| 1. |
- Kabel, Daan, 1995-
(författare)
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Exploring customer needs from a digital healthcare service
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cost-effectively capturing and understanding customer needs allows a firm to stay synchronized with the market, to stay ahead of competitors, and to enable service innovation. Traditional qualitative market research methods, such as interviews and focus groups are well-known methods for identifying and capturing customer needs but can be costly, tedious, time-consuming, and can require intensive collaboration with customers. As social media platforms become increasingly central in customers' daily lives, they can become valuable sources for identifying and capturing customer needs. The process of using social media content in market research is called netnography. In this thesis, the instrumental case to study customer needs is from a healthcare context.The healthcare system is an interesting illustrative case because it struggles with satisfying customers' needs – due to the difficulty of delivering high-quality services across multiple channels and devices, to secure customers' data, and to offer customized human-centred care. Against this backdrop, the purpose of this thesis is, by taking on a customer-centric view, to contribute to a better understanding of the quality of digital services. To fulfil this purpose, two research questions are formulated and answered. The first research question concerns the differences and outcomes between netnography and focus groups when capturing customers' needs. Formally, it is formulated as: What are the differences and outcomes between netnography and focus groups when capturing customers' needs? The second research question concerns the customer value cocreation activities and qualities necessary in a digital healthcare service to satisfy customers' needs. Formally, it is formulated as: What customer value cocreation activities and qualities satisfy customers' needs in a digital healthcare service? Taking customer-centric views, findings from three papers and empirical data from a survey, netnography, and a focus group project are used to shed light on the theoretical entity of customer needs – which is the unit of analysis.The contextual differences between netnography and focus groups are related to the embedded rules, norms, and space-time conditions. Such conditions pattern the information about the service and customers' needs. The netnography method captures sociohistorical-patterned information about more critical events, and realistic and negative service encounters. When capturing customers' needs, the netnography method captures more dominant, unmet, and actual (real time) needs. The focus group method captures transcultural-patterned information about more positive, memorable, and ordinary service encounters. When capturing customers' needs, the focus group method captures more evenly distributed, met (satisfied), and memorable needs. Most surprisingly, both methodologies capture, almost, the same needs. However, the proportion of needs discussed across the two samples is significantly different. The netnography method did not capture the needs of "system capacity" and "access". The focus groups method did not capture the need of corporate "responsibility".A conceptual model is illustrating four value creating activities and quality bundles necessary to deliver customer-determined benefits. The conceptual model is a synthesis of the customer journey, perceived electronic service quality and value concept – and provides a new, integrative view of customers' perceptions of digital healthcare service. The model gives a comprehensive understanding of what makes service journeys superior and supportive, and how service providers can optimize the customer experiences – which includes perceptions of personal health and well-being. This thesis offers several important conclusions for quality management. Broadly speaking, the thesis raises an awareness of the importance of the continuous variables – rules, norms, and space-time conditions – which pattern research data or information about the service and customers' needs. The conceptual model can guide managers on how to allocate resources – and that is to design high-quality service encounters.
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| 2. |
- Martin, Jason, 1969-
(författare)
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Quality Management Competencies-in-use : exploring competence and practice perspectives on quality management work
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality management is an established, widespread and well-researched management concept. Yet, surprisingly little research can be found on understanding the potential for action that is required in order to perform quality management work. The field of quality management has a strong emphasis not only on a customer and supplier focus (external), but also on a process focus (internal). This creates a constant challenge in the way in which quality management is conceived and realised. Another challenge is reflected in current research that describes the need for conceptual change in quality management due to extensive ongoing changes in society and the business environment. The nature and pace of technological development, coupled with changes in social behaviour, continuously bring out new customer needs and new ways for customers to interact with the producers of goods and services. This requires adaptive and innovative approaches for organisations, in order to stay competitive and relevant.This thesis uses competence-based and practice-based perspectives to better understand the requirements placed on quality management in meeting these challenges. It investigates what quality management work is and what properties must exist, in terms of competence and practice, in order to make quality management work possible. The purpose of this thesis is, therefore, to explore how the theoretical perspectives of competence and practice can contribute to an increased understanding of what is required to perform quality management work. Three research questions are posed and answered. The first research question concerns the nature of quality management work and how its key factors may be characterised; the second research question deals with competencies of quality management and how these are interrelated with quality management work; the third research question concerns how the interplay between quality management competencies can be understood. The research questions are answered by interpreting the findings of five papers included in the thesis, using a conceptual framework.The results of the thesis suggest two main directions of quality management work: expansive and adaptive quality management work. Expansive work is characterised by explorative practice, radical change to existing processes or the development of new processes, a logic of development, an orientation towards development and innovation, a striving to increase external efficiency and a striving to increase process variation. Adaptive work is characterised by exploitative practice, incremental change to existing processes, a logic of performance, an orientation towards goals and productivity, a striving towards internal efficiency and a striving to decrease process variation. Quality management competencies relate to quality management work in combining role dependency and discretion. Role dependency signifies the potential and capability to assume multiple role-responsibilities. Discretion is the ‘freedom of movement’ for quality practitioners to engage in practices and choose quality management work directions according to task and situation. The interplay between quality management competencies is understood as the combined effects of two competence antecedents: individual and/or collective dispositions to change and learning. This thesis extends research on quality management by increasing our knowledge and understanding of the requirements needed, not only to select and perform existing quality management practices, but also to adopt and engage in practices where emergence is accommodated by ambidexterity.
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| 3. |
- Olsson, Olle, 1986-
(författare)
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Managing variation in hospital patient flows
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Performing healthcare services is a complex practice. With the continuous developments in the medical field, healthcare organisations and professionals have become increasingly specialised, and healthcare services increasingly fragmented. When focusing on how to treat and cure diseases, the organisational and managerial aspects of care delivery can be overlooked. This increases the risk of sub-optimisation, when focusing on single activities, patient flows or healthcare units without considering the impact on the organisation as a whole. With every individual patient also having different combinations of diseases, severity levels and responses to medical interventions, much variation is introduced into patient flows. To address these challenges, the purpose of this thesis is: To explore the impact and management of variation in patient flows within hospitals. This thesis reports the results from three different studies, performed at three different hospitals. The first study analyses the impact of changes in patient inflow, available resources, treatment times and duration of activities on bed occupancy and length of stay. It does so by developing a simulation model of an emergency department (ED) and inpatient ward. The results show that the impact of variation in acute patient flows is smaller for the ED than the inpatient ward, which indicates that EDs might be more adaptable than inpatient wards in handling variation in acute patient flows. Bed occupancy on inpatient wards also seems to be strongly influenced by variation in patient flows. The second study is based on a single case study of the management of variation in acute patient flows at a university hospital. In accordance with the results of the first study, this second study shows that many actions are used to handle high bed occupancy, while few are used to handle ED overcrowding. More actions are also used to improve the situation in clinical departments than in the hospital as a whole, increasing the risk of sub-optimisation. The study highlights the need for top management to support department chiefs in managing variation in patient flows, e.g. by establishing a hospital-wide strategy for handling variation in acute patient flows. In the third study, the combined results from a case study and a quantitative before/after study are used to analyse whether the implementation of standardised cancer care pathways leads to crowding out effects, in terms of longer waiting times for other elective patient groups. The study shows that care pathway implementation is likely to lead to crowding out effects, if these effects are not addressed in the implementation process. Hence, a strategy to handle variation in one patient flow influences the options for handling variation in other patient flows and at the healthcare units as a whole. Crowding out effects were evaluated as most likely for patients from the patient group that is overtaken by the care pathway patients, and least likely for patients from the patient group with the lowest priority, due to a redistribution of waiting times between different patient groups. All in all, the research reported in this thesis demonstrates the need to take a systems perspective when managing variation in patient flows in order to avoid sub-optimisation, which otherwise often follows when focusing on just one part of a system.
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| 4. |
- Samuelsson, Peter, 1984-
(författare)
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Framing service innovation in healthcare
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare faces multiple challenges. Besides a raging pandemic have the number of people struggling with mental illness and chronic illnesses increased. Service innovation is a possible way of meeting these problems. However, service innovation is a scattered concept, with many different conceptualizations and schools of thought, all providing vital research aspects. Research has unraveled three elements that form different approaches for service innovation research. Healthcare also offers a complex context for conducting change and service innovation, containing prerequisites challenging previous understanding and conceptualizations of service innovation.To study service innovation in healthcare and to clarify research, this thesis aims to develop a framework for service innovation that relates and differentiates three approaches and their key characteristics and to determine how the prerequisites for healthcare relate to this framework, and finally to study, test, and illustrate the framework in the empirical context. The thesis builds upon three studies and four individual papers. The studies consist of one literature review, providing the conceptual groundwork for constructing the framework, and two empirical studies assessing and further developing the framework. The individual papers uses the empirical studies and depart from the different approaches to service innovation and healthcare prerequisites, providing key insights and clarifying the different approaches' strengths and weaknesses. The proposed framework recognizes the need for multiple service innovation research approaches since no single approach is enough to study the multifaceted service innovation phenomena in healthcare. The individual papers also contribute to the growing literature stream addressing service innovation in healthcare by describing social entrepreneurs' motivation during the service innovation process and explaining some of the effects of different service innovation types.
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| 5. |
- Smeds, Magdalena, Teknisk licentiat, 1990-
(författare)
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Exploring Tampering : Towards an Understanding of Why Improvement Efforts Sometimes Fail
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ever-increasing competition together with increasing and changing customer demands place high demands on organisations to maintain and improve their current products and services while also developing and renewing their offerings. However, research claims that many improvement efforts carried out in organisations fail. A line of research in quality management focusing on process improvement proposes that tampering, i.e. attempts to solve problems without targeting the fundamental causes of the problem, may be one reason why some attempts to improve fail. This dissertation focuses on faulty identification of causes of problems, as well as responses to such problems made by individual employees in their day-today work.The purpose of this dissertation is to enhance knowledge on tampering as a means to understand why attempts to improve sometimes do not lead to the desired results. This dissertation also answers the research questions How is tampering manifested in various types of approaches to identifying and responding to problems? and How can customers cause employees to take tampering actions? Studying how tampering is manifested in different ways depending on how a problem is interpreted and consequently the approach taken to respond to the problem can enhance knowledge about which interpretations and actions may lead to tampering. In this dissertation, approaches are viewed as alternative courses of actions available to employees when responding to problems. Four different types of approaches are studied: inaction, workaround, local improvement and system change. In addition, possible connections between customers and tampering are discussed and in this dissertation, it is proposed that the customer may have a negative impact on employees’ improvement efforts. In addition to answering the two research questions, a contemporary understanding of the tampering concept is proposed.Three studies have been conducted: a narrative literature review, a qualitative interview study and a case study with data collection through interviews, observations and a document study. This dissertation includes five appended papers. To answer the first research question, the main findings from the papers have been analysed by applying flexible pattern matching. The flexible pattern matching process was conducted by developing a theoretical framework of approaches, summarising the findings from the papers, and then comparing the findings to the theoretical framework to identify similarities and differences. To answer the second research question, examples of tampering were studied where the customer affected which problem was to be remedied or how.The analysis in the first research question results in five manifestations of tampering in various approaches to identifying and responding to problems. Actions proposed to cause tampering are passivity/wait-and-see, symptomatic response, locally focused response, disproportionate vision and vicious spiral of firefighting. The analysis in the second research question shows multiple examples of customer-induced tampering. Customers do not tamper with an organisation’s processes, but may express demands or concerns about perceived problems or how to execute a process that the organisation complies with. The saying ‘the customer is always right’ seems to be applied especially when the demand is placed by customers who are considered particularly important for relational or economic reasons.This dissertation contributes to research on quality management in general and improvement efforts through employees approaches as well as the customers role in identifying and responding to problems in particular. This dissertation and the appended papers explore the concept of tampering, and suggest that there is a need for a revitalisation and a broader understanding of the concept in order to increase its applicability in contemporary contexts. This dissertation also explores the previously under-exploredperspective on how customers can cause organisations to take measures that – from a process perspective – create process deterioration.
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| 6. |
- Sten, Lilly-Mari, PhD student, 1971-
(författare)
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A Deeper Understanding of Real Teamwork and Sustainable Quality Culture
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Today's organisations are faced with increasingly complicated and complex challenges. To master these challenges, organisations need to work more together, both within their own organisations and in collaboration with others. Working as a ‘real’ team, while also creating a sustainable quality culture, can be one way to address these challenges. The top management team within the organisation will play a crucial role in determining the organisation's success. The purpose of this thesis was to contribute to a deeper understanding of real teamwork and how real teamwork relates to a sustainable quality culture. The purpose was also to describe perceived success factors in creating real teamwork and sustainable quality culture, aiming at increasing an organisation’s performance. Conclusions drawn from this research can be summarised into seven overarching proposals or recommendations on how to increase the abilities for real teamwork alongside with creating a sustainable quality culture: Embrace the heart and develop ‘emotional commitment’: this involves ‘touching the hearts’ of individuals in the organisation, both when it comes to ‘real’ teamwork and in creating sustainable quality culture. Balance between structure and culture: structure and culture should go ‘hand in hand’ and harmoniously complement each other. Apply a systems view: this entails considering ‘real’ teamwork within the broader context and viewing core values as a system. Foster a culture of continuous improvement: improvement is achieved through reflexivity and the adoption of novel perspectives. Continuous improvement is fundamental for both ‘real’ teamwork and the development of sustainable quality culture. Apply a customer perspective on value creation: this is critical for practicing ‘real’ teamwork, as well as in developing a sustainable quality culture aiming to increase organisational performance.Apply long-term and sustainable thinking: as a part of practicing ‘real’ teamwork and when creating a sustainable quality culture. Both the presence and the future should be built into the system.Measuring and assessing ‘real’ teamwork and sustainable quality culture is valuable in establishing the prerequisites and abilities necessary for ‘real’ teamwork, as well as for advancing the development of a sustainable quality culture within an organisation.The research has also led to practical suggestions on how the participating organisations can enhance their abilities for real teamwork and strengthen the culture of quality within their organisations.
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| 7. |
- Wiger, Malin, 1980-
(författare)
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Logistics management operationalised in a healthcare context : Understanding care chain effectiveness through logistics management theories and systems theory
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare improvements is constantly relevant and an important topic. Healthcare is frequently being called upon to be more cost-efficient and still fulfil demands regarding waiting times, quality and availability. Experience from structural changes in other contexts gives reason to be positive about the potential for logistics improvements in the healthcare sector as well. From a logistics perspective patients pass different care functions, units, organisations and health facilities. It is assumed that logistics management knowledge applied in healthcare can lead to lower costs, shorter waiting times, better patient service, shorter treatment times and increased capacity. This dissertation therefore presents an exploration of how logistics management theories can be operationalised in a healthcare context to understand care chain effectiveness.Theoretically, the operationalisation is done by systems theory creating compatibility between logistics management theories and the healthcare context. As a first step, features for a logistics system forms features for achieving care chain effectiveness. High care chain effectiveness is thus a desired condition and the care delivery system is the tool to achieve it. As the final step in the operationalisation the features for care chain effectiveness are in turn used to analyse today’s practices. Empirically, the research is based on qualitative data from a single case study with multiple units of analysis. It includes four care units at one of Sweden’s university hospitals, where the data is gathered through interviews, insight into management systems and document analysis. One of the main results is the 21 areas identified for analysing today’s practices by means of features for care chain effectiveness. Another main result is the four important concepts revealed through the operationalisation:Lead time - the episode of care from order to delivery as the amount of time for patient cases between first contact with healthcare and the last.Patient order fulfilment - fulfilment of patients’ needs, broken down into several smaller steps performed over time within different care units in one or several organisations, consisting of five sub-processes - order handling, diagnosis, treatment, follow-up, and discharge.True demand – patients’ needs that is to be met and thus sets what care to deliver, i.e. the production plan and the subordinate resource plan.System boundaries - defines which care units to include when focusing on the care delivery system’s performance as a whole and should be more important than the performance and productivity of each individual care unit.A number of direct suggestions for care chain improvement can also be found in the concluding remarks, for example that objectives linked to economic influx or penalty narrow the system and that lead time data on an aggregated level is needed to cover episodes of care. The theoretical contribution of the dissertation is to the field of logistics management through the methodological development of using these theories in a new context. The managerial contribution is to healthcare managers through providing opportunities to improve care chains primarily by means of a greater understanding of care delivery systems.
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| 8. |
- Martin, Jason, 1969-, et al.
(författare)
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Närhet på distans : En guide för ledarskap på distans med stöd av digitala arbetssätt
- 2023
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Det du nu läser är en guide tänkt att användas som ett stöd och en vägledning till dig som i arbetet leder eller deltar i aktiviteter på distans med stöd av digitala arbetssätt. Guiden är utvecklad av forskare och organisationer i flera forskningsprojekt som studerar möjligheter och utmaningar i ledarskap på distans med stöd av digitala arbetssätt. Guiden vänder sig i första hand till er som är chefer och ledare med ansvar för att planera och genomföra aktiviteter på distans med stöd av digitala arbetssätt, men den kan även läsas av medarbetare och andra funktioner i era organisationer. En central del i guiden är ”verktygslådan” där vi, utifrån våra egna forskningsresultat samt med stöd av tidigare forskning, har satt ihop ett urval av praktiska verktyg som kan användas för att möjliggöra ett effektivare ledarskap på distans. Guiden och verktygen i verktygslådan tar avstamp i vardagsnära situationer och aktiviteter som vi i våra forskningsprojekt sett innehåller stor potential att förbättra hur arbete på distans med stöd av digitala arbetssätt kan organiseras och ledas. Vi visar vanligt förekommande arbetssätt och verktyg och ger konkreta och praktiska tips på hur ni kan arbeta tillsammans för att kunna uppnå bättre resultat, lära och utveckla både för individer och för organisationen samt bidra till bättre hälsa och välbefinnande. Guiden kan ses som en palett av arbetssätt och verktyg som ni antingen kan pröva direkt och/eller ha som underlag för diskussion i syfte att ta fram egna, skräddarsydda arbetssätt. Använd den som inspiration och hjälpmedel för att utveckla ditt ledarskap och medarbetarskap samt ditt sätt att leda och möjliggöra digitala aktiviteter på distans. Om du vill testa någon eller några av de verktyg och arbetssätt som presenteras i guiden tillsammans forskare så hör av dig till Jason Martin (jason.martin@liu.se) eller Andreas Wallo (andreas.wallo@liu.se) på Linköpings universitet.
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| 9. |
- Smeds, Magdalena, 1990-
(författare)
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Managing care pathways for patients with complex care needs
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient.Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs.The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care.The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions.Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways.This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway.Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation.This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
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| 10. |
- Elg, Mattias, 1968-
(författare)
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Performance measures and managerial work : a modified behavior setting approach to the study of usage of performance measures in managerial meetings
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The application of different technologies in managerial work has received widespread attention among both academics and practitioners. Performance measures constitute one such technology related to planning, coordination, control and improvement of organizational activities. What kind of significance do performance measures have in their usage in managerial work? This study focuses on the various social, material, temporal and spatial resources of usage of performance measures; the activities taking place within meetings where performance measures are being used, and the significance of performance measures in the coordination of units within a hierarchical organization.The usage of performance measures is conceptualized by a modified version of behavior setting theory, which was originally developed by the psychologist Roger Barker and his research group. A behavior setting can be seen as a small-scale social system whose components include people and physical objects. This social system is guided by its setting program; the goal and the sequentially ordered activities. To fulfil the requirements of the focus in the present study, a setting program must partly consist of activities devoted to the usage of performance measures.The empirical study encompasses observations from managerial meetings (selected by a formal procedure) within various hierarchical levels of a manufacturer of complex industrial products. Some of the themes highlighted in this study are: I) the social, material and temporal environment of managerial work influencing the usage of performance measures; 2) that the usage of performance measures is mainly a reflective activity emerging from the organizational history; 3) that linkages between hierarchical levels, such as leadership and population overlapping as well as performance measure overlapping, both limit and enable coordination; and 4) that performance measures within the studied context constitute an important role in creating knowledge about organizational activity.
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