Explaining anomalous high performance in a health care supply shain

Rachna Shah, Susan M. Goldstein, Barbara T. Unger, Timothy D. Henry

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


An implicit assumption in distributing and coordinating work among independent organizations in a supply chain is that a focal organization can use financial or contractual mechanisms to enforce compliance among the other organizations in meeting desired performance objectives. Absent contractual agreement or financial gain, there is little incentive for independent organizations to coordinate their process improvement activities. In this study, we examine a health care supply chain in which the work is distributed among independent organizations. We use a detailed case study and an abductive reasoning approach to understand how and why the independent organizations choose to coordinate and collaborate in their work. Our study makes two contributions to the literature. First, we use well-established lean principles to explain how independent organizations achieve superior performance despite highly uncertain and variable customer demand - a context considerably different from the origins of lean principles. Second, we forward relational coordination theory to explain why the organizations in this decentralized supply chain coordinate their work. Relational coordination includes the use of shared goals, shared knowledge, and mutual respect for one another's work as primary mechanisms to explain process improvement in the absence of any contractual incentives. Our study constitutes a first step in generating theory for work design and its improvement in decentralized supply chains.

Original languageEnglish (US)
Pages (from-to)759-789
Number of pages31
JournalDecision Sciences
Issue number4
StatePublished - Nov 2008


  • Case study research
  • Lean production
  • Work design


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