Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM-Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals. Findings Results from the interviews show that there is a specific deployment path for TQM-Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers' commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits. Research limitations/implications The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry. Practical implications Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals. Originality/value The results of this research show that there is a specific, new deployment path for implementing TQM-Lean strategy in some public hospitals.
Keywords: Lean; Patient satisfaction; Performances benefits; Public healthcare; Strategy deployment; Total quality management.