Case Analysis: 1.1 Hospitals are Driving toward a Leaner Organization Background: To obtain sustainable organizational efficiency and service quality, many hospitals have adopted an Open Systems Perspective by using “lean management” procedures borrowed from leading car manufacturers, in an effort to “reduce and remove waste from work processes”. These processes improved organizational efficiency reduced costs and provided better patient care. i What ‘seems’ to be the Problem: Secondary Symptoms Full waiting rooms, long wait times, inefficient use of supplies and budgets, needless stress and high mortality rate is feedback from the external environment that the hospitals are not meeting the needs of their stakeholders, or fitting in with their environment. Before adapting lean management processes, hospital staff and patients alike shared the burden of what appeared to be the inevitable consequences of health care delivery and a closed systems perspective.ii These problems are manifestations of organizational deficiencies which negatively affect the quality of patient care, the distribution of hospital resources and employee morale. The Real Reasons Hospitals are Facing Difficulties: Primary Problems The secondary symptoms are indicative of underlying issues, highlighting their poor organizational-environmental fitiii and the ineffectiveness of communication between Internal Subsystems.iv To a large extent hospitals have not adapted to their external environment nor have hospitals managed it effectively.v Hospital management, for example, has not adequately promoted the appropriate use of hospitals as opposed to family physicians. The departmentalization of hospitals has unintentionally caused a disconnection between internal subsystems. The lack of coordination between hospital management, physicians, hospital staff and patients prevents the flow and use of