Evaluating Lean Thinking Implementation in a Jordanian Public Hospital: A Mixed- Methods Case Study

Background Lean Thinking has gained global attention as a framework for improving efficiency and quality in healthcare systems. However, its implementation in public hospitals, particularly in low- and middle-income countries like Jordan, remains limited. This study aimed to assess Lean readiness at Jordan University Hospital (JUH), explore existing quality improvement practices, and identify enablers and barriers to Lean adoption across clinical and non-clinical departments. Methods An inductive, mixed-methods case study was conducted at JUH, a tertiary public teaching hospital in Amman. Quantitative data were collected in two phases using self-administered questionnaires. The first targeted quality management staff to assess current quality improvement practices and Lean awareness. The second, broader survey assessed staff perceptions of 10 Lean readiness attributes across hospital departments. A total of 231 valid responses were analysed using descriptive statistics and Mann–Whitney U tests in SPSS. For the qualitative phase, six semi-structured in-depth interviews were conducted with managers from both clinical and non-clinical areas. Transcribed and translated data were analysed thematically using NVivo. Ethical approval was obtained, and informed consent was secured from all participants. Results FOCUS-PDSA was reported as the most widely used quality improvement methodology, while Lean was largely unfamiliar to staff and managers from both departments. Clinical departments reported slightly higher Lean-readiness scores across most attributes, except for the “Immediate Work Environment,” where non-clinical staff rated more favourably. A statistically significant difference was observed only for “Training and Development” (p = 0.043), with clinical staff reporting more favourable views. Qualitative analysis confirmed these findings and revealed key barriers, including limited Lean awareness, frequent staff rotation, outdated infrastructure, and financial limitations. Nevertheless, supportive leadership, a responsive organizational culture, and a positive attitude toward improvement were recognized as major enablers. Conclusion JUH exhibits a moderate readiness for Lean implementation but faces substantial challenges, including limited awareness, rigid bureaucracy, and resource constraints. Despite strong leadership commitment and a positive improvement culture, achieving true Lean transformation requires targeted training, digital advancement, and structural reform. By fostering continuous learning, empowering frontline teams, and enhancing digital integration, JUH can translate its Lean readiness into tangible and lasting organizational progress.