Paper short abstract:

Based on an ethnographic study of how Lean consultants work to optimize the practice of referring patients in a children’s hospital, this paper investigates the interplay between valuation and organization and shows how this has implications for the enactment of center and margin.

Paper long abstract:

This paper investigates the interplay between valuation and organization. Empirically it is grounded in a practice-based, organizational ethnography of the use of Lean management in a children's hospital. This established a unique access to the Lean consultants' valuation work as well as to the conduction of the actual valuation practice under scrutiny; the task of deciding in which bed to put the patient. This task of referring patients is not trivial. It may have far-reaching consequences not only for the present patient, but also for the one who needs to move, and for the hospital in general. This is why it is under scrutiny by Lean consultants. While Lean consultants and the referral team share the goal of putting the right patient in the right bed, there is a strident dissonance between the way Lean and the current referral practice connect the task of referring patients to the 'flow' of patients. In order to explore this dissonance, the paper revisits the concept of organization as decision situations as developed by March and colleagues (1972, 1976 etc). Using this concept, the paper shows that practices of valuation enact not only values but also organization. It suggests that in moving forward, organizational perspectives may be productive for valuation studies, as they expand the scope of how things come to count as valuable to include the study of how things are organized, which is highly relevant in exploring how valuations can become marginalized and how some margins become organized.