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- Dellve, Lotta, 1965-, et al.
(författare)
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Lean implementation approaches at different levels in Swedish hospitals : the importance for working conditions, worker engagement, health and performance
- 2014
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Konferensbidrag (refereegranskat)abstract
- BackgroundSwedish healthcare organizations are investing heavily in internal reforms. Lean has been frequently used as an overall concept to improve care processes and decrease costs. Some evidence shows positive results, especially if work environment issues are considered in parallel with other desired outcomes. However, there are considerable difficulties in evaluating lean as a concept since its application and interpretation seem to vary widely. Further, like for other management concepts, lean outcomes crucially depend on the implementation process.Aim This program investigates implementations of lean and lean-like developments of processes of care, and how these affect the working conditions, health, and performance of healthcare employees. We also investigated organizational factors and conditions that mediated specific outcomes.MethodMixed method design: questionnaire to employees (n=880) and managers (n=320), qualitative interviews (n=55) and observations with follow up during three years. Five hospitals were selected, and within them five units that were connected by their flow of acute care patients, i.e. the emergency unit, the medical and surgical emergency ward (or ICU at small hospital) as well as one medical and one surgical ward. Initially we used qualitative-driven analyses and thereafter quantitative-driven mixed method analysis.ResultsThe implementation strategies varied between the hospitals and between the strategic and operative levels. Strategic managers also used different approaches to overcome the gap between strategic and operative levels. Operative managers shared similarities in their stepwise and coaching approaches encouraging participation among employees, but differences regarding how assignments were delegated. Social capital and attitudes among health care profession were of importance for employees’ work engagement and active engagement in development work.
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| 3. |
- Dellve, Lotta, 1965-, et al.
(författare)
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The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up
- 2015
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Konferensbidrag (refereegranskat)abstract
- Introduction The public sector has during the last decades been struggling with the challenge of how to increase the efficiency, the quality of performance, as well as with problems related to work environment and recruitments. Hospitals have struggled with increased focuses on costumer orientation, rationalizations and care processes redesign, and have often used Lean production (LP) as management model.Aim to assess the long-term importance of implementing LP in hospitals for the psychosocial work conditions. Based on earlier research (e.g. Westgaard & Winkel, 2011), the following hypothesis were tested (1) Strategic large scale implementation of LP is associated with negative impact on mental health; (2) Implementation of LP is associated with weak negative impact on psychosocial work conditions; (3) The association between implementation of LP and psychosocial conditions is moderated by profession and participatory approaches.Method Five hospitals working with improvements of care processes were studied 2012-2014 using questionnaires to employees (T1 n=1303) and interviews at strategic and operative levels. Analyzes with mixed models repeated measurements were performed. The explaining variables for the models were implementation of lean at strategic resp operative level, and time (T1, T2, T3). The outcome variables were work-related health (SRH, work ability, stress-symptoms) and psychosocial work conditions.Results Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There were no overall differences in self rated health and work ability with regard to implementation of LP. A higher degree of LP at operative level was associated with decreased work demands. There was, especially initially, more beneficial or improved working conditions in relation to higher degree of LP at operative levels. The long-term follow-up showed that quantitative demands increased and predictability as well as leadership decreased in the non-lean hospitals. There were different patterns with regard to profession and participatory approaches that will be presented.
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| 4. |
- Holden, Richard, et al.
(författare)
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Healthcare workers' perceptions of lean : A context-sensitive, mixed methods study in three Swedish hospitals
- 2015
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Ingår i: Applied Ergonomics. - : Pergamon Press. - 0003-6870 .- 1872-9126. ; 47, s. 181-192
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Tidskriftsartikel (refereegranskat)abstract
- As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.
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| 5. |
- Rex, Emma, 1978-, et al.
(författare)
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Tailored for decision – Knowing your target group prior to adaptation
- 2017
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Konferensbidrag (refereegranskat)abstract
- Life cycle thinking is but one perspective - if at all considered -, in everyday business decisions throughout the organization; in the selection of suppliers, in the strategy of new product ranges, and, in what information is chosen to be highlighted to the customers. Tradeoffs are constantly made between e.g. environment, quality, price and other company goals. Before any successful adaptation and visualization of life cycle information, it is important for internal life cycle experts to identify and understand how other functions of the company perceive and value life cycle information in their specific working situations.To get a better understanding of these internal users of life cycle information, life cycle experts in four multinational companies (Akzo Nobel, Vattenfall, Volvo Cars, Volvo Group) have joined forces with researchers in life cycle management and behavioral science to create a graphical map of how life cycle information is spread and used in different parts of an organization. The aim of the map is to be used as a basis for discussions and recommendations on how to tailor life cycle information in order to support decision making throughout a company.The map is constructed by combining a) inventories on how quantitative data seeks its way to internal users through databases, reports and KPIs, with b) qualitative interviews on goal framing and decision weights of e.g. environmental and economic information. As a result, the map illustrates both the “physical” flows of life cycle information and the “cognitive logics” of this information for different users (e.g. how values, attitudes and norms influence the target groups’ likelihood of including life cycle information in their decision processes).Based on the map, each company can identify and discuss who the main users of life cycle information are and what premises for life cycle thinking these users have: In what decision making situation is, or can, life cycle information be used? How is the information understood? What other sources of information and rationales for decisions are used in parallel to, or in conflict with, LCA-results?Initial analyses on the usefulness of the map point to a better understanding of how life cycle experts can tailor information for decisions in different parts of the company, as well as on its usefulness in illustrating to people outside of the environmental departments the widespread use of life cycle information that already exist in the company. The latter is not least important for creating an understanding in how the organization respond to ongoing external pressure to focus more on a life cycle approach, e.g. new requirements in ISO 14001, new EU Directives on public procurement and current EU work to establish a common LCA methodology.
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