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The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.

Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015–2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.

Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted “patient safety”, a paradoxical injunction to do more with less and conflicting organizational priorities.

This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

The purpose of this paper is to examine the implementation of lean methods in an Emergency Department (ED) and the role of the professions in this process.

Qualitative, semi-structured interviews with ED staff in a UK NHS hospital.

Lean was met with more engagement and enthusiasm by the professionals than is usually reported in the literature. The main reasons for this were a combination of a national policy, the unique clinical environment and the status of the professional project for doctors in emergency medicine.

Single site, one-off study.

The status and development of professionals involved may play a big part in the acceptability of initiatives like lean methods in health care. The longer term sustainability of the organisational changes introduced remains open to question.

This paper analyses the success of lean methods in health care with reference to the professional status and stage of development of the professions involved, using the sociology of professions. This approach has not been used elsewhere.