| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Gunnarsdottir, Sigrun, et al.
(författare)
-
Improving Health Care Organizations Through Servant Leadership
- 2018
-
Ingår i: van Dierendonck D., Patterson K. (red) Practicing Servant Leadership. - Cham : Palgrave Macmillan. - 9783319756448 ; , s. 249-273
-
Bokkapitel (refereegranskat)abstract
- Health care managers are often absent from organizational developments in practice despite evidence on the foundational role of first line management to facilitate changes. This chapter presents contributions to servant leadership and a model for developing care processes and well-being at work based on findings derived from studies of exceptionally successful managerial work in hospital wards. Key elements in the servant leadership approach was anchoring in practice and having a sincere follower- and servant focus through continuous involvement and interconnecting values, goals and challenges from different perspectives, and the development and implementation of care processes. The practice servant leader is attentive to psychosocial dynamics and fosters humility and a community of equals. The practice servant leader uses loci of anchoring to involve staff and interconnect management and practice.
|
|
| 5. |
- Jarebrant, Caroline, et al.
(författare)
-
Development of a tool for integrating Value Stream Mapping and ergonomics in healthcare - A Nordic Multicenter study.
- 2014
-
Ingår i: The 7th Nordic Working Life Conference. Book of Abstracts and Programme. - 9789198119558 ; , s. 123-124
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To present the most recent draft Nordic version of the ErgoVSM tool for healthcare and some contextual factors influencing the intended impact of the tool. Material and Methods: The ErgoVSM tool is tested at 7 wards on 4 different hospitals in Denmark, Iceland and Sweden. The tests include assessment of tool usability and main factors facilitating or inhibiting the intended impact of the tool. On the basis of these trials a final version of the ErgoVSM is developed. The ErgoVSM tool: According to common VSM procedure the Current State is mapped (visualized) followed by a similar procedure regarding a wanted Future State. The Ergo-module includes assessments of physical exposures (posture, forces, variation, porosity) and psychosocial exposures (demands, control, variation, communication, porosity). It focuses task as well as values stream level. The exposures are assessed by ratings scales with verbally defined end points. The analysis includes discussion of solutions and establishment of an Action Plan needed to realize the wanted Future State. Main contextual factors influencing the intended impact of the tool seem to be previous Lean experience, management style, volume of competing projects and type of value stream analysed.
|
|
| 6. |
|
|
| 7. |
- Styrkarsdottir, Unnur, et al.
(författare)
-
GWAS of bone size yields twelve loci that also affect height, BMD, osteoarthritis or fractures
- 2019
-
Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- Bone area is one measure of bone size that is easily derived from dual-energy X-ray absorptiometry (DXA) scans. In a GWA study of DXA bone area of the hip and lumbar spine (N ≥ 28,954), we find thirteen independent association signals at twelve loci that replicate in samples of European and East Asian descent (N = 13,608 – 21,277). Eight DXA area loci associate with osteoarthritis, including rs143384 in GDF5 and a missense variant in COL11A1 (rs3753841). The strongest DXA area association is with rs11614913[T] in the microRNA MIR196A2 gene that associates with lumbar spine area (P = 2.3 × 10 −42 , β = −0.090) and confers risk of hip fracture (P = 1.0 × 10 −8 , OR = 1.11). We demonstrate that the risk allele is less efficient in repressing miR-196a-5p target genes. We also show that the DXA area measure contributes to the risk of hip fracture independent of bone density.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
A Nordic evaluation of a work environment complement to Value Stream Mapping for increased sustainability of patient flows at hospitals - The NOVO Multicentre Study I
- 2015
-
Ingår i: Abstract book, The 9th Novo symposium: Sustainable Health Care Production Systems. ; , s. 34-36
-
Konferensbidrag (refereegranskat)abstract
- Conclusions: •Both the ErgoVSM and VSM tools seem mostly to result in intervention proposals causing improved or no change in the work environment without impaired performance. •Based on Swedish data only the use of ErgoVSM may result in some improvement of the work environment compared with VSM. Such an effect is weakly supported by the Icelandic data and not by the Danish data. Thus, only under some conditions the ErgoVSM tool may be used in favour of the VSM tool. •Most proposals were assessed to cause ergonomic improvements at system level (‘job content’ and ‘work situation’). This is in contrast to intervention proposals investigated in the ergonomic intervention literature mainly focusing task level and the individual (cf. Westgaard and Winkel, 2011).
|
|
| 11. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
A Nordic work environment complement to Value Stream Mapping for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2011
-
Ingår i: Abstract at the Nordic Workshop: ’Nordiske perspektiver på arbejdsmiljø’, National Research Centre for the Working Environment, Copenhagen, Denmark. November 21-22, 2011.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The Nordic Council of Ministers (NCM) granted 2007-09 a project with the aim to establish and develop a Nordic Network for scientists (‘the NOVO network’) regarding research on work environment and efficiency in the health care sector. The vision is a “Nordic Model for sustainable systems” in health care. A “Sustainable system” is here defined as the joint consideration of competitive performance and working conditions in a long-term perspective (Westgaard & Winkel, 2009, 2011). A preliminary project plan for a Nordic Multicenter project focusing a specific aspect of the vision was developed as part of the above mentioned NCM project. This was entitled: “A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study”. In healthcare Value-Stream Mapping (VSM) is a common Lean tool used to identify and minimize non-VAW ( (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and thereafter suggest the interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. In addition, VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment if the proportion of VAW is increased and management issues are not properly considered (e.g. Jonker et al 2011, Rolander et al submitted, Westgaard & Winkel 2011). In the rationalization process both physical and psychosocial working conditions should therefore be integrated to obtain a competitive performance in a long term perspective (Westgaard & Winkel 2011). In practice, this is rarely done. Thus, health of the employees and system performance goals often end up on a collision course with short-term performance demands as the winner (e.g. Winkel & Westgaard 1996, Westgaard & Winkel 2011). A management style based on dialog between the parties seems to be crucial in order to consider both competitive performance and health issues as part of the same intervention process (Westgaard & Winkel 2011). Due to this, we claim that the Nordic countries have special opportunities to develop sustainable production systems. This is based on the presence of "The Nordic model" which has regulated industrial relations in our part of the world (Guðmundsson 1993). It has evolved gradually over a period of over hundred years in the light of our special historical circumstances. The Nordic model has been the subject of extensive discussions and studies supported by the Nordic Council of Ministers (Schiller et al 1993, Fleming et al 1998, Fleming and Thörnqvist 2003). During the period 2002-10 an ergonomic intervention process tool (ErgoVSM) was developed in a series of Swedish projects, based on existing scientific evidence and in close co-operation with Swedish industry and the healthcare sector. The aim was to facilitate simultaneous consideration of waste minimization and health issues (i.e. risk factors for musculoskeletal and mental health)(Jarebrant et al 2004, 2009). This requires a high degree of consensus between the parties and it is presumed that the Nordic countries with a common anchoring in "The Nordic model" offer the best prerequisite for this kind of research and practice. A prototype of ErgoVSM is now available (Jarebrant et al 2010a, b), but proper validation and further development are needed. As part of the NCM-funded NOVO project 2009, Sweden suggested that this could be performed within the healthcare sector as a Nordic Multicenter study. September 2011 NCM decided to grant our project plan, thus allowing a Nordic co-ordination of the national studies and initiatives in Denmark, Iceland, Norway and Sweden. The present Nordic multicenter project adds to the national projects and initiatives by: -strengthening the empirical basis in the evaluation and further development of the tool -highlighting a practical example of the Nordic perspective on ergonomic (physical and mental) intervention research through a common Nordic scientific publication -potentially increasing the practical use of the process instrument to more/all Nordic countries By moving from a separate Swedish project to identical national studies in several countries extra demands are put on each project. The projects, each comprising several case and control patient flows, will be strictly co-ordinated into a Multicenter study to allow comparative analyses, further development of the tool and common conclusions. The final delivery will be a common Nordic version of the process tool ErgoVSM comprising the work from survey to development and implementation of solutions.
|
|
| 12. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2012
-
Ingår i: Abstract book. 6th NOVO Symposium. - 9789163723803 ; , s. 57-
-
Konferensbidrag (refereegranskat)abstract
- The Nordic Council of Ministers (NCM) granted 2007-09 a project with the aim to establish and develop a Nordic Network for scientists regarding research on work environment and efficiency in the health care sector (‘the NOVO network’). The vision is a “Nordic Model for sustainable systems” in health care. A “Sustainable system” is here defined as the joint consideration of competitive performance and working conditions in a long-term perspective (Westgaard & Winkel, 2009, 2011). A preliminary project plan for a Nordic Multicenter project focusing a specific aspect of the vision was developed as part of the above mentioned NCM project. This was entitled: “A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study”.Development of production systems in healthcare is at present to an increasing extent based on Lean Production ideas. In the Lean terminology “value-adding work” (VAW) represents the portion of process time that employees spend on actions that create value as perceived by the customer (Liker 2004). The complementary part is “non-VAW” or “waste” as the general Lean term of non-value-adding activities.In healthcare VSM is a common Lean tool used to identify and minimize waste (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and subsequently suggesting the interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. In addition, VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment if the proportion of VAW is increased and management issues are not properly considered. In the rationalization process both physical and psychosocial working conditions should therefore be integrated to obtain a competitive performance in a long term perspective. In practice, this is rarely done. Thus, health of the employees and system performance goals often end up on a collision course with short-term performance demands as the winner (e.g. Winkel & Westgaard 1996, Westgaard & Winkel 2011).
|
|
| 13. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Effect modifiers in intervention research at hospitals in three Nordic countries
- 2016
-
Ingår i: Abstract book of the 10th NOVO symposium, Reykjavík, 10 – 11 November, 2016. s. 33. - 9789935926555
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The impact of ergonomic interventions may be offset by other changes at the work place, primarily rationalizations. These have previously been shown to imply a dominant negative effect on health and risk factors, thus causing effect modification (Westgaard & Winkel 2011). The present paper aims to present assessment of potential effect modifiers in intervention studies at hospital wards in Denmark, Iceland and Sweden. Material and methods: The effect modifiers were assessed by a newly developed method (the EMA method; Edwards & Winkel 2016). It is a type of group interview including 3-6 participants representing all occupational groups in the investigated organization. The group is asked to write down significant changes at the workplace during the investigated period. The method also includes a semi-qualitative assessment of the potential Work Environment (WE) impact of each modifier. It aims to capture both the individual and collective account of all significant events that may have caused a significant impact in relation to the specific aim of the investigated intervention. Thirteen hospital wards went through interventions based on either the lean tool VSM (Value Stream Mapping) (6 wards) or the ErgoVSM method (Jarebrant et al, 2010) where additional focus is on ergonomic issues (7 wards). Results: In total 120 interventions were implemented. However, 322 significant modifiers were assessed to have occurred during the intervention period. Of these, 120 were assessed to imply impaired WE, 166 a positive impact, 33 no impact and 3 were not assessable. The number of significant modifier events varied between wards from 8-48, while the number of implemented interventions varied from 0-28. The semi-qualitative assessments suggested a major impact on WE due to modifiers. At seven wards the dominating impact of the modifiers was estimated to improve WE; at two wards the modifiers were estimated mainly to impair WE while four wards showed a mixture of modifiers, some estimated to improve and other to impair WE. Conclusion: Numerous effect modifiers occurred parallel to the investigated interventions. This jeopardizes any inference regarding impact of the investigated interventions on WE. The study thereby highlights the significance of considering effect modifiers in ergonomic intervention research.
|
|
| 14. |
|
|
| 15. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Facilitating and inhibiting factors in change processes based on the lean tool ‘value stream mapping’: an exploratory case study at hospital wards
- 2015
-
Ingår i: International Journal of Human Factors and Ergonomics. - 2045-7804 .- 2045-7812. ; 3:3/4, s. 291-302
-
Tidskriftsartikel (refereegranskat)abstract
- “Lean production” has become a prevalent rationalization methodology in healthcare. Value Stream Mapping (VSM) is a commonly used Lean tool to identify non-Value-Adding-Work. VSM is a participatory tool. Thus it may offer an opportunity to combine interventions for improved performance and ergonomics. The aim of the present exploratory study is to report observations that seem to play significant roles as inhibitors and facilitators for proper intervention processes when using VSM. Seven hospital wards have been investigated in Denmark, Iceland and Sweden. Information was obtained by screening key hospital documents and interviewing participants in and around the VSM processes. Nine tape-recorded interviews were performed. The results tentatively point to the facilitating effect on the VSM process by emphasizing involvement and decision-making among the participants, 1st line manager support and engagement, allocation of sufficient resources, work environment issues as part of the VSM methodology and VSM routines that are well-established and broadly accepted.
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
May sustainability of patient flows at hospitals be increased by adding a work environment module to Value Stream Mapping (VSM)? - A NOVO Multicenter study in Denmark, Iceland and Sweden
- 2014
-
Ingår i: In: Kasper Edwards & Jørgen Winkel (Eds.) Abstract book, The 8th Novo symposium: Sustainable Health Care Production Systems, Copenhagen, November 6 - 7, 2014, Technical University of Denmark. ; , s. 23-24
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
|
|
| 19. |
- Winkel, Jörgen, 1946, et al.
(författare)
-
Value Stream Mapping in healthcare: ergonomic implications and the significance of adding an ergonomic module - The NOVO Multicentre Study I
- 2018
-
Ingår i: The 12th NOVO symposium : Care integration, systems reform and sustainability in health care, Helsinki, 15-16 November. - Helsinki, Finland : Juvenus Print - Finnish University Print Ltd. - 2323-363X. - 9789523431959
-
Konferensbidrag (refereegranskat)abstract
- Background: During the recent decade “Lean production” has become a prevalent rationalization methodology in healthcare. A commonly applied Lean tool is Value Stream Mapping (VSM). It is a participatory tool, i.a. used to identify non-Value-Adding-Work (non-VAW) in patient flows. The process results in an Action Plan suggesting interventions aiming at minimizing non-VAW in order to increase the proportion of value creation. Scientific evidence indicates that non-VAW often represents periods of physical and mental recovery. Reduction of non-VAW may therefore cause ”Work intensification”. On this background the VSM tool has been complemented by an ergonomic module (ErgoVSM) to be used in the healthcare sector (Jarebrant et al., 2010). The aim of the present study was to investigate differences in Action Plans regarding expected impact on ergonomics and performance issues when using ErgoVSM rather than VSM. Material and Methods: Fourteen hospital wards were investigated, six in Denmark, two in Iceland and six in Sweden (one VSM ward refused to complete). In each country half the wards used VSM according to their ordinary Lean routines and the other half used ErgoVSM. All action plans were collected and each proposal was analysed based on triangulations between different stakeholder assessments. Data were analysed using Fisher's exact test of contingency tables of impact on four factors: Work Environment (WE, +/0/-), task/job content/system and efficiency according to VSM/ErgoVSM. Results: Of a total of 175 proposals from all the investigated wards 106 were assessed as causing WE+, 8 WE-, 20 WE0, and 41 Not Assessable. Of the 106 WE+ proposals 78% aimed at system level changes (job content and work situation), the remaining at task level changes or not assessable. This is in contrast to the intervention proposals generally investigated in the ergonomic intervention literature focusing almost exclusively interventions at task and individual level. Using ErgoVSM rather than VSM in Sweden and Iceland resulted in a higher proportion of proposals aiming at reduction of ergonomic risks compared to the Danish wards (p=0.02). Using ErgoVSM did not result in fewer proposals aiming at improving efficiency (p=0.5). Conclusions: Integration of ergonomic criteria into the rationalization tool VSM seems to imply a potential for more comprehensive ergonomic improvements without inhibiting the development of proposals improving efficiency. However, this impact of ErgoVSM seems to be modified by contextual factors.
|
|
