| 1. |
- Ahrén, Jonatan, et al.
(författare)
-
A hypothesis - generating Swedish extended national cross-sectional family study of multimorbidity severity and venous thromboembolism
- 2023
-
Ingår i: BMJ Open. - 2044-6055. ; 13:6, s. 1-8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Venous thromboembolism (VTE) is a common worldwide disease. The burden of multimorbidity, that is, two or more chronic diseases, has increased. Whether multimorbidity is associated with VTE risk remains to be studied. Our aim was to determine any association between multimorbidity and VTE and any possible shared familial susceptibility.DESIGN: A nationwide extended cross-sectional hypothesis - generating family study between 1997 and 2015.SETTING: The Swedish Multigeneration Register, the National Patient Register, the Total Population Register and the Swedish cause of death register were linked.PARTICIPANTS: 2 694 442 unique individuals were analysed for VTE and multimorbidity.MAIN OUTCOMES AND MEASURES: Multimorbidity was determined by a counting method using 45 non-communicable diseases. Multimorbidity was defined by the occurrence of ≥2 diseases. A multimorbidity score was constructed defined by 0, 1, 2, 3, 4 or 5 or more diseases.RESULTS: Sixteen percent (n=440 742) of the study population was multimorbid. Of the multimorbid patients, 58% were females. There was an association between multimorbidity and VTE. The adjusted odds ratio (OR) for VTE in individuals with multimorbidity (2 ≥ diagnoses) was 3.16 (95% CI: 3.06 to 3.27) compared with individuals without multimorbidity. There was an association between number of diseases and VTE. The adjusted OR was 1.94 (95% CI: 1.86 to 2.02) for one disease, 2.93 (95% CI: 2.80 to 3.08) for two diseases, 4.07 (95% CI: 3.85 to 4.31) for three diseases, 5.46 (95% CI: 5.10 to 5.85) for four diseases and 9.08 (95% CI: 8.56 to 9.64) for 5 ≥ diseases. The association between multimorbidity and VTE was stronger in males OR 3.45 (3.29 to 3.62) than in females OR 2.91 (2.77 to 3.04). There were significant but mostly weak familial associations between multimorbidity in relatives and VTE.CONCLUSIONS: Increasing multimorbidity exhibits a strong and increasing association with VTE. Familial associations suggest a weak shared familial susceptibility. The association between multimorbidity and VTE suggests that future cohort studies where multimorbidity is used to predict VTE might be worthwhile.
|
|
| 2. |
- Bengt, Halling, 1959-
(författare)
-
Lean Implementation : the significance of people and dualism
- 2013
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lean, with its origins at the Toyota Motor Company, is a concept that is known to increase effectiveness in manufacturing. The Lean concept is now argued to be relevant not only in manufacturing but in service and health-care delivery as well. The reported results of Lean implementation efforts are divided. There are reports that most of the Lean implementation efforts are not reaching the goal; on the other hand, there are reports of promising results. The divided results from Lean implementation efforts show how important it is to research and identify factors that are barriers to successful implementation of Lean. This thesis aims to contribute knowledge about barriers to Lean implementation by collecting empirical findings from manufacturing and health care and structuring the perceived barriers and difficulties to Lean implementation. My first study aimed to compare similarities and divergences in barriers to Lean described by key informants in manufacturing and health care. The data was collected via semi-structured interviews. Findings showed that the perceived difficulties and barriers are much the same in manufacturing and health care. The second study was a case study at a manufacturing firm, researching how the views on Lean of the managers implementing Lean influence its implementation. Data was collected via semi-structured interviews with 20 individuals and covered all hierarchical management levels in the company. Findings showed that managers' views on Lean influence the implementation but also that learning during the implementation process can alter managers' views of Lean. The third study aimed to research how management of Lean is described in the literature. This was done through a literature review. The findings showed that Lean management is a matter of dualism, consisting of two complementary systems of action, management and leadership, which are related to the two basic principles of Lean, continuous improvement and respect for the people.
|
|
| 3. |
|
|
| 4. |
- Halling, Bengt, et al.
(författare)
-
Application of a sense of coherence-based leadership for productivity and health at Scania
- 2019
-
Ingår i: International Journal of Human Factors and Ergonomics. - : Inderscience Enterprises Ltd.. - 2045-7804 .- 2045-7812. ; 6:2, s. 179-194
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose was to explore if sense of coherence (SOC) theory can be used in human factors ergonomics (HFE) practice as a leadership approach to decrease the rate of sick leave and rehabilitation cases and increase work attendance among assembly personnel without impeding productivity. Via three studies carried out at the Swedish truck manufacturer Scania, we investigated the company’s key performance indicators and documented meetings with managers during the intervention. The results show that SOC can be used in HFE practice and that productivity, quality and attendance at work increased, while rehabilitation cases decreased. Our conclusion is that a health promotion approach among managers is essential in a lean organisation that aims to reduce waste in the company and optimise human capability and thereby productivity. SOC theory can support the creation of workplaces that are high performing and healthy, starting with concerns for the people creating the output.
|
|
| 5. |
- Halling, Bengt, 1959-, et al.
(författare)
-
Experienced Barriers to Lean in Swedish Manufacturing and Health Care
- 2013
-
Ingår i: International Journal of Lean Thinking. - 2146-0337. ; 4:2
-
Tidskriftsartikel (refereegranskat)abstract
- A B S T R A C T Purpose: The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden.Design/methodology/approach: Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM) and Porras and Robertson’s(1992) change model.Findings: In both organizations, the view of Lean changed from a toolbox to a human behavior view. Eight barriers were experienced in both organizations. Three barrierswere unique to manufacturing or to health care, respectively. Nine barriers were elements of social factors;five were elements of organizing arrangements.Research limitations/implications: Only people practically involved and responsible for the implementation at the two organizations participated in the study.Practical implications: Persons responsible for implementing Lean should consider organizational arrangements and social factors in order to limit barriers tosuccessful implementation.Originality/value: Most research on Lean has been about successful Lean implementations. This study focuses on how Lean is viewed and what barriers personnel inmanufacturing and health care have experienced. In comparing the barriers to Lean experienced in the two groups, common, archetypical, and unique barriers for manufacturing and health care can be identified, thus contributing to knowledge about barriers to Lean implementation.
|
|
| 6. |
|
|
| 7. |
- Halling, Bengt, et al.
(författare)
-
From Fantasy to Reality : Learning From Seven Years of Lean Implementation
- 2013
-
Ingår i: Journal of US-China Public Administration. - 1548-6591 .- 1935-9691. ; 10:4, s. 368-378
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to address the question of how manager’s views on Lean in terms of “toolbox Lean” or “Lean thinking” impact their view of the implementation process. This paper is based on a case study at a globally established Swedish manufacturing company. Findings show that managers’ definitions of Lean have evolved from a “toolbox” view toward more of a “Lean thinking” view during the implementation process, due to the learning taking place in the organization during the implementation. As the understanding of Lean develops, new and unforeseen deviations or needs may be identified. This in turn affects the managers’ views on the implementation process and perceived needs in regard to Lean development. The study also shows that fragmented development of an organization, such as production units developing individually without support from middle management or human resources (HR) may impede Lean development efforts. Lean implementation and development requiresystem wide change in order to be sustainable, which primarily concerns the management system and management approach but also all support functions within an organization. The use of external consultants in selected parts of an organization, thereby by-passing management levels and support functions may generate conflicting priorities and tension within an organization. The paper contributes to a deeper understanding regarding the learning process related to Lean implementations and to the aspects of people development and leadership required for sustainable Lean development.
|
|
| 8. |
- Halling, Bengt, 1959-
(författare)
-
Human Lean : Combining Sense of Coherence and Lean to achieve productivity and health
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis is to identify barriers to and supportive factors for Lean implementation and to investigate how application of the Sense of Coherence (SOC) theory combined with Lean philosophy may affect health and productivity. The thesis is based on five studies. The first study compared similarities and divergences in barriers to Lean described in interviews by informants in manufacturing and health care. The second study was a case study at a manufacturing firm. Interviews with managers implementing Lean revealed how their views on Lean influenced the implementation. In the third study, a literature analysis was used to conceptualize the concepts and roles of leadership and management in regard to Lean. In the fourth study it was explored how productivity, quality, work attendance and numbers of rehabilitation cases were influenced after implementation of sense of coherence theory based managerial behavior at three workplaces. The fifth study examined how the implementation of a new leadership approach based on the SOC theory combined with Lean philosophy relate to productivity, quality and levels of sick leave at a steel-producing company. The results from the studies show that the perceived difficulties and barriers are much the same in manufacturing and health care. Another finding was that managers' views on Lean influence the implementation but also that learning during the implementation process can alter their views. A third finding is that lean management is a matter of dualism, consisting of two complementary systems of action, management and leadership, which are related to the two basic principles of Lean, continuous improvement and respect for people. After application of the SOC theory combined with Lean as a basis for the managerial approach, there were improvements in productivity, quality, attendance at work and reduced levels of sick leave at all four studied workplaces, as well as fewer cases of rehabilitation at three workplaces. Several conclusions can be drawn. One is that Lean consultants with a limited approach to Lean, lack of a common organization-wide definition of Lean, and lack of supportive leadership are barriers to Lean implementation. Lean consultants with deep knowledge and capability to teach others Lean is a supportive factor. An organization-wide definition of Lean through an organization-specific Lean philosophy is another supportive factor. Managers that use both leadership and management to support people is a supportive factor to Lean. The study also shows that an application of SOC theory combined with Lean may be positively associated with health and productivity improvements. The overall conclusion is that people’s way of thinking and acting is the nucleus in Lean. To emphasize the importance of people, I suggest to call the approach of combining SOC and Lean “Human Lean.”
|
|
| 9. |
- Halling, Bengt, et al.
(författare)
-
Intervention för ökad produktivitet och minskad sjukskrivning vid ett svenskt stålföretag
- 2018
-
Ingår i: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 Gävle. - Gävle : Gävle University Press. - 9789188145284 ; , s. 49-
-
Konferensbidrag (refereegranskat)abstract
- BakgrundVid Fagersta stainless produktionsenhet för dragen tråd vidareförädlas rostfri valsad tråd till dragen tråd som sedan kan användas för tillverkning av olika produkter. Vid produk-tionsenhet för dragen tråd hade de under en längre tid haft lönsamhetsproblem och hög sjukfrånvaro och företagets ledning ansåg att något måste göras för att ändra detta. En ny produktionschef och tre produktionsledare anställdes med uppdraget att vända den negativa situationen. Beslut togs om en intervention som påbörjades år 2015.InterventionenSamtlig personal vid produktionsenheten (n=46, inkluderande en produktionschef, tre produktions-ledare samt operatörer) genomgick utbildning under våren 2015 vid Human Lean Center, Högskolan i Gävle. Utbildningen bestod av en teoretisk och en praktisk del. Utbildningens teoretiska del handlade om hälsa och hälsofrämjande samt Lean filosofi. Utbildningens praktiska del innebar att montera trampbilar vid taktad monteringslina med hjälp av Lean metoder och ett hälsofrämjande perspektiv utgående från att arbete skall vara meningsfullt, begripligt och hanterbart. Kunskapen från utbildningen omsattes sedan vid Fagersta stainless produktionsenhet för dragen tråd genom att fyra förändringar gen-omfördes. 1. Skapa möjlighet för arbetsledarna att tillbringa tid på produktionsgolvet för att stödja produktionspersonalen. 2. Introduktion av ”whiteboardmöten” för information vid början av alla skift. 3. Byggandet av gemensam lunchplats. 4. Standardiserat arbets-sätt vid avvikelser.MetodResultatet av interventionen mättes av Fagersta stainless med företagets system för upp-följning av produktivitet mätt i producerat ton stål per arbetare och sjukskrivningar mätta i procent av förlorad arbetstid i förhållande till möjlig arbetstid. Mätningar gjordes för år 2014, året före interventionen och för åren 2015-2017.ResultatResultatet efter interventionen visar att Produktivitet per arbetare ökade för åren 2015-2017. År 2014 som var året före interventionen var produktiviteten per arbetare 158,3 ton. År 2015 ökade den med 24,9%, 2016 ökade produktiviteten per arbetare med 3,6% och för 2017 var ökningen 11,4%. Under samma tid åren 2015-2017 som produktiviteten ökade så minskade sjukskrivningar. 2014 året före interventionen uppgick sjukskriv-ningarna till 15% av total möjlig tid för arbete (100%). År 2015 sjönk sjukskrivningarna till 7% och 2016 sjönk de till 3% för att 2017 sjunka ytterligare till 2,5%.SlutsatsGenom att kombinera hälsofrämjande teorier och Lean filosofi som delar i en utbildning med teoretiska och praktiska moment kan en kunskapsgrund läggas för en kontext-anpassad intervention som kan resultera i ökad produktivitet per arbetare samtidigt som sjukskrivningar kan minska. Verksamheter som vill öka produktivitet och samtidigt minska sjukskrivningar bör överväga att kombinera Lean filosofi med hälsofrämjande teori som strategi.
|
|
| 10. |
- Halling, Bengt, 1959-
(författare)
-
Lean : en fråga om tvåfald eller enfald
- 2012
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- SammanfattningBiltillverkaren Toyota anses vara ett av världens effektivaste företag och beskrivs som en framgångssaga.Toyotas framgångar har lett till att många företag och organisationer inom olika branscher försökt lära av Toyota och deras sätt att bedriva sin verksamhet med syfte att nå liknande framgångar som Toyota way gett Toyota. Detta har vanligtvis skett under begreppet Lean. Lean som begrepp myntades och spreds av forskare i USA. Undersökningar av resultatet av de Lean införanden som gjorts i olika företag och organisationer visar att mycket få lyckas. SyfteReflektera över motsättningar och överensstämmelser av olika beskrivningar av Toyota Way och Lean, samt 2. reflektera över varför få lyckas med Lean.Resultaten viktig faktor bakom den höga andelen misslyckade Lean införanden är att Toyota way är ett tvåfaldigt system medan Lean, som införs med syfte att nå framgångar liknande de Toyota uppnått, oftast införs som ett enfaldigt system. För att fungera behöver Lean samma tvåfaldighet som Toyota way annars uppnås bara något som kan benämnas ”bluff Lean”.DiskussionÄr lösningen på nuvarande problem med den låga andelen framgångsrika Lean införanden att lära om och då från primärkällan Toyota.Finns det behov att skapa svenska Leanbegrepp?Är många Leankonsulter ett hot mot framgångsrikt införande av Lean?Vad lärs ut om Lean på svenska lärosäten, den tvåfaldiga eller den enfaldiga ”Lean modellen”?Är erfarenheterna från TWI och insikten från The European Productivity Agency’s Report of the Rome Conference 1958, om att överordnat allt annat är produktivitet en fråga om inställning, glömda i västvärlden?
|
|
