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This study aims to examine to what extent the relationships between hospital workers’ perceptions of lean leadership behaviour, their engagement and the hospital unit’s perceived performance are mediated by job demands.

The data (n = 1,624) come from a lean implementation study in a Dutch hospital and are analysed using structural equation modelling in Mplus (v8.4).

The results confirm that lean leadership behaviour is related to employee engagement and hospital unit performance as perceived by employees, and these relationships are partially mediated through job demands. More specifically, the authors found that the type of job demand explains the direction of mediation effects. On the one hand, so-called challenging demands positively mediate the relationships between lean leadership behaviour and its outcomes. Conversely, hindering demands negatively mediates the relationship between lean leadership behaviour and perceived unit performance.

The authors recommend hospital organisations and human resources managers start by helping hospital leaders understand the underlying mechanisms that explain the effects of leadership on employees’ perceptions and, second, support their frontline leaders by providing training, coaching and feedback on how to influence job demands in a way that creates an optimal work environment for hospital employees.

The authors contribute to the literature by building upon insights from the job demands-resources model to explain the effects of lean leadership behaviour and by investigating the relevance of lean leadership in a hospital context, given the phenomenon’s strong roots in manufacturing.