| 1. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 2. |
- Halling, Bengt, 1959-
(författare)
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Human Lean : Combining Sense of Coherence and Lean to achieve productivity and health
- 2020
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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.”
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| 3. |
- Kahm, Therese, 1973-
(författare)
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Creating a Force of Development in Swedish Healthcare : A Contribution from the First-Line Managers’ Perspective When Driving Improvement Work Based on Lean
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about the healthcare managers, working at operational levels, defined as the first-line managers. These managers often are given the role and responsibility to integrate improvements into daily work. A stronger development ability of Swedish healthcare requires first-line managers with a developed ability to lead change. Thereby efforts must be made to provide these managers with supportive work conditions when leading and developing organizations. One approach to organizational development is Lean, which refers to a strong improvement culture based upon a supportive and highly engaged leadership as well as a strong customer focus. The purpose of this thesis is to contribute to knowledge about and an understanding of the conditions that influence first-line healthcare managers’ abilities to drive improvement work based on Lean. Some of the conditions investigated are; time, receiving support from the own manager, feeling joy in improvement work and being assured about the effects of Lean.The thesis is based on three separate analyses of a web-based survey, which relate to the two research questions. The study was conducted in a Swedish healthcare organization two years after the initiation of Lean. The analyses are presented in three separate papers. The first research question considers; How can an instrument be developed that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? The second question is; What can be learned from using the instrument that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? A qualitative study based on a hermeneutic, inductive, qualitative research approach was conducted in order to meet the research purpose and answer the research questions.The thesis is mainly based on three papers. In paper 1 it is stated that the assuredness about the effects of Lean was quite high among the managers when the survey was conducted, such as that Lean contributes to a greater patient focus and to the development of an improvement culture. In paper 2 it is noted that the first-line managers view their role as crucial in improvement work based on Lean. Time, support from coworkers, and a clear vision and clear goals were the three conditions they considered to be most important for their ability. The results presented in paper 3 show that to initiate improvement work based on Lean, they ask for own managers who are assured about Lean and include them in discussions. They view their role and responsibility in relation to their coworkers as extensive, for instance increating a culture where problems and mistakes are viewed as possibilities to improve and for encouraging that new work procedures are tested. The findings indicate a need for a deeper understanding of Lean. It is concluded that a thorough understanding of Lean is a main condition for the first-line managers´ ability to drive improvement work based on the approach. Developing a common view of Lean takes time, which is important to emphasize in the practical setting to motivate for a long-term perspective. This development takes highly motivated, assured and persistent leaders with a continuous improvement attitude and a mission to improve healthcare together.There is also an applied research question; How can the use of the instrument contribute to developing first-line managers’ role, conditions, and ability to drive improvement work based on Lean? In its essence, Lean is concerned with improving a system and since the instrument raises questions about relationships between organizational members, it sets focus on the system and calls on a system view. The responsibility for one management level must continuously be set I relation to another, when putting the pieces together in the “improvement puzzle”. Change depends on adjustments in human behavior and the instrument establishes a focus on the people in the processes necessary for development and results. The instrument also provides opportunity and structure to investigate and talk about the soft conditions important for the ability, such as receiving support from the own manager, and feeling inspiration and being assured. The practice of Lean requires changes in attitudes, new habits, new skills in the whole system, meaning in each individual from the executive management to the front-line workers. Thereby self-reflection becomes important, which requires forums for dialogue. It is concluded that such forums can influence first-line healthcare managers’ abilities to drive improvement work based on Lean. In dialogue forums improvement work can be reflected upon and learned from together.
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| 4. |
- Kurilova-Palisaitiene, Jelena, 1985-, et al.
(författare)
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Lean improvements in remanufacturing : solving information flow challenges
- 2017
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Ingår i: QMOD proceedings.
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Konferensbidrag (refereegranskat)abstract
- Purpose - One efficient way to prolong the functional life of used products is remanufacturing. Compared to manufacturing, remanufacturing is a complex industrial process due to among other things high product variability, low production volumes and uncertain quality of returned used products. Remanufacturers are dependent on product information from Original Equipment Manufacturers (OEM), but that information is often not shared. Remanufacturers struggle to access or develop lacking product information and need a strategy to address information flow challenges. Lean could be a suitable strategy to improve the information flow. Therefore, the purpose of the paper is to identify and suggest Lean improvements to address remanufacturer’s information flow challenges.Methodology/Approach - Based on a case study of a filling machine remanufacturer, this paper discusses the information flow challenges and Lean-based solutions. The data was collected through a three-hour focus group interview combined with a Value Stream Mapping (VSM) method with the participation of seven company employees representing sales, logistics, quality, maintenance and production departments.Findings - Two key information flow challenges were identified at the company: a lack of available product data and miscommunication with the OEM, and poor internal information sharing. The analysis of the identified challenges and improvement ideas created a platform for developing Lean-based solutions:1) developing standard operations through instruction checklists and kitting areas;2) boosting supplier and customer relations through six best partnering practices; and3) developing people and teams through teamwork and training.Originality/Value of paper – All industries have their own specific challenges and development needs. This paper focuses on information flow challenges in remanufacturing. Original product information is often not shared, even when the remanufacturer has a contract with the OEM. Only few remanufacturers work with Lean today, but Lean could be a strategy to address the information flow challenges. This paper contributes to the knowledge on how Lean could be applied in the remanufacturing context.
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| 5. |
- Poksinska, Bozena Bonnie, et al.
(författare)
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Does Lean healthcare improve patient satisfaction? : A mixed-method investigation into primary care
- 2017
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Ingår i: BMJ Quality and Safety. - : BMJ Publishing Group Ltd. - 2044-5415 .- 2044-5423. ; 26:2, s. 95-103
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Tidskriftsartikel (refereegranskat)abstract
- Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.
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| 6. |
- Poksinska, Bozena Bonnie
(författare)
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Lean healthcare : what is the contribution to quality of care?
- 2015
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Ingår i: Management innovations for health care organizations. - New York : Routledge. - 9781138825697 ; , s. 209-226
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Bokkapitel (refereegranskat)abstract
- This chapter aims to present how Lean has been adopted by healthcare provider organizations in hospital and primary care settings, and to discuss the implications for quality of care. Could Lean be the management innovation that helps healthcare organizations tackle their current challenges? How is Lean adopted in healthcare? What are the opportunities and limitations of adopting a production-based system to an advanced service system such as healthcare? The findings and conclusions presented in this chapter are based on six years of research on the practices and outcomes of adopting Lean in hospital units and primary care centers in Sweden.
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| 7. |
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| 8. |
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| 9. |
- Poksinska, Bonnie, Biträdande professor, 1973-, et al.
(författare)
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From hospital-centered care to home-centered care of older people : propositions for research and development.
- 2024
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Ingår i: Journal of Health Organization & Management. - : EMERALD GROUP PUBLISHING LTD. - 1477-7266 .- 1758-7247. ; 38:9
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.DESIGN/METHODOLOGY/APPROACH: The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).FINDINGS: The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.PRACTICAL IMPLICATIONS: The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.ORIGINALITY/VALUE: The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.
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| 10. |
- Poksinska, Bonnie, Biträdande professor, 1973-, et al.
(författare)
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The pros and cons of cancer care pathways from the health care professionals’ perspective
- 2019
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Ingår i: Operations adding value to society.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this paper is to outline pros and cons of cancer care pathway (CCP)components perceived by health care professionals involved in the diagnostic process.The results are based on a comprehensive national survey. The biggest pros follow from the component of care pathway description, which make cancer diagnostics more processoriented and standardised and thereby contribute to more timely, safe and patient-centred for the CCP patients. The component of standardised criteria for referral are associated with most cons. The biggest cons are the perceived “crowding out” effects, which imply impaired access and longer waiting times for non-CCP patients.
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