will be followed by some critical observations.
(3) In the final part of the article, the commonalities and shared features of the literature on Lean Service under review will be described, as well as the trends and
directions detected from the review, and specific proposals will be made as to
further recommendations for research in the field.
2. Method of analysis and classification
There are several ways of conducting literature review such as a narrative literature
review, a meta-analysis or a systematic review methodology (SRM) (Baumeister &
Leary, 1997; Tranfield, Denyer, & Smart, 2003). Based on our consideration on these
methods we have adopted the SRM, not only because the method has been widely
implemented, but also due to its systematic, scientific and transparent process of conducting literature review. As Tranfield et al. (2003) suggested, we have divided the review
process into three stages of (1) planning, (2) conducting, (3) reporting.
Under the planning stage, main activities have been in identifying review objectives
and review protocol which include clear review criteria and process of inclusion and

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Total Quality Management 361

exclusion of papers. We have included publications written in English. Most papers
were peer-reviewed, however due to the scarcity of articles on this subject other
publications from less-academic sources were also considered whose intended readership was more for practitioners than scholars. Reports, articles, columns or newspaper
editorials were excluded from this search when it was felt that the authors only presented general information that did not bring new insights to the research area. On
the other hand, books and publications in hard copy which clearly referred to the
subject in hand were included. A total of 172 references were collected.1 Using the
term Lean Service, a search was made of various academic databases such as
Proquest, Business Source Elite, Business Source Premier, Emerald, Science Direct
and Google Scholar. The final date for the systematic collection of papers for
review was December 2009.
Under the second stage of actual review process, determining the relevance of collected literature, identifying and compiling keywords after the screening of the papers
have been main activities. At this stage due to the scarcity of the relevant literature that
referred to Lean Service directly, a further search was made in specific fields (which
were converted into sub-categories) such as health, education, airlines, hotels and restaurants, and finally banks and financial institutions. The authors tried their best to make a
thorough sweep of the publications that related to Lean Service but that does not
presume that the list presented in this article is by any means complete or exhaustive.
The next and the final step was to make a schematic classification and analysis. First a
list was drawn up of the all the publications that were collected and from each one, an
abstract was written which included the main findings from the paper in question; for
these findings, an Excel spreadsheet was created which formed the database of the research
findings.
Consistent with the adopted methodology, the next section of the paper shows the
results of the classifications of the literature.

2.1

Categories and sub-categories: results of the literature classification

The classification scheme for this study emerged from the parallel and simultaneous exercise of categorising and sub-categorising the collected papers and texts. The result of this
exercise was the grouping of all the articles into the following four main categories:
(1) Exploration of Lean Service (first reflections and foundations). All the literature
reviewed in this category relates to the articles that were the pioneers in the
field, exploring the applications of the concepts in service organisations. Therefore, although the concept of Lean was not used explicitly in these articles, they
can be regarded as providing the foundations of Lean Service.
(2) Creation of the theoretical framework of Lean Service (some models). From 1990
onwards, when the concept of Lean Production or Lean Thinking first entered the
academic arena, different authors gave themselves the task of comparing how
different service organisations went about trying to improve on or innovate the
operational aspects of the services they provided. The first article to refer to
Lean Service in this sense was written by Bowen and Youndahl in 1998, entitled
Lean Service: in defence of the production line approach; this was the first time
the term was used (Radnor, Walley, Stephens, & Bucci, 2006, p. 98) and the article
used examples of service firms like Taco Bell, McDonalds and Southwest Airlines,
putting forward the first arguments for Lean Service.

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362 M.F. Suarez-Barraza et al.

Figure 1. Bar graph showing the distribution and trends of the publications in the study.

(3) Specific applications of Lean Service (Academic and practitioner case studies).
Managers of service organisations are becoming more and more interested in
how Lean Service methods can be applied and like to read about success stories
regarding their application so they can make use of such techniques to bring
about improvements in their own organisations. In this respect this group of
articles in the research literature is of direct use because it includes various case
studies, by both academics and practitioners, of service firms in health care, education, banks and finance, airlines and hotels and restaurants.
(4) New trends and extensions of Lean Service. Although the term Lean Service is by
no means saturated through popular overuse nor exhausted in the academic literature of empirical and theoretical research, some new trends and extensions of the
term have been noted in the literature reviewed. In this category new uses of the
term Lean Service have been identified relating to Lean-Kaizen Public service, eservice, Total Quality Service, Service Excellence or one possible theoretical evolution of the term known as Service Science.
For obvious reasons it is clear that a strict demarcation between the categories cannot
be drawn since during the analysis of the literature certain areas overlapped with each
other. In addition, some of the articles refer, directly or indirectly, to Lean Service as
having a central or determining meaning in research streams relating to Service
Quality. To view the distribution and scale of the four different categories which were
derived from the publications under review, see the bar graph (Figure 1).

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Total Quality Management 363

The publications which were analysed and classified underwent a further analysis by
ascribing sub-categories which were coded according to the year of publication, the sector
of the service described or the subject of the article (for the most recent cases the year of publication was not taken into account): this was done in order to help the reader follow the
articles. So each category was given a number from 1 to 4 which is shown on the horizontal
axis of the bar chart, and in the key to the graph. The codification of these categories followed
the same logical sequence as they appeared in the academic emergence of Lean Service, which
means to say that the term was not coined or described by the researchers until they had finished the studies that underpinned the creation of the theoretical framework. For that reason,
category 1, following the logic described above, is assigned to the first research articles that
explored the concepts of manufacturing in the service sector such as the work by Skinner,
Levitt and Lawler. But returning to the explanation of category 2, this group of articles was
classified in turn into three sub-categories, arranged by year of publication of the articles
thus 2a (19801989); 2b (19901999); and 2c (20002008). For example, the article
by Bowen and Youngdahl belongs to category 2b because it was published in 1998.
Category 3 is arranged in the same way; publications were assigned to this category
which made reference to Lean Service applications in the service sector, and then when a
deeper study had been made of them (and the research and analysis is ongoing) the
creation of guidelines and models were set up to contribute to the theory-building. The
classification method for category 3 was formed by selecting the type of service-sector
activity where the term Lean Service was applied and which was then published as a case
study either in the academic literature or for the practitioner audience. This means that 3a
refers to the health-care sector; 3b to education; 3c to banks and financial services; 3d to
airlines; and 3e for the sector of hotels and restaurants. In these sub-categories, the year
of publication is less relevant due to the scarcity of published case studies in the literature
for each sector. It is worth noting that, as can be seen in the graph in Figure 1, this category
has at most 80 publications and that number is made up of articles which were written more
for practitioners which are included to add weight to our study. Also, within the five sub-categories, that of Health Care (with 32 publications) is the one with the most case studies,
nearly all of which make a solid case for the benefits of applying Lean Service in the
health field (see Tables 1 and 2). An example of this could be the article by Spear (2005)
which is found in sub-category 3a of Health Care, following the method that was used to
classify all the analysed articles. Finally, it can be seen that the year of publication is not
taken into account when making the divisions into sub-categories (see Tables 1 and 2).
Finally, in category 4 all those publications that seem to belong to the theory-building
of Lean Service are described, adding to them those articles that indicate new trends in
other sectors such as the public service (sub-category 4a) as well as peripheral or
linked articles dealing with Total Service Quality, Service Excellence or Service
Science (sub-category 4c) and then associated topics like e-service (sub-category 4b). It
is important to note that in this classification it is likely that there are other publications
that describe and analyse each sub-category in greater depth; however, we have chosen
articles in the sub-categories that various authors have considered relevant to building
theory. So it is clear that there are probably far more than the 28 articles that have been
selected here for this literature review and this can be illustrated in the graph in Figure
1 and Tables 1 and 2.
In Table 1, the classification of the categories and sub-categories of the literature under
review can be seen.
In Table 2, the details of the major publications under review can be seen, with their
categories and sub-categories, adding the date and author-details of each of them.

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364 M.F. Suarez-Barraza et al.

Table 1.

Summary of the coding pattern for the categories and sub-categories and the number of publications.

Sub-category/
category
Category 1
(exploration)
Category 2
(theorybuilding)
Category 3
(applications)
Category 4 (new
trends)
Total

Classical
papers

2a
(80
89)

2b
(90
99)

2c
(00
08)

31

22

60

32

27

80

15

10

28

31

22

32

27

15

10

172

3a
3b
3c
3d
(Health) (Education) (Banks) (Airlines)

3e
4a (Public
(Hotels) service)

4b (e- 4c (Excellence
service)
TSQ)
Total

Total Quality Management 365

Table 2.

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Category

Categorisation of the major publications reviewed.

Major references reviewed

Category 1. Exploration of Lean Service (reflections and foundations)

1
Skinner (1969), Levitt (1972), Levitt (1976), Lawler (1978)
Category 2. Creation of the theoretical framework of Lean Service
2a (19801989)
Chase and Garvin (1989), Parasuraman et al. (1988),
Schmenner (1986)
2b (19901999)
Armistead (1990), Bowen and Lawler (1992), Chase,
Kumar, and Youngdhal (1992), Fitzsimmons and
Fitzsimmons (1994), Gallouj and Weinstein (1997),
Ghobadian, Speller, and Jones (1994), Harvey (1998),
Heskett, Sasser, and Hart (1990), Reichheld and Sasser
(1990), Schlesinger and Heskett (1991), Womack and
Jones (1996)
2c (20002008)
Abdi et al. (2006), Allway and Cobertt (2002), Dahlgaard
and Dahlgaard-Park (2006), Gronroos (2000), Hing Yee
Tsang and Antony (2001), Karmarkar (2004), Kumar
et al. (2008), Lovelock and Wright (2001), Prajogo
(2006), Swank (2003), Weekkody, Currie, and
Ekanayake (2003)
Category 3. Specific applications of Lean Service
3a (Health care)
Aherne (2007), Ben-Tovim et al. (2007), Collins and
Muthusamy (2007), Dahlgaard et al. 2011, Fillingham
(2007), Jones and Mitchell (2006), Kollberg et al.
(2007), Komashie, Mousavi, and Gore (2007), Lipley
(2008), Martin (2007), Massey and William (2005),
Spear (2005), Sprigg and Jackson (2006), Togal-Taner,
Sezen, and Antony (2007)
3b (Education)
Andersen Rostgaard (1995), Hines and Lethbridge (2008),
Bergman (1995), Comm and Mathaisel (2005), Emiliani
(2004), Emiliani (2005), Dahlgaard et al. (1995),
Dahlgaard and Ostergaard 2000, Kells (1995),
Logothetis (1995), Spanbauer (1995), Tofte (1995), Van
Der Wiele (1995), Van Zadelhoff, De Wet, Pothas, and
Petrorius (1995)
3c (Banking and finance)
Batiz-Lazo and Wood (1999), Cocheo (1995), George
(2003), Streeter (1990)
3d (Airlines)
Greenwood et al. (2002), Hutchins (2006), Newton (2007),
Reinhardt (2007)
3e (Hotels and restaurants)
Heskett (1987), Berger et al. (1989), Johnson and Martin
(1993), Suarez-Barraza (2008)
Category 4. New trends and extensions of Lean Service
4a (Lean-Kaizen Public Service)
Bhatia and Drew (2006), Krings, Levine, and Wall (2006),
Furterer and Elshennawy (2005), Radnor and Boaden
(2008), Suarez-Barraza and Ramis-Pujol (2008), SuarezBarraza et al. (2009)
4b (e-service)
Voss (2003)
4c (Service excellence total quality Gupta et al. (2005), Sureshchandar et al. (2001), Den
service, service science)
Hartog and Verburg (2002), Johnston (2004)

366 M.F. Suarez-Barraza et al.

3. Analysis of the categories and sub-categories of Lean Service research, with
observations

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This section of the article presents a detailed discussion of each category and sub-category
analysed for this study, with the addition of certain critical comments on each one.
3.1 Category (1): exploration of Lean Service (first reflections and foundations)
The four articles in this category show where the authors who first recognised that concepts from manufacturing could possibly be applied to service firms had gained knowledge
of those concepts and techniques, and set out their reflections and explorations of those
first insights. Skinner (1969) recognised that the manufacturing sector led the service
industry in terms of finding ways and mechanisms to improve the productivity of the
organisation; among those techniques were strategies of low costs, quality and flexibility,
all of which were forged in the manufacturing sector. However, the change of thinking and
turn towards the industrialisation of the service sector did not come about, according to
the authors, until the 1970s with two pioneering articles by Levitt (1972, 1976). As Levitt
(1972, p. 52) claimed:
Service will be viewed as something residual to the ultimate reality to a tangible product, to
a specific competence (like evaluating loans, writing insurance policies, giving medical aid,
preparing on-premises foods). Hence, it will have residual respectability, residual attention,
and be left, somehow, for residual performance.

Levitt (1972, 1976) was the first to recognise the potential of adopting Lean Thinking
for the service sector, one which was more or less forgotten in the seventies when manufacturing dominated the economy (Bowen & Youndahl, 1998). In his two articles, Levitt
indicated that the service sector at the time was backward and inefficient when compared
with the focus on mass production techniques in the manufacturing sector. This backwardness and inefficiency derived from the way the service sector was dominated by a bureaucratic model of operations that had been consolidated over years, and which operated in an
environment where the clients wishes or desires were unimportant. Therefore, a focus on
mass production assembly line methods based on a technocratic point of view could represent at that moment in time a solution for bringing about change and improvement in the
service sector (Levitt, 1972).
This classic author showed that if the same care that was taken in the manufacturing
sector was applied in the services sector to aspects like planning, control, quality, improvement and client reaction then the services industry could reach much greater client satisfaction in that period. Using MacDonalds as an example of a firm that had applied this
technocratic standardisation approach to the service they offered to clients, Levitt
(1972, p. 30) concluded that mass production methods or assembly line methods
applied to the service sector would permit this sector to ensure better efficiency in its operations, lower costs and satisfy clients in more specific ways.
3.1.1 Some observations
It is hard to criticise the four articles, each pioneering in the conceptual reflection and
foundation of Lean Service. However, he indicated that service should be seen as a
residual part of a tangible product, as something apart but complementary (Levitt
1972, p. 52). At the same time, he indicated the importance to service of the human
factor. So this division has to fit with his focus on technocratic efficiency for service, as
in a manufacturing assembly line. These two observations by Levitt are contradictory,

Total Quality Management 367

as one confirms the importance of the human component while the other stresses the
importance of technical efficiency in production. He said that every service encounter is
a moment of truth (Carlzon, 1991) and is when one individual meets another individual
and experiences an isolated moment free of interaction. Perhaps at the time, these terms
were intuitive but the profound effects they could have on an organisation had yet to be
studied.

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3.2

Category (2): creating the theoretical framework of Lean Service (some models)

When the model of the industrialisation of service organisations (with the focus on production lines or mass production) which was first described by Levitt (1972, 1976) and
exemplified by Macdonalds began to lose ground in the mid-1980s and early nineties
(Schlesinger & Heskett, 1991), some publications in the arena of services began a shift
towards a new logic which was ironically reinforced by both the service and the manufacturing sectors; this logic was known as quality service as sustained by the Total Quality
Management (TQM) movement which centred on services not just in terms of production
methods but also with an orientation towards the customer, searching out the best ways
to satisfy his needs and requirements, as TQM preached (Dean & Bowen, 1994). The
shift can be traced from Chase and Garvin (1989) who described in their article Service
factory the forces that had pushed manufacturing firms to rescue service and search for
advantage through service; these forces were the same that gave rise, in the same sector,
to terms like quality, attention to the customer and inter-functional teams. Further, this
shift led to searching out organisational effectiveness in manufacturing, and to the generation of specific models to measure the perceptions, the needs and the expectations of customers like the SERVQUAL of Parasuraman, Zeithaml, and Berry (1988). This journey
through the literature began to open new fields in the knowledge arena of service, such as
Service Marketing or Service Operations, Quality of Service although in practice,
there were many overlaps of practices, techniques and principles.
However, it was not until the end of the 1990s and in the next decade that a theoretical
framework began to be developed in the literature for the specific term lean service.
Some authors had called it re-industrialization of service which can be explained,
according to the literature we analysed, by the appearance of a new management approach
developed in Japan in the 1960s and 1970s known as the Toyota Production System (TPS)
(Ohno, 1978). This approach became known as Lean Production after a study carried out
by two North American researchers studying TPS (Dahlgaard & Dahlgaard-Park, 2006).
The principles of Lean Production that arose in the manufacturing sector were adopted
by two researchers at Thunderbird, the American Graduate School of International Management, who proposed the first theoretical framework for Lean Service (Abdi, Khalili
Shavarini, & Seyed Hoseini, 2006, p. 199). This theory, proposed Bowen and Youndahl
(1998, p. 199), suggested that Lean Service could be present when certain principles
could be discerned in an organisation. These principles are: (1) Flexibility and responsiveness; (2) focus on individual customers; (3) value-chain integration and disaggregation; (4)
empowerment of employees and teams; (5) knowledge management; and (6) networked
organisation. These six principles converge in organisations under the personalisation of
mass, whether for products or for services (customisation).
Following the literature analysis some consultancy organisations with a clear practitioner orientation made claims about the way they considered Lean Service should be
understood and applied. In this way Allway and Cobertt (2002) indicate that in order to
explore the term Lean Service in organisations in the service sector it is necessary for

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368 M.F. Suarez-Barraza et al.

senior managers to recognise that this type of organisation the service organisation
functions through a conjunction of operations and/or processes with the objective of delivering an output in the form of services and/or products. Also, during this transformation,
each service organisation should seek to deliver the maximum value possible to clients in
the way the services satisfy the clients needs and expectations.
Therefore, Abdi et al. (2006) propose their own version of a Lean Service model by
showing that four dynamic phases need to be implemented: (1) Learn: Thinking lean
about your service; (2) Expect: Setting the expectation by avoiding the mean service;
(3) Analyse: Benchmarking your operations with service role models; (4) Navigate
using the practitioners and consultants experiences. Finally, and in accordance with Emiliani (2004, p. 489) and Dahlgaard and Dahlgaard-Park (2006, pp. 267 268) the majority
of the activities in both service and manufacturing organisations are non-value adding. As
illustrated in Dahlgaard and Dahlgaard-Park (2006), 74% of the total salaries were used on
waste of different kinds in a case study conducted in a leading Danish service company.
3.2.1

Some observations

As has been suggested above, there is a clear theoretical gap when it comes to defining and
profiling the conceptual framework of Lean Service, and despite some authors efforts in
producing empirical case studies (Bowen & Youndahl, 1998) to begin the development of
such a framework, the remainder of the articles continue to adopt a practitioner approach
with little empirical support.
Another key point to be made in these observations is that various writers do in fact
broach the theme of services by writing about service management, including possible
transference of techniques from manufacturing to service organisations, among which
can be found Lean Thinking, or a possible equivalent in the context of Lean Service
(Kumar, Smart, Maddern, & Maull, 2008). However, among all the empirical studies
and research that are presented it seems that organisations cannot manage to distinguish
the exact moment to put into practice all these various techniques that improve the performance of service operations. This confusion is made even worse when certain principles and tools belonging to the various approaches (TQM, Lean approach and
Business Process Reengineering) are interspersed one with the other. Therefore, it is difficult to clearly define what we are talking about when we use the term Lean Service.
Another key aspect that is related to the earlier point is that the literature analysed in
this category agrees on the point that in all service organisations, the most important
element is the people themselves who manage and deliver the service in question. This
point in particular needs theoretical support; there needs to be a detailed and specific theoretical framework of Lean Service in which aspects such as the development of skills and
capabilities of the personnel, the spirit of service, quality of service (customer attention) and even the moment of truth become part and parcel of the service process,
even if this functions as a production line.
3.3 Category 3: specific applications of Lean Service (academic and practitioner
case studies)
Analysing the literature we find that various sectors in services have presented case studies
and research that illustrate success stories about the application of Lean Thinking. These
include both case studies conducted by academics as well as accounts or articles that
reflect the practitioner viewpoint. These we can place into five sub-categories of category

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Total Quality Management 369

3; 3a Health Care; 3b Education; 3c Banks and financial institutions; 3d Airlines and
mechanical workshops; and 3e Hotels and restaurants. Of the five sub-categories, the
first one, that of healthcare, is the one with the most published articles, namely 31. Interestingly, nearly all of these 31 publications have appeared in the most recent period of
analysis which is between 2004 and 2008 (when the analysis was closed.) The analysis
of the five sub-categories begins, then with the first and largest, 3a, Health Care.
Womack and Jones (1996) indicated that it was possible to apply Lean Thinking to
health systems. Aspects like placing patients at the centre of the processes of the
service (focus on the client) and including waiting times for medical attention as well
as variables such as comfort and quality of services delivered could all be regarded as
the first steps towards applying Lean Thinking in the sector. Different authors have indicated, bearing out this argument, that Lean Thinking could be applied in order to eliminate
the number of errors and mistakes, reduce delays and waiting times, and address
inadequate procedures and bureaucratic processes in the health sector (Collins & Muthusamy, 2007).
Likewise, one of the reasons that service improvements have been applied is that there
has been a general trend within the health service globally to abandon the bad old ways,
and pressures have been brought to bear for change due to extra demand on the health services, low effectiveness and efficiency in public systems, cost increases in health care, the
lack of professionalism in certain techniques, and specialisms in health and bureaucratic
processes, among others (Spear, 2005). On this point, Martin (2007, p. 25) reports that
in the 2007 Quality Report Survey, 18.5% of the health-care organisations in the USA
used techniques like the Six Sigma, 13.3% used Lean Thinking, 12.2% outsourced
health care and a significant 29.2% did not use any techniques at all. It is worth repeating
that the former of the two techniques might be considered as a single one (31.8%) which is
a significant fact taking into consideration that the application of Six Sigma and Lean
Thinking are considered by some authors to be very similar (Dahlgaard & DahlgaardPark, 2006).
Following this theme, different articles, practitioners and empirical studies from the
USA (hospitals like Virginia Madson in Seattle and Theadacare in Wisconsin), Canada,
Australia, the National Health Service in UK, Bolton Hospital, for instance, have
described case stories which outline the feasibility and then the application of Lean
Service with results that have had positive impacts on productivity, cost savings,
reduced patient waiting times, improved treatment for emergencies, improvements in
management and medical material storage, and time savings in services such as cancer
treatment (Jones & Mitchell, 2006; Lipley, 2008). On the other hand, a theoretical framework for measuring the performance in healthcare based on Lean application was also proposed in a Swedish study by Kollberg, Dahlgaard, and Brehmer (2007). Lean Service was
considered as one element that formed part of an overall management plan to change the
mentality and the daily work performed by health-care centres. In the end, and this is in
tune with other authors who have studied the subject, the great challenge for Lean
Service in the health sector is to make all the actors technical staff, doctors, nurses,
auxiliaries and administrators aware of the potential benefits that exist if Lean principles
and methods are applied in their context (Aherne, 2007).
For all these reasons, and supported by the literature which was analysed, it can be said
that the principles of Lean can be and in fact are applied in the sector (Health Care),
including a high level of direct involvement in the processes that deliver the services,
as has been noted. However it cannot be said (as does Spear, 2005), that the healthcare organisations which were studied work like Toyota; on the contrary, the research

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370 M.F. Suarez-Barraza et al.

shows that the principles of Lean Service can be considered as a way of improving the
health services. As one of the main focuses of Lean approach is to identify and remove
waste in every aspect of organisational processes, the principle can be applied also in
healthcare and enhance efficiency. Even though they do not make cars, all work is a
process and therefore it is possible to improve it (Fillingham, 2007, p. 340). Finally,
Dahlgaard, Petersen, and Dahlgaard-Park (2011) recently proposed ILL (Innovability,
Learnability and Leanability) self-assessment methodology which was applied in healthcare organisation for diagnosing its ILL capability. It is shown that results of ILL
self-assessment can be used to strategically identify critical areas to improve in healthcare
organisations.
Second sub-category (3b) education. Just as in the health sector, education has
experienced different pressures in recent years, especially as so many changes have
taken place in educational programmes: on-line programmes, distance-learning, global
executive education, workshop-type training and so on, such that constant improvement
in educational programmes has become a critical point for educational intuitions all
over the world (AACSB, 2002). This pressure on educational organisations to continuously improve their quality of service is a mounting and relentless challenge.
If we want to trace back the origin of Lean Service in the literature of education we
need to go back to a pioneering Special Issue published in 1995 of the Total Quality Management Journal, volume 6, issues 5 and 6 (Dahlgaard, Kristensen, & Kanji, 1995). The
special issue was the fruit of a first international forum held in Denmark, October 1993.
The forum was organised by Prof. Jens Dahlgaard with financial support from European
Commission and the focus was specifically on Quality in education. There were various
contributors at this forum that evidenced the crucial first observations of the application
of Lean in education sectors. Dahlgaard et al. (1995) discuss and analyse the key principles
of TQM for education sector. Of the five main principles espoused in TQM (managements commitment (leadership), focus on customer and the employees, focus on facts,
continuous improvement (Kaizen) and everybodys participation) at least three of them
have a strong link with Lean Service: Kaizen, focus on customer and the employees
and focus on facts.
Kells (1995) indicates in the conclusions and recommendations of his paper that the
role of both formal and informal leaders is critical if TQM is to be implemented as part
of the agenda of an educational institution. He also stresses that improving the processes
relating to quality is vital to ensure levels of service without causing damage to the management of a university (Kells, 1995, p. 466). Continuing along these lines, Van Der Wiele
(1995) presents a case study set in Holland at Albeda College where a project to improve
communication between educational departments helped to improve the management of
services generally. In addition, implementing a roll-out policy of quality, all the departments and administrative areas of the college organised themselves in turn in order to
execute the policy. These first empirical studies confirmed the findings of later developments of the concept of quality and TQM in universities related how Lean Service can
be applied in educational sector (Anninos, 2007).
In this way, Spanbauer (1995) indicates that in order to apply these elements of TQM
to education it is necessary to concentrate on one element which cuts across the others and
is essential customer service. Spanbauer (1995) considers this as the fundamental
element when he reaches conclusions about delivering educational service at the lowest
possible costs because customer service is the key to ensuring waste reduction in Lean
Service (muda). Logothetis (1995) in the same Special Issue also proposes elements
which he considers as essential indicators of Lean Service which equally apply to

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Total Quality Management 371

TQM: working in teams (quality circles of teachers and students), clearly determining the
needs of the client (students, parents and society) to help in the educational design and of
course monitoring the quality of education service through using the tools of quality
control and improvement. In a similar study more recently, Emiliani (2005) concluded
that, to improve educational processes both in the classroom and administratively
through the application of Kaizen, significant improvements were achieved in the
design process of the course as well as improvements in ideas regarding teaching
methods for the Faculty teachers.
In a paper, Dahlgaard and Ostergaard (2000) show for the first time a relationship
between the five principles of Lean Production and the seven types of waste (muda) in
the context of organisations in the sector of higher education. They analyse each principle
in detail according to the main clients in higher education the students, employers and
society. In addition they suggest eight muda (waste) in the ambit of higher education, an
example of one being uncoordinated teaching, coaching and testing, with the consequence that students do not pass exams. In a similar work, later on, Comm and Mathaisel
(2005) conducted a quantitative study on the development and application of a questionnaire referring to Lean Thinking and its equivalent of Lean Service in 18 public and private
Universities in the USA. The authors conclude that any type of University or college can
be a good candidate to apply the practices and principles of Lean. However, this application was centred more on the administrative operations than academic ones such as
teaching or research (Comm & Mathaisel, 2005). The Lean applications in the institutions
under scrutiny led to significant waste reduction and improvements in terms of quality of
services.
The third sub-category (3c) to be analysed is the banking and finance sector. The literature has some practitioner-style articles on how banks and financial institutions have
tried to apply Lean Service principles in their offices or branches (eight articles found).
The most significant reference is provided by Cynthia Swank (2003) vice-president of a
US financial services company in her article: Lean Service Machine published in the
Harvard Business Review. The author presents a case about a company dedicated to financial insurance services in the USA called Jefferson Pilot Finance where, due to various
problems related to its process for collection and requests for insurance policies, the
company was losing clients and money. The managers decision, according to Swank
(2003, p. 124) was to take a look at Lean Thinking to help mitigate the problem. The
result was unexpected as the redesign of the processes led to a reduction of 26% in
labour costs and 40% in the costs resulting from errors and subsequent corrections and
re-work of insurance policies. On the other hand, the main thrust of these research articles
revolves round the financial problems of banks when faced with debts and non-payment of
credit card bills and the diversification strategies of different multinational banks (BatizLazo & Wood, 1999; Cocheo, 1995; Streeter, 1990).
The fourth sub-category (3d) is airlines. A total of nine articles could be located which
make reference to the application of Lean Service in this sector of service organisations.
All the analysed articles were practitioner-style case stories there were no academic
articles focusing on this sector. As far as airlines are concerned, the most significant
and interesting article was presented by Reinhardt (2007) about how Delta Airlines
applied the concepts of Lean-Kaizen to redesign the baggage-handling process at the
airport of Hartsfield-Jackson in Atlanta, USA. A similar case with a similar focus is one
by Hutchins (2006) describing how United Service, the aircraft maintenance division of
United Airlines, recovered from near-bankruptcy by beginning a process of Lean
Service in its repair workshops in Maintenance. According to Hutchins (2006, p. 17)

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372 M.F. Suarez-Barraza et al.

this effort to improve its operations helped the service unit improve its operational
capacity and response times for clients in its Maintenance Centre in San Francisco so
much that it was able to capture new clients (more than 150 clients) including external
ones to United Airlines.
Lastly, in this aviation area, there are two similar accounts. The first is by Newton
(2007), which shows how the personnel in the ground-maintenance unit of Japan Airlines
applied Lean Service principles taken from the Toyota model to improve their operational
processes. According to Newton (2007) the savings made through this application of Lean
Service rose to 413 million dollars (50 billion Yen). The second article is by Greenwood,
Bradford, and Green (2002, p. 39) and is about the Cessna Aircraft Company whose objective when applying Lean Service was, according to the authors, to reduce the lead times
(15%) of its production processes and increase the satisfaction of its clients in their customised products (from two to three aircraft per year). Not an easy task but achieved,
according to the authors, by the successful application of Lean Thinking. The three
tools which were most applied were the 5 Ss, Total Productive Maintenance and Standard
Work Sheet.
Finally, the fifth sub-category (3e) analysed was the hotel and restaurant sector. Some
articles were found for this category, all of them having the same practitioner-style
approach in the form of case stories. Ever since the pioneering work by Heskett (1987)
appeared in the Harvard Business Review entitled Lessons in the Service Sector there
has been keen interest in the subject of how organisations in the service sector dedicated
to hospitality and food try to improve their work and management practices by applying
non-manufacturing (private-sector) approach. The articles we have found show how hotels
like the Park Inn International Hotel in USA, during their efforts to expand, worked with
certain Lean principles (which are not cited directly in the article) (Johnson & Martin,
1993); other similar articles such as one by Berger, Ferguson, and Woods (1989) report
on research which looked into how eight hotels in the USA tried to improve their competitiveness by applying certain methods from the private sector. More recently, three cases
described by Suarez-Barraza (2008) indicate how Lean-Kaizen principles used in the
context of Lean Service helped both the hotels and the restaurant to reduce their operating
costs, their client-response time and the quality of service delivered to the clients.
3.3.1 Some observations
In general terms, which is from the point-of-view of the five sub-categories, we can see
that there are certain problems when applying Lean Service in each of the sectors that
have been analysed. Among others these are: (1) the gap between theory and practice
which indicates a clear need for a more complete and thorough definition of what Lean
Service actually means so that when the time comes to apply its methodologies, the
ensuing confusions, frustrations and failures can be avoided and the Lean Service will
be more effective and efficient; and (2) various organisations in different sectors apply
some principles of Lean Service under the flag of other kinds of management approaches
such as TQM Quality Service and even including terms linked to strategic management, learning organisations and marketing.
Most of the articles and research in the literature we have analysed, in practically all
categories (except Health Care and Education, both of which have rigorous academic
studies), are case-stories, anecdotes and general accounts from a practitioner vantagepoint about how Lean Service was successfully implemented in these organisations in
the service sector. Apart from this theoretical limitation, many of these articles only

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show a positive face and practically none of them indicate or refer to possible inhibitors to
their efforts to improve.
3.4 Category (4): new trends and extensions of Lean Service
First of all, it is difficult to show that there are new trends or possible extensions to a term
like Lean Service when the term itself is so new and under-specified and only now in the
throes of creating a theoretical framework. In fact, as we have observed earlier, there are
very few empirical studies to support it. For this reason, we have placed 28 articles into
Category 4 and classified them into three sub-categories, and by so doing, the authors
will try to find common ground between Lean Service and fields like Service Management
through an analysis of the relevant literature. We are aiming to find a possible theoretical
bridge between these different fields which share, to some extent, certain aspects of Lean
Thinking principles. In the next sections we analyse each sub-category and their possible
linkages.
The first sub-category, 4a, refers to the application of Lean Service in the public
service sector, and so the use of the term Lean can be regarded as an extension of the
generic term because the governmental and civil service sector is so context-specific
and particular. In February 2008 the journal Public Money & Management published
various articles that debated the application of Lean thinking in the public sector; the
majority of the articles agreed that Lean thinking is indeed applicable to public sector management, with certain adjustments (Radnor & Boaden, 2008). Other authors also have discussed the subject showing the possible different cultural and working-environments in
governmental settings for Lean applications (Bhatia & Drew, 2006). In the same vein,
other articles are in the form of case stories which present favourable results in terms of
improvements in the quality of public services, improvements in timeliness of client
response, cost savings and naturally, improvements in citizen client satisfaction
(Suarez-Barraza & Ramis-Pujol, 2008). Finally, recent empirical research studies have
begun to centre on Lean Service as a possible independent theoretical term specifically
applied in the public sector as Lean-Kaizen Public Service (Suarez-Barraza et al.,
2009, p. 163).
The second sub-category, 4b, refers to e-service, and can have certain links to Lean
principles in so far as the work towards the elimination of waste (muda) or any activities
that do not add value to the processes of the service can be improved through the use of IT
(information technology) in a virtual environment which brings along an improved quality
of service as a consequence and the possible positive perception by clients of higher satisfaction. The clearest example of this use of Lean is an article by Voss (2003) in which the
writer re-thinks service in a virtual setting, from the buffer connections (reducing the
contact with the client due to the relationships within the organisation) to the connected
connections in which the client is intimately involved with the service through the information platform (an example is the personalisation of the purchasing process at Dell). In
this sense, providing a service in the virtual dimension requires processes that flow continuously, without obstacles, waste or re-work.
Lastly, the third sub-category 4c Service Excellence, Total Quality Service and
Service Science is at the earliest stages or the setting-up of their respective theoretical frameworks. Referring to Service Excellence both Johnston (2004) as well as Den Hartog and
Verburg (2002) show in their definition of service excellence that at the moment of providing a service it is not enough to satisfy the expectations of the client by keeping a
promise; there have to be mechanisms in the work processes that guarantee that any

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errors committed during the delivery of the service can be corrected and prevented. From
this point of view, the principle of perfection from Lean thinking (Womack & Jones,
1996) can be closely tied to the perfection approach of Service Excellence. On the
other hand, in Total Quality Service there are various theories put forward in different
articles by Sureshchandar, Rajendran, and Ananthraman (2001), as well as the theoretical
model presented by Gupta, McDaniel, and Herath (2005) which confirm the need
for working on the management of processes and for a clear focus on the quality of the
service and satisfaction of the client, which links again the perfection principle to
the search to find solutions to problems and to the elimination of muda. However in
none of the articles reviewed do we find a mention of the term Lean explicitly.
4. Conclusions and emerging trends
To bring this article to a conclusion, the following two sections will show a criticaloverview of the points in common that have been found for the term Lean Service in
the literature review as well as pointing to the direction and trends that research into
Lean Service as a new term or concept might follow. As indicated in the first section
we will draw together the points we have identified as common in the use of the term
Lean Service which might limit or set boundaries to its use so as to specify it more
closely. This will be described under three major headings, as follows:
4.1

Clarification of the term Lean Service

In accordance with the results of the analysis of the literature review, it is of utmost importance to clarify more exactly the meaning or use of the term Lean Service and in spite of
the efforts of certain writers in this endeavour (Bowen & Youndahl, 1998), the term continues to be ambiguous when it comes to putting it into practice. It is basic for organisations of today to find a series of guiding principles and/or road maps that derive from
an integrated and holistic vision rather than to rely on random ready-made recipes or
check lists. To achieve any lasting impact there is the need for a constant effort to
make improvements on a day-to-day basis in service organisations in order to face the
changes and pressures arising from the external business environment; this effort has a
greater yield from a Lean Service approach which can be applied as a series of principles
that directs the improvement processes and promotes continuous learning. Before this we
need to go much further than the characteristics that were presented through the three case
studies made by Bowen and Youndahl (1998, p. 199) in organisations previously studied
on various occasions. Having said this, in fact there are other service organisations in other
fields that have demonstrated that they can apply Lean principles successfully, and these
might lead to a deeper, clearer and stronger definition of the theory behind the term Lean
Service. Finally, it is worth repeating that the clarification of the concept Lean Service in
future research is not a question of mere semantic abstraction. On the contrary, it is vital
for organisations to understand that what we are talking about is in order to avoid errors,
frustration and disappointment when they come to put Lean principles into practice.
4.2 Applications of Lean Service
There is a wide range of articles in the literature we reviewed on the application of Lean
principles in service organisations in the last eight years, (that is, in this twenty-first
century), above all in the sectors of Health Care and Education. Albeit slowly, now

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Table 3.

Emerging trends in lean service.

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Possible theme

Current status

Position regarding
theoretical
clarification of Lean
Service

Few studies; need for data to

support finding so far

Position regarding
application of Lean
Service

Various studies most of which

have clear practitioner focus
(case stories) except for those
set in the Health Sector

Position regarding new

tendencies and
extensions of Lean
Service

Different fields of study have

opened up in Service
Management with hitherto
unstudied direct links to Lean
Service

Emerging
Development optimisation and/or
testing of emerging theoretical
models and fundamental features
of Lean Service
Integration of resulting qualitative
models with quantitative studies
to obtain more robust
conclusions
Development and examination of
more studies into service
organisations following the
strategy of case study
methodology using a dual
approach in these organisations
currently apply Lean Service
Compare and validate the
principles, characteristics, tools
and techniques of Lean Thinking
in the health sector to check if
they are Lean Service or some
other peculiar theoretical
dimension exclusive to Health
Care
Develop and examine more case
studies looking for critical
factors, techniques, tools,
enablers and inhibitors key to
application of Lean Service
Explore, analyse and compare the
singularities of Lean Service
application in the private sector
with the application of LeanKaizen Public service
Future studies could analyse the
impact of join applications and
possible links between Lean
service and other approaches a
possible dependent variable
might be Process Management
which might serve as a base to
find the link between Service
Excellence, Total Service
Quality and e-service
Analyse and study the effects of
Lean Service in areas which are
to do with to the direct
relationship between the client
and the organisation (the people
who deliver the service, Moment
of Truth or Quality of Service)

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376 M.F. Suarez-Barraza et al.

there are beginning to be more research articles about other service sectors. Considering
the great number of articles that are starting to appear, it is important to continue exploring
firstly from a qualitative, epistemological point of view, which is exemplified by the case
study, which combines longitudinal and retrospective cases. A more rigorous approach is
needed in order to add to and transform the current approaches of various articles which
are case stories and help them to become more robust case studies using a dual
methodology.
To this end, it is also vital to study service organisations where Lean Service is said to
have been applied using the analytical dimensions of content (what is Lean Service? How
do they interpret and understand it?) and context (What are the conditions and environment? What are the characteristics of the internal as well as the external environment in
which they operate? What are the motives for initiating Lean?). By way of an example
of this dimension we can cite the sub-category of Health Care which has been studied
in depth in a number of recent publications. Last, but not least, it is important to study
the dynamics which are present when Lean Service is applied, such as understanding if
the management approach is given gradually, in evolving phases over time, or not. And
if it is, if these steps are influenced positively by a series of enablers or inhibitors.

Common features and/or shared characteristics of Lean Service

4.3

In the third section and by way of a conclusion, we will present a first attempt to draw
together the common ground and/or characteristics of the term Lean Service that the literature review has revealed. This attempt is in order to begin the orientation of the
debate surrounding the current definition of the term Lean Service on the basis of what
has been written and discussed in the literature so far. It should be said that at no
moment do we try to indicate that the following points of common ground can fully
characterise the theory of Lean Service and each of the proposed points we raise needs,
for obvious reasons, to be followed up by further exploration, research and testing. The
following common points are found in many of the articles reviewed revolving around
Lean Service:
.

Lean Service can be seen as a derivation of Lean thinking, and can be of great use for
organisations in the services sector if it is used as an approach to improvement and
continuous innovation in work processes. In addition, Lean Service can improve the
work (the processes) of service organisations.
Lean Service seeks to reduce waste, culture change to focus on customers and continuous improvement rather than correcting failures.
Lean Service centres on the training of employees who develop behaviours and skills
centred on service to the client, as well as making clients aware of how their organisations in turn can contribute to, collaborate with and participate in the joint creation
of value and assurance of the quality of the service.
Lean Service is a strategic approach that has as its priority and reference the fact that
it places the client at the centre of the service, whether internally or externally.
Lean Service invests significantly in behaviours and methods as well as in organisational mechanisms of involvement and participation of the employees at the team
level and at the individual level. It is done by setting up systems for mutual recognition so as to raise the awareness of the employees to apprehend and apply the
lesson that 90% of service is based on the value equation: client satisfaction

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benefit obtained by the client (fulfilling his needs) + the treatment received + solution delivered.
Finally, Lean Service can bring to the service organisation a new sense of discovery,
experience and or re-discovery of the pleasure of service itself; that the delight in
doing business in this sector (serving people) includes minimise waste and maximise
value creations and by doing that improve quality in all aspects of service.

The present analysis and classification of the literature pertaining to Lean Service (the
search for it) continues to be ongoing research and to that end, certain possible trends or
lines of research have been identified that might lead to a better understanding of Lean
Service. It should be noted that the research lines that are presented in Table 3 might be
inadequate if they are analysed through the lenses of other theories or using other date
sources (literature reviews). In addition the authors confirm that the fact that this is a
list of possible themes does not imply that it is possible to satisfactorily cover all the
fields of study that might be opened up as far as Lean Service is concerned.

Note
1. For reasons of clarity and structure, when writing this article we have only included the bibliographical references of pioneering papers in terms of their findings for the field and their date
of publication. If readers wish to consult all the articles we studied academic and practitioner
they are invited to contact the lead author for a more detailed study of the works analysed in the
longer version of this paper.

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