Exploring lean-trained employee perceptions of organizational change amid an aging crisis at a non-urban regional healthcare provider : an embedded single-case study.

The U.S. healthcare system is facing a worsening aging crisis that is stretching clinical capacity, workforce sustainability, and infrastructure resilience. As patient acuity increases and chronic conditions grow, many healthcare organizations remain stuck in legacy practices and short-term gains, hindering long-term organizational change. These pressures are especially severe in non-urban regional areas, where geographic isolation and social inequalities worsen access and quality issues. In such environments, understanding how organizational change happens—especially when guided by lean principles that focus on people, purpose, and systems learning—is essential for meeting the complex needs of aging populations. This qualitative embedded single-case study explored how lean-trained employees perceive organizational change at a non-urban regional healthcare provider facing demographic pressures. I used criterion‑based and purposive sampling to select nine participants across three embedded units of analysis: senior leaders, middle leaders, and frontline staff. Data collection involved semi-structured and focus group interviews, guided by Fullan’s (2008) six-component framework for organizational change: valuing and appreciating people, connecting people to purpose, building capacity in people, promoting learning is the work, demonstrating transparency, and creating systems learning. A multi-cycle thematic coding process—encompassing preparation, immersion, coding, interpretation, and presentation—enabled triangulated insights across roles and organizational layers. Participants described people‑centered leadership, purpose‑driven engagement, and a transparent learning work environment as important influences on their positive perceptions of change. Practical implications include enhancing leader visibility and accessibility, integrating lean principles into onboarding and daily routines, formalizing recognition and mentorship, and creating structures that support system learning despite resource constraints. For board of directors and senior leaders, the study highlights that investing in employee voice and co-creation is not merely operational—it is strategic. For physicians and staff, the study suggests that employees can benefit from changes that make work more manageable, meaningful, and supported—when leaders prioritize people, learning, and systems that sustain improvement. These insights offer actionable guidance for non-urban healthcare providers aiming to develop resilient, inclusive, and adaptive change strategies in response to the aging crisis.

Name thesis:degree_name

Ed.D.

Level thesis:degree_level

Doctoral

Grantor

Baylor University.

Year dc:date.issued

2026

Author dc:creator

• Plymell, Shane, 1969-

Advisor dc:contributor.advisor

• Pratt, Sarah Smitherman.

• Aging crisis.
• Lean principles.
• Organizational change.
• Workforce sustainability.
• Non-urban healthcare.
• Qualitative case study.
• People-centered leadership.
• Systems learning.

Statement dc:rights

• Baylor University works are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. Contact libraryquestions@baylor.edu for inquiries about permission.

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/2104/14716

OAI identifier oai:identifier

oai:baylor-ir.tdl.org:2104/14716