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- Kaltenbrunner, Monica, 1975-, et al.
(author)
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A questionnaire measuring staff perceptions of Lean adoption in healthcare : development and psychometric testing
- 2017
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector.METHODS: A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care.RESULTS: The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors.CONCLUSIONS: We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.
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- Kaltenbrunner, Monica, 1975-
(author)
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A staff perspective on Lean maturity, well-being, and quality in primary care
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: Lean is commonly implemented in healthcare but it is unclear how much of Lean is adopted and whether Lean is associated with staff’s well-being and quality of care.Aim: To describe staff perception of Lean maturity in primary care, and to determine to what extent staff-rated Lean maturity is associated with staff rated thriving, exhaustion, and musculoskeletal complaints, as well as staff rated quality of care.Method: Survey data were collected in 2015 (n=481 staff) and 2016 (n=351 staff) at 48 primary care units; they were analyzed using confirmatory factor analysis (Paper I), and multiple regression analysis, taking nesting within units into account when possible (Paper II-IV). Interviews (n=12 staff) and observations (n=28 staff) were analyzed deductively.Results: The developed Lean in Healthcare Questionnaire, based on Liker’sdescription of Lean, generally showed acceptable psychometric properties (Paper I). Lean maturity varied within and between units. The highest maturity concerned staff adherence to routines, and the lowest concerned having a change agent at the unit (Paper II). Lean maturity was positively associated with staff satisfaction with care, both cross-sectionally (Paper II) and, mediated by increased resources, in a longitudinal analysis (Paper IV). The 12-month prevalence of musculoskeletal complaints in the shoulders, neck, and low back was 50-58%, and the 7-day prevalence 25-37% (PaperIII). Lean maturity was not associated with musculoskeletal complaints (PaperIII). Increased Lean maturity was, however, associated with increased thriving, mediated by increased job resources, as well as with decreased exhaustion, mediated by decreased job demands (Paper IV).Conclusion: Lean maturity varied in primary care. It was positively associated with staff-rated quality of care and thriving, and negatively associated with exhaustion. Musculoskeletal complaints were common, but not associatedwith Lean maturity.
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- Kaltenbrunner, Monica, 1975-, et al.
(author)
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Associations between lean maturity in primary care and musculoskeletal complaints among staff : a longitudinal study
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:2
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Journal article (peer-reviewed)abstract
- ObjectiveThis study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later.DesignDescriptive, correlational and longitudinal design.SettingPrimary care units in mid-Sweden.ParticipantsIn 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016.Outcome measuresAssociations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving.ResultsThe shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year beta: -0.002, 95% CI -0.03 to 0.02), neck (beta: 0.006, 95% CI -0.01 to 0.03), low back (beta: 0.004, 95% CI -0.02 to 0.03) and upper back (beta: 0.002, 95% CI -0.02 to 0.02).ConclusionThe prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.
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- Kaltenbrunner, Monica, 1975-, et al.
(author)
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Lean i primärvården - en bild av hur Lean tillämpas
- 2018
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In: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 Gävle. - Gävle : Gävle University Press. - 9789188145284 ; , s. 112-
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Conference paper (other academic/artistic)abstract
- BakgrundLean har sitt ursprung i bilindustrin och har spridits till andra sektorer såsom hälso-och sjukvård. Implementering av Lean syftar vanligtvis till att öka vårdkvaliten. Vid utvärderingar av Lean saknas ofta en beskrivning av vilka principer av Lean som implementeras och i vilken utsträckning. Föreliggande studie utgår från Likers beskrivning av Lean. Liker beskriver Lean i fyra övergripande grupper kallad 4P modellen; philosophy, processes, people and partners, och problem-solving (filosofi, processer, anställda och partners, och problemlösning), som består av ett antal principer. Att implementera alla principer och involvera alla medarbetare är ovanlig, vilket Liker menar är avgörande om organisationen ska nå de mål de satt med att införa Lean.SyfteSyftet med studien var att illustrera hur Lean praktiseras inom primärvården. Metod Studien utgår från ett större forskningsprojekt där både privata och landstingsägda primärvårdsenheter deltog. All personal vid enheterna fick 2016 besvara en enkät om Lean-principer, svarsfrekvens 35% (298 medarbetare vid 45 enheter). Höga Lean skattningar indikerade hög mognad av Lean vilket innebar att medarbetarna var kunniga rörande den efterfrågade Lean-principen; låg mognad av Lean innebar att man helt saknade principen på sin arbetsplats eller hade implementerat den i liten utsträckning av ett fåtal medarbetare. Baserat på enkätsvaren valdes fyra enheter ut för observationer, två med hög mognad av Lean och två med låg mognad. Observationerna inkluderade intervjuer och fältanteckningar som illustrerade hur 4P-modellen praktiserades på enheterna. Hälso- och sjukvårdspersonal med olika professioner deltog (n=28).Resultat Rörande filosofi ansåg medarbetarna vid alla fyra enheter att den närmaste chefen, återkommande men i varierande utsträckning, kommunicerade gemensamma mål. Patienternas behov styrde planeringen av vården. Processer kunde innefatta att medarbetarna baserade sin planering av vården på statistik. För vissa patientgrupper eller symtom fanns generella ordinationer, d.v.s. utan kontakt med läkare, t.ex. på vilka prover som skulle tas. Rörande anställda och partners var det vanligt att arbeta i team både inom och utanför sin enhet. Men det framkom även att medarbetarna inte arbetade tillsammans fast de borde det. Problemlösning förekom men ofta ostrukturerat med brister på uppföljning. En enhet hade påbörjat utvecklande av problemlösning genom dagliga möten och strullistor att dokumentera problemen på.Konklusion Tillämpning av Lean varierar i stor utsträckning mellan vårdcentralerna. Ett par enheter hade implementerat Lean i större utsträckning och dessa enheter var mer strukturerade rörande t.ex. problemlösning och teamarbete.
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- Kaltenbrunner, Monica, 1975-, et al.
(author)
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Lean maturity and quality in primary care
- 2019
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In: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 32:2, s. 141-154
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Journal article (peer-reviewed)abstract
- Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality. Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.
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| 9. |
- Kaltenbrunner, Monica, et al.
(author)
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Lean maturity and quality in primary care
- 2019
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In: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 33:2, s. 141-154
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is twofold: first, to describe Lean maturity in primary care using aquestionnaire based on Liker’s description of Lean, complemented with observations; and second, todetermine the extent to which Lean maturity is associated with quality of care measured as staff-ratedsatisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of allLean principles throughout the organization and by all staff.Design/methodology/approach – Data were collected using a survey based on Liker’s four principles,divided into 16 items (n ¼ 298 staff in 45 units). Complementary observations (n ¼ 28 staff ) were carried out atfour units.Findings – Lean maturity varied both between and within units. The highest Lean maturity was found for“adhering to routines” and the lowest for “having a change agent at the unit.” Lean maturity was positivelyassociated with satisfaction with care and with adherence to NG to improve healthcare quality.Practical implications – Quality of primary care may benefit from increasing Lean maturity.When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly,addressing all Liker’s principles and using the results as guidance for further development.Originality/value – This is one of the first studies to evaluate Lean maturity in primary care, addressing allLiker’s principles from the perspective of quality of care. The results suggest that repeated actions based onevaluations of Lean maturity may help to improve quality of care.
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- Kaltenbrunner, Monica, et al.
(author)
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Utvärdering av boendeprocessen inom Kalmar kommun
- 2022
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Reports (pop. science, debate, etc.)abstract
- Genom bland annat omställningen till Nära vård men även utifrån en strävan att höja kvalitén inom vård- och omsorgsverksamheten har ett behov av att omstrukturera arbetsprocesser vid vård- och omsorgsboenden i Kalmar kommun uppstått. Utifrån det behovet skapades boendeprocessen som introducerades till medarbetare i verksamheterna hösten 2021 och därefter infördes praktiskt i verksamheterna i början av 2022.Vid organisationsförändringar är det viktigt att få kännedom om hur medarbetare och chefer uppfattat och tar till sig förändringen. Vissa individer är snabba att ta till sig av nya förändringar medan andra behöver mer tid. Genom att utvärdera införandet av boendeprocessen kan insatser kring införandet anpassas till medarbetarnas och verksamheternas behov. Deltagare i utvärderingen var chefer och medarbetare (sjuksköterskor, undersköterskor, vårdbiträden, arbetsterapeuter och biståndsbedömare) vid 13 vård- och omsorgsboenden samt 8 nattenheter som arbetar med boendeprocessen i Kalmar kommun. Vid utvärderingen av införandet av boendeprocessen användes enkäten ”Implementation process assessment tool” (IPAT). Chefer och medarbetare fick besvara enkäten under första delen av 2022. Svarsfrekvens uppgick till 49% (234 deltagare). Resultaten visar att verksamheterna befinner sig i början av införandet av boendeprocessen. De allra flesta chefer och medarbetare är motiverade till, och engagerade i, att föra in boendeprocessen i sin verksamhet. Många deltagarna skattade att de tror att de kan bidra till att införa boendeprocessen samt uppger att de har stöd i processen. Det framkom också att många tror att boendeprocessen kan gynna både sin egen arbetsmiljö och att den kan vara gynnsam för omsorgstagarna.
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