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| 3. |
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| 4. |
- Edwards, K, et al.
(författare)
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Using Chronicle Workshop to quantify impact of context in case studies
- 2014
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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..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Jarebrant, Caroline, et al.
(författare)
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Development of a tool for integrating Value Stream Mapping and ergonomics in healthcare - A Nordic Multicenter study.
- 2014
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Ingår i: The 7th Nordic Working Life Conference. Book of Abstracts and Programme. - 9789198119558 ; , s. 123-124
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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.
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| 11. |
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| 13. |
- Jarebrant, Caroline, et al.
(författare)
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Ergonomic Value Stream Mapping (ErgoVSM). Tool and User Guide.
- 2016
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Ingår i: Nordic Council of Ministers, ANP 2016:731. - : Nordic Council of Ministers. ; :APN 2016:731
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Recent years Lean Production (”Lean”) has become a prevalent rationalization strategy in healthcare to create more efficient value streams. Research shows that this often results in impaired Ergonomics, i.e. impaired work content and physical work load (“physical ergonomics”). A common Lean tool used to rationalize value streams in healthcare is Value Stream Mapping (VSM). An ergonomic “add-in module” Ergonomic Value Stream Mapping (ErgoVSM) – has therefore been developed to be used as an integrated part of VSM in the analysis of value streams in healthcare. ErgoVSM as well as VSM are participative tools. All occupational groups performing tasks directly related to the investigated value stream should be represented when using the tool. This Guide includes description of methods and assessment templates for physical ergonomics and work content. An initial version of ErgoVSM for manufacturing industry was developed in Sweden. Later, this was further developed for the health-care sector. This tool was then evaluated in a Nordic Multicenter Study by national projects in Sweden, Denmark and Iceland. The Nordic evaluation showed that using the ErgoVSM tool may result in more focus on ergonomics in the Action Plans compared to just using VSM. This is obtained without jeopardizing performance aspects. Based on the field experiences from the Nordic Multicentre Study I, the ErgoVSM tool was further developed, resulting in this present English version.
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| 19. |
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| 20. |
- Jarebrant, Caroline, et al.
(författare)
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ERGONOVA Workbook. Ergonomic Value Stream Mapping in health care
- 2013
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Preface to the present English edition: This edition has been translated and printed as part of the Nordic Multicenter Study "A Nordic work environment complement to Value Stream Mapping (VSM) for more sustainable patient flows at hospitals – A NOVO Multicenter study", funded by the Nordic Council of Ministers. The present prototype version of the Workbook is now evaluated at 14 hospital wards in Denmark, Iceland and Sweden. We aim to deliver a revised Workbook for intervention processes towards increased sustainability of patient flows based on our specific Nordic opportunities with our strong tradition of agreement between the parties (cf. ‘the Nordic Model’).Jörgen WinkelProject leader of the Nordic Multicenter StudyCaroline JarebrantProject leader of the Swedish project
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| 21. |
- Jarebrant, Caroline, et al.
(författare)
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ErgoVSM: A Tool for Integrating Value Stream Mapping and Ergonomics in Manufacturing
- 2016
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Ingår i: Human Factors and Ergonomics in Manufacturing & Service Industries. - : Wiley. - 1090-8471 .- 1520-6564. ; 26:2, s. 191-204
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Tidskriftsartikel (refereegranskat)abstract
- Value stream mapping (VSM) is a Lean tool aiming at waste reduction. Previous research suggests that the use of VSM may result in work intensification and thus an increased risk for the workers of developing work-related musculoskeletal disorders (MSD). In the current study, VSM was developed to also consider physical exposure in the analyzed production system (ErgoVSM). As the VSM, ErgoVSM is based on a participatory approach. ErgoVSM was tested in a Swedish manufacturing company. The results suggest that ErgoVSM catalyzes change processes to include intervention proposals emphasizing ergonomics in addition to waste reduction. Thus, ErgoVSM appeared useful for the investigated target group of production engineers and experienced operators. The performance improvements suggested when using the ordinary VSM seemed not to be hampered by adding the ergonomics complement. However, the use of ErgoVSM was somewhat more time-consuming than the use of VSM. In conclusion, ErgoVSM is suggested as a feasible tool to be used by production engineers and experienced operators for including ergonomics considerations in the rationalization process.
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| 22. |
- Jarebrant, Caroline, et al.
(författare)
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Framtidens VårdArbete. Proaktivt förändringsarbete för hållbart arbetsliv
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Projektets övergripande hypotes utgår från att riskfaktorer för mental och fysisk ohälsa kan minskas, genom att arbetsmiljöarbetet integreras i utvecklings- och effektiviseringsarbetet. Verktyget Ergonomisk VärdeFlödesAnalys (ErgoVFA) har vidareutvecklats för att stödja förändringsprocessen. Tre vårdenheter arbetade med ErgoVFA (värdeflödesanalys med arbetsmiljöperspektiv) och två använde traditionell värdeflödesanalys (VFA). Ett gemensamt tillvägagångssätt tillämpades men där förändringsprocessen utgick från respektive vårdenhets behov och förutsättningar. Handlingsplanerna (central del i processen) innehöll mellan åtta och 39 förändringsförslag. Handlingsplanerna tyder på att ErgoVFA genererar fler förslag än traditionell VFA. Effektivitet beaktas i lika omfattning. ErgoVFA tenderar att i högre grad fokusera den psykosociala arbetsmiljön. När endast patientkvalitet prioriteras, noteras risker för försämringar i arbetsmiljön. Resultaten tyder på att ErgoVFA jämfört med VFA medför effekter på förändringsarbetet som skulle kunna leda till högre grad av organisatorisk hållbarhet. Beträffande upplevd förändring under projekttiden visade resultaten att ErgoVFA-enheterna upplevde den ”psykosociala arbetsmiljön” som signifikant bättre jämfört med VFA-enheterna. I projektet framkommer att ErgoVFA skapar engagemang och ger möjlighet till helhetslösningar. En arena för kommunikation skapas, där kontinuitet i analysarbetet över tid möjliggörs. ErgoVFA har vidareutvecklats där arbetsgången förtydligats och verktyget som ett processinstrument betonas. I vidareutvecklingen har förenkling av handledningstext och bedömningsmallar eftersträvats.
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| 23. |
- Jarebrant, Caroline, et al.
(författare)
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Previous experiences of Value Stream Mapping (VSM) at the hospital units included in the Swedish part of the NOVO Multicenter Study
- 2012
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Ingår i: Abstract book. 6th NOVO symposium. - 9789163723803
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Konferensbidrag (refereegranskat)abstract
- Within the county councils of Sweden (hospitals, elderly care, etc.) two waves of introduction of Lean Production (Lean) have occurred. The first occurred during the 1990s and was unsuccessful mainly due to dramatic and negative impact on the employees (Härenstam et al, 1999). The 2nd wave started after the turn of the millennium. In 2011 about 80% of the county councils were running Lean projects (SKL, 2012). Now more emphasis was put on leadership and teamwork as well as knowledge on methodology. Successful projects creating e.g. more efficient patient flows are supposed to save time. A key issue is, however, that no general agreement seems to occur on how these saved resources should be reprioritized (cf. the “50/50-basis” in Denmark). Due to this, Lean projects are often perceived as “saving projects” where staff will eventually be phased out leading to further “work intensification”. VSM is a main Lean tool used to reduce waste in production flows. Our present case studies show differences between hospitals in Lean and VSM experiences. At one hospital Lean has been developed from "below" in the organization since 2004 through successive education (SkaS-guiden 2008). In our 2 cases from this hospital the initial steps of VSM were guided by internal Lean educated stakeholders. No resistance was met from any employee. However, the writing of action plans and the following actions were integrated in parallel rationalization processes. In contrast, our 2 other cases at another hospital had only been marginally influenced by Lean. The VSM processes were guided by an external Lean educated stakeholder (one of the authors). Especially one of the cases had significant difficulties in achieving consensus on an action plan including work environment issues. The required time for the VSM analyses became considerably prolonged, partly related to lack of Lean and VSM experience. Conclusions: The duration of the VSM process seems to depend on previous Lean experiences. Problems in the assessment of an action plan, an essential part in the VSM procedure, seems partly due to employee uncertainty regarding the consequences for the individual and parallel rationalization processes.
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| 24. |
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| 25. |
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| 26. |
- Jarebrant, Caroline, et al.
(författare)
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Utveckling och validering av verktyg och arbetssätt för hållbara produktionssystem inom vård och omsorg
- 2007
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Ingår i: Nordisk FoU-nätverk inom Vård och Omsorg. NOVO.
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Konferensbidrag (refereegranskat)abstract
- En väl etablerad metod inom Lean Production är värdeflödesanalysen (VFA) som är ett proaktivt processverktyg baserat på delaktighet. Verktyget visualiserar flöden och slöserier. Nuläget visualiseras, problem identifieras och genom förslag till förbättringar skisseras ett framtida bättre och mer effektivt läge, där tid i icke-värdeskapande arbete minimeras i omfattning. Våra tidigare studier tyder på att värdeskapande arbete innebär mer riskfyllda exponeringar än ickevärdeskapande arbete. Mot denna bakgrund har vi påbörjat utveckling av en evidensbaserad belastningsergonomisk tilläggsmodul ERGONOVA (Ergonomisk Värdeflödesanalys). Nästa steg är att även utveckla denna tilläggsmodul för användning inom vård- och omsorgssektorn där lean-principerna håller på att introduceras. Verktyget ska utvecklas till ett fungerande förändringsverktyg innehållande såväl belastningsergonomiska som psykosociala dimensioner i syfte att underlätta en balansering mellan värdeflödesbaserade effektiviseringar och arbetsmiljöinsatser.
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| 27. |
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| 28. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
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Leader-Member Exchange (LMX) and Psychosocial Factors at Work Among Healthcare Professionals
- 2014
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Ingår i: Journal of Nursing and Care. - : OMICS Publishing Group. - 2167-1168. ; 3:5
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The study aims to examine the associations between leader–member exchange (LMX) and psychosocial factors at work. Methods: A questionnaire-based cross-sectional study was undertaken at four units in two not-for-profit hospitals in southwestern Sweden. The study sample included 240 employees. Results: Significant correlations were found between LMX items and most of the psychosocial domains and dimensions. The strongest correlations were found between the LMX item affect and rewards/recognition, role clarity and predictability, and the LMX item loyalty and rewards/recognition. In sum, high-quality LMX was associated with good psychosocial work conditions experienced by the employees. Conclusions: The results support possible ways for managers and employees to strengthen their relationships and this may in turn lead to more sustainable systems in health care.
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| 29. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
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Lean och arbetsmiljö inom sjukvården: Proaktivt förändringsarbete för hållbara arbetsprocesser inom vården
- 2013
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Ingår i: FALF Abstracts. Arbetslivets föränderlighet. FALF 17-19 juni 2013, Stockholm. ; , s. 15-16
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med projektet (som finansieras av AFA Försäkring) är att skapa bättre förutsättningar för att kombinera effektiva patientflöden och en god arbetsmiljö bland anställda inom sjukvården. Ett delsyfte är att utveckla ett ergonomiskt integrerat komplement till LEAN-verktyget värdeflödesanalys (VFA). Ett annat delsyfte är att studera vilka faktorer som har betydelse i selektionsprocessen av lösningsförslag. Inom Lean är VFA ett etablerat verktyg för att effektivisera flöden. När ett flöde kartläggs så är huvudsyftet att reducera icke värdeskapande aktiviteter, dvs. den tid/aktiviteter som inte tillför varan eller tjänsten något värde. Genom visualisering av olika arbetsuppgifter i flödet (med hjälp av post it-lappar) och dialog tar man sig från ett nuläge till ett önskat framtida läge. Vid VFA finns dock en risk för arbetsintensifiering och därmed en risk för försämrad fysisk och/eller psykosocial arbetsmiljö. Därför är verktyget ERGONOVA (ergonomisk värdeflödesanalys) framtaget som ett integrerat komplement till VFA. Med ERGONOVA beaktas arbetsmiljöaspekter i ett flöde. De arbetsmiljöaspekter som beaktas är fysisk belastning(arbetsställningar, lyft av föremål mm) och arbetsinnehåll (krav, kontroll, kommunikation). Här görs bedömningar på arbetsuppgiftsnivå, flödesnivå och jobbnivå. Utifrån en nulägeskarta för flödet identifieras problem/hinder för arbetets utförande och arbetsmiljöbrister. Analysprocessen resulterar i konkreta lösningsförslag och en preliminär handlingsplan vad gäller ett framtida flöde. Förslagen exponeras sedan på avdelningen, där alla medarbetare ges tillfälle att lämna synpunkter. Slutligen fastställs en handlingsplan med de aktiviteter och åtgärder som krävs för att förändringarna ska kunna genomföras och implementeringen påbörjas. Resultat från tre vårdenheter inom Västra Götalandsregionen visar att de anställda blir delaktiga i förändringsarbetet, där analys av arbetssätt blir i centrum. Fördelen med att använda post it-lappar (olika färger för olika yrkeskategorier) är att de anställda får arbetsuppgifter och flödet ”framför ögonen”. Därmed förskjuts fokus från person till arbetssätt och flöde. De preliminära resultaten visar att den anställde ofta får en bättre förståelse för vad de gör i ett flöde och vad andra yrkeskategorier gör. Ergonomisk värdeflödesanalys genererar en betydande idérikedom vad gäller förslag till förändringar. Resultaten indikerar att de anställda får en tvärfunktionell dialog där man diskuterar och föreslår förändringar som ofta leder till både ökad effektivitet och bättre arbetsmiljö.
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| 30. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
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Optimering av handlingsplaner för utveckling av hållbara arbetsprocesser inom vården
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med projektet var att skapa bättre förutsättningar för att kombinera effektiva flöden och en god arbetsmiljö bland anställda inom sjukvården. I projektet studerades vad som har betydelse i selektionsprocessen av lösningsförslag fram till handlingsplan vid användning av Ergonomisk VärdeFlödesAnalys (ErgoVFA), dvs. värdeflödesanalys med integrerat arbetsmiljöperspektiv. Tre vårdenheter ingick i projektet. Tillvägagångssättet vid vårdenheterna var att identifiera ett flöde i sin verksamhet, genomföra analys av det valda flödet med hjälp av ErgoVFA, ta fram lösningsförslag och upprätta en handlingsplan och implementera. Datainsamling skedde med hjälp av intervjuer med vårdenhetschefer och analysgrupper. Syftet med intervjuerna var att få en förståelse för val av flöde, problemidentifiering samt eventuella selektionsmekanismer från lösningsförslag fram till handlingsplan. Dessutom ställdes intervjufrågor utifrån ledarskapsteorin ”servant leadership” när det gäller dialogen och samspelet mellan vårdenhetschefen och medarbetarna under förändringsprocessen. Resultaten indikerar, när det gäller den initiala selektionsprocessen av lösningsförslag, att det är viktigt att det finns en öppenhet och delaktighet på vårdenheten där ledningen uppmuntrar sina medarbetare att komma med nya idéer (”empowerment”). När det gäller faktorer som har betydelse för hur goda idéer på bästa möjliga sätt når fram till handlingsplanen visar resultaten att det är viktigt med en förankring hos ledningen. Med ErgoVFA visualiseras problem för olika yrkeskategorier och på så vis skapas transparens i organisationen. Resultat från vårdenheterna vittnar också om betydelsen av att ha en långsiktig vision (”stewardship”) för att medarbetarnas idéer ska nå fram till handlingsplaner.
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| 31. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
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The impact of servant leadership dimensions on leader–member exchange among health care professionals
- 2016
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 24:2, s. 228-234
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the current study was to investigate the impact of servant leadership dimensions on leader–member exchange (LMX) among health-care professionals. Background: Leadership support and the quality of the dyadic relationship between the leader and the employee are essential regarding the work environment and turnover intentions in health care. Method: A questionnaire-based cross-sectional study was undertaken at four hospital units in Sweden. The study sample included 240 employees. Results: Significant bivariate correlations were found between all servant leadership dimensions and LMX. The strongest correlations were found between ‘humility’ and LMX (r = 0.69, P < 0.001), and ‘empowerment’ and LMX (r = 0.67, P < 0.001). The hierarchical regression analyses indicated that ‘empowerment’, ‘humility’ and ‘stewardship’ explained about 55% of the variance in LMX. Conclusion: In our study servant leadership dimensions were strongly related to LMX. Implications for nursing management: The results identify specific servant leadership dimensions that are likely to be useful for developing a stronger exchange relationship between the leader (e.g. nursing manager) and individual subordinates in health care.
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| 32. |
- Löfving, Malin, 1979-, et al.
(författare)
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Design and Application of a Development Map for Aligning Strategy and Automation Decisions in Manufacturing SMEs
- 2023
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Ingår i: Advances in Production Management Systems. - : Springer. - 9783031436611 - 9783031436628 ; 689 AICT, s. 228-241
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Konferensbidrag (refereegranskat)abstract
- The research in this paper focused on (i) to increase the knowledge about the strategic role of automation technology and (ii) how automation technology investment decisions can be aligned with the strategy in manufacturing SMEs. This paper describes the design, application, and evaluation of the Strategic Development Map (SDM) in three settings, whereof two manufacturing SMEs. The SDM was also applied in more than 500 SMEs in a Swedish initiative called the Robot Lift. The SDM was derived from existing literature about Toyota management principles and thereafter adapted to the topic. The process of designing, testing, and evaluating the tool was inspired by design science research. It also contains explanations of the outcomes and mechanisms that lead to the successful adaptation and use of the SDM. The SDM provides a structured guidance process to understand the strategic role of automation technology investments in SMEs. This process can support companies towards a deeper understanding of the current state, target state and obstacles and challenges to reach the target with a focus on automation technology investments. The SDM was emphasized by companies and external coaches as very simple to understand and use. Using the SDM increased involvement and knowledge about strategic role of automation technology.
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| 33. |
- Löfving, Malin E S, 1979, et al.
(författare)
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Evaluation of flexible automation for small batch production
- 2018
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Ingår i: Procedia Manufacturing. - : Elsevier BV. - 2351-9789. ; 25, s. 177-184
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Konferensbidrag (refereegranskat)abstract
- Traditionally it has been difficult to use automation in small batch production with high variation in volumes and high mix of products. However, this is changing as there exist new types of flexible automation. The purpose of this paper is to understand the requirements on enterprises to use automation in small batch production, and evaluate flexible automation technologies suitable for small batch production. The study is based on literature reviews and interviews. Identified requirements are for example to change between manual access and automation, and easy programming. The results show that a flexible mobile robot automation may fulfill a majority of the identified requirements.
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| 34. |
- Löfving, Malin E S, 1979, et al.
(författare)
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Guide for Automation of Low VolumeProduction
- 2020
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Ingår i: Advances in Transdisciplinary Engineering. - 9781614994398 ; 13, s. 13-23
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Konferensbidrag (refereegranskat)abstract
- There is a remaining need from both academia and practitioners, to gainfurther knowledge about the decision making process for automation of low volumeproduction. This paper includes insights of drivers for automation, the developmentof a guide for low volume production and the outcome of using the guide. Theresearch in this study is based on both empirical data and theoretical considerations.The empirical data was collected in five case studies and a questionnaire. This paperis part of a research project with the main objective to develop knowledge about howflexible automation may contribute to improvements in efficiency, ergonomics,quality and production economics in different industries with low volumeproduction. One of the results in the project was a comprehensive guide, developed,refined and improved in an iterative collaborative process, where tools and parts ofthe guide were tested and verified by five manufacturing case companies. The paperdescribes briefly the development process of the guide and content. The requirementsof the guide derived from literature, case companies, questionnaire as well asindustrial experts. The resulting guide can be used in several ways, depending on therequirements of the application. The guide includes guiding principles, a decisionmodel for the analysis of the company, choice of automation and facts aboutautomation. In the end of the project, four companies had invested or decided toinvest in different types of automation.
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| 35. |
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| 36. |
- Wikholm, Charlotte, et al.
(författare)
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Strategisk kompetensförsörjning för hållbart arbetsliv : En kunskapsöversikt och analys av utvalda ESF-projekt
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är resultatet av ett uppdrag från ”Temaplattformen hållbart arbetsliv” (Svenska ESF-rådet tillsammans med Forte) med syftet att bidra med ökad kunskap om hur socialfondsfinansierade projekt inom målområde 1.1 kan stärka organisationers strategiska kompetensförsörjning och därigenom skapa förutsättningar för ett hållbart arbetsliv. Studien har genomförts genom ett samarbete mellan Swerea IVF och HELIX Competence Centre vid Linköpings universitet.Studien baseras på tre olika delstudier som sammantaget ger en bred kunskapsöversikt över såväl relevant och aktuell teori och lärdomar från tidigare stora programsatsningar som erfarenheter och lärdomar från projekt under innevarande programperiod.Den första delstudien utgörs av en översikt över teorier, begrepp och modeller kopplade till kompetensförsörjning som organisatorisk strategi och de strategiska processer som ingår i en sådan strategi. Processerna presenteras i form av en modell kallad IN-I-UT-modellen. IN-fasen innehåller organisationers strategiska val och arbete med frågor kring att attrahera och rekrytera personer med rätt kompetens. I-fasen handlar om att behålla, utveckla, utvärdera och belöna. UT-fasen innebär att ta tillvara kompetens i samband med avveckling och omställning när anställda slutar. Den första delstudien fokuserar främst på frågor I-fasen i fråga om organisatoriska strategier kopplade till kompetensutveckling och lärande.Den andra delstudien utgörs av en dokumentstudie av rapporter som gjort kunskapssammanställningar av större programsatsningar på kompetensförsörjning.Studiens syfte var att sammanställa de viktigaste erfarenheterna och lärdomarna från dessa i fråga om strategisk kompetensförsörjning. Resultaten strukturerades utifrån IN-I-UT-modellen. I analysen av rapporterna framkom dock även en tredje dimension – samverkan MELLAN organisationer. Delstudien sammanfattas med en lista över kriterier för framgångsrik kompetensförsörjning under temana analys, planering och förankring; Ledarskap, samordning och engagemang; Lärande och kompetensutveckling, samt Uppföljning och efterarbete.Den tredje delstudien består av en empirisk studie av utvalda ESF-projekt inom programområde 1, huvudsakligen inom programområde 1.1 (kompetensförsörjning och livslångt lärande med fokus på anställda), men även några inom programområde 1.2 med fokus på att bygga strukturer och plattformar). Urvalet gjordes av respektive region och den nationella enheten. Totalt 21 intervjuer med till största delen projektledare gjordes som berörde följande teman: innehåll och målgrupp, Socialfondens tre obligatoriska horisontella principer som ska integreras i ESF-projekt, delaktighet, resultat och lärdomar. De utvalda projekten var riktade mot olika branscher och offentliga verksamheter och med olika storlek på budgeten.De utbildningar som genomförts inom projekten har varit både fysiska och digitala, allmänna och företagsanpassade. Några projekt hade en tydlig inriktning på lärande på arbetsplatsen. Hur projekten arbetat med ESFs tre obligatoriska horisontella principer varierar. Från att vara integrerade och inbyggda i projektet för att vara det direkta syftet i vissa projekt, till andra projekt som aktualiserade det vid olika steg i projektet. Att använda ett språk som var tillgängligt för alla var centralt för flertalet projekt. När det gäller utbildning i de horisontella principerna av ”utbildarna/konsulter” som upphandlas bör det undersökas former för detta, då det efterfrågas av projekten.Projektledarna lyfter en hel del erfarenheter och lärdomar från genomförda projekt, till exempel: vikten av förankring i hela den deltagande organisationen, att förändringsarbete tar tid, svårigheter att få de som har en anställning att avsätta tid för att delta i utbildningar, den tunga och tidskrävande administrationen.När det gäller framgångsfaktorer nämns bland annat korta återkommande utbildningsinsatser, effektiva informationsflöden i projektet, prioritering av projektet på högsta nivå i de deltagande organisationerna och tillit inom projektgruppen.En bra behovsanalys underlättar genomförandet av projektet och framför allt bäddar den för att projektresultatet kan integreras i den ordinarie verksamheten och skapa en förbättringskultur.Vem som är ägare till resultatet av ett ESF-projekt efter avslut så att kunskaper, erfarenheter, arbetssätt etcetera kan leva vidare och utvecklas är oklart i många projekt. Om ägare pekas ut så rör det sig oftast om ”de deltagande organisationerna” eller ”implementerat i ordinarie verksamhet”.ESF-rådets samordnare verkar arbeta på olika sätt och vid frågor kan man få olika svar beroende på vilken samordnare som tillfrågas, även om det är i samma region. Flera intervjuade påtalade att ESF borde hålla i utvärderingarna själva så att det blir mer likvärdigt och jämförbart med andra projekt för att öka möjligheterna att dela lärdomar och erfarenheter mer och bättre över regiongränserna.ESF borde även göra uppföljning och intervjuer flera år efter ett genomfört projekt och studera om det har blivit några långsiktiga kvarstående effekter.
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| 37. |
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| 38. |
- Winkel, Jörgen, 1946, et al.
(författare)
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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
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Ingår i: Abstract book, The 9th Novo symposium: Sustainable Health Care Production Systems. ; , s. 34-36
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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).
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| 39. |
- Winkel, Jörgen, 1946, et al.
(författare)
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A Nordic work environment complement to Value Stream Mapping for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2011
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Ingår i: Abstract at the Nordic Workshop: ’Nordiske perspektiver på arbejdsmiljø’, National Research Centre for the Working Environment, Copenhagen, Denmark. November 21-22, 2011.
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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.
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| 40. |
- Winkel, Jörgen, 1946, et al.
(författare)
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A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study
- 2012
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Ingår i: Abstract book. 6th NOVO Symposium. - 9789163723803 ; , s. 57-
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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).
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| 41. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Effect modifiers in intervention research at hospitals in three Nordic countries
- 2016
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Ingår i: Abstract book of the 10th NOVO symposium, Reykjavík, 10 – 11 November, 2016. s. 33. - 9789935926555
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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.
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| 42. |
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| 43. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Ergonomic Value stream Mapping (ErgoVSM) – potential for integrating work environment issues in a Lean rationalization process at two Swedish Hospitals
- 2013
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Ingår i: 7th NOVO Symposium: A Nordic Model for Sustainable Systems in the Health Care Sector, Helsinki 25 – 26 November, 2013. - 2323-363X. - 9789523020580
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Lean is used in healthcare as a tool for business development and rationalization. Lean aims at contributing value from a holistic perspective including reduction of waste. Previous research indicates that this often creates work intensification with possible negative implications for the working environment (WE). WE considerations generally take a back seat on the rationalization process and are most often introduced later in a separate process. This paper reports findings from the Swedish part of a Nordic Multicenter Study where WE considerations have been integrated into a rationalization process based on Value Stream Mapping (VSM). ErgoVSM incorporates aspects of the physical and psychosocial WE into the VSM process. The abstract presents pros and cons for using ErgoVSM in relation to VSM at 2 wards at 2 different hospitals based on some of our preliminary data. Material and Methods: The case ward (“Ca”) used the ErgoVSM tool and the control ward (“Co”) the VSM tool. The resulting Action Plans were analyzed regarding number of suggested interventions and expected impact on performance (P) and WE. The expected WE impact was finally categorized according to impact at “Task”, “Work Content” and “Work Situation” (Westlander 1993). Two of the present researchers made these assessments independent of each other followed by a consensus procedure. Results: The Action Plan from Ca comprised 37 and Co 22 interventions. For both wards 65% of the interventions were expected to improve both P and WE. However, for Ca none of the interventions were expected to imply negative or no impact on WE, while this was 23% for Co. For Ca 16% of the interventions concerned Tasks, 46% Work Content and 38% Work Situation. The corresponding results for Co were 55%, 36% and 9% respectively. Conclusions: The Ca ward suggested more interventions, none of these with expected negative impact on WE and the suggestions were more often at a system rather than task level. The present preliminary data suggest that the ErgoVSM tool facilitate development of an Action Plan that may result in higher organizational sustainability compared with VSM.
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| 44. |
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| 45. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Factors facilitating and inhibiting Value Stream Mapping processes at hospital units in three Nordic countries - A Nordic Multicenter study
- 2014
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Ingår i: O. Broberg, N. Fallentin, P. Hasle, P.L. Jensen, A. Kabel, M.E. Larsen, T.Weller (Editors). 11th International Symposium on Human Factors in Organisational Design and Management 46th Annual Nordic Ergonomics Society Conference. - 9788793130135
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 1.Conceptual framework and Purpose In healthcare Value Stream Mapping (VSM) is a common Lean tool used to improve the efficiency of patient flows by identifying and minimizing 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 appropriate interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment. Due to this, Lean is often perceived as a “threat” by employees at hospitals (Härenstam et al 2000, personal communications). Physical and psychosocial working conditions should therefore be taken into account in the rationalization process to obtain sustainable solutions, i.e. solutions that allow for competitive performance and acceptable work environment in a long term perspective. On this background we have complemented the VSM tool by an ergonomic module assisting the users to consider also physical and psychosocial implications of the suggested interventions. This ErgoVSM tool is now evaluated in a Nordic Multicenter Study including Denmark, Iceland and Sweden (Winkel et al, 2012). The aim of this paper is to present observations that may indicate facilitating and inhibiting factors for the VSM process. 2.Methods Seven wards have used the ErgoVSM and seven the traditional VSM. Information was obtained by screening key hospital documents and interviewing participants in the VSM processes. 3.Results In Sweden one out of three wards using VSM decided not to fulfil the VSM process. On Iceland the only ward using VSM also decided not to fulfil their VSM process. The hospitals of the investigated wards using VSM in Sweden and Iceland had a strong primary focus on financial balance of the business according to key documents. Decisions on when and which value stream to analyse were made by management with little/no dialog with the employees. Work environment issues were not discussed as part of this. In addition, Iceland had a short experience of Lean, mainly based on support from McKinsey, an American global management consulting firm that focuses on solving issues of concern to senior management (http://en.wikipedia.org/wiki/McKinsey_%26_Company). Thus, they had no attention to the wellbeing to the employees and their work environment when introducing Lean. In general, the Icelandic Lean coaches had problems motivating the employees. However, they perceived a facilitated VSM process at the investigated ErgoVSM ward. Due to this, the main Lean coach decided to include work environment aspects in the VSM processes performed at other wards not part of the present Multicenter Study. Positive effects on those VSM processes were reported back to the researchers. In Denmark all three wards using VSM fulfilled their VSM process. This hospital had a long Lean experience. The main Lean coach reported process problems during their 3 initial years when using a top-down approach. Before the present project was initiated they had turned to a bottom-up initiation of the VSM processes. The Lean coach also expressed that work environment issues might be articulated as part of the VSM process. All seven wards using ErgoVSM in the 3 countries fulfilled the process. 4.Conclusion When using the Lean tool “Value Stream Mapping” it seems to be important not only to focus on efficiency but also on issues that are perceived important for the well-being of the individual employee. 5.Financial support The Nordic Council of Ministers and national grants. 6.References Härenstam A, Bejerot E, Johansson K, Leijon O, Schéele P. “Mager och god” eller ”Lean and mean”? Samband mellan organisationsförändringar och arbetsförhållanden. In: Barllöf K (Ed.) Smärtgränsen? En antologi om hälsokonsekvenser I magra organisationer. Rådet för arbetslivsforskning, pp 2000 Keyte, B., Locher, D., 2004. The Complete Lean Enterprise. Value Stream Mapping for Administrative and Office Processes. Productivity Press, New York. Winkel J, Birgisdóttir B D, Dudas K, Edwards K, Gunnarsdóttir S, Jarebrant C, Johansson Hanse J (2012). A Nordic work environment complement to Value Stream Mapping (VSM) for sustainable patient flows at hospitals – A NOVO Multicenter study. 6th NOVO Symposium: Sustainable Health Care: Continuous Improvement of Processes and Systems. Karolinska Institute, Stockholm Sweden. November 15-16, 2012, pp 58-59. ISBN: 978-91-637-2380-3
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| 46. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Introduction of Lean/Value Stream Mapping at hospital units in three Nordic countries and expected impact on the working environment - A Nordic Multicenter study
- 2013
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Ingår i: International HELIX Conference 2013.
-
Konferensbidrag (refereegranskat)abstract
- Conceptual framework and Purpose A recent review has documented mostly negative effects of rationalization on musculoskeletal and mental health and corresponding risk factors. This goes in particular for the healthcare sector (Westgaard & Winkel, 2011). Lean Practices are increasingly used in healthcare and Value Stream Mapping (VSM) seems to be a commonly used tool to identify and minimize waste (Keyte & Locher, 2004). The health impact of Lean varies considerably between investigations. This may to a large extend be due to differences in the operationalization of Lean (Brännmark et al, 2012). VSM 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 increased impact. On this background rationalizations based on VSM may offer a procedure that also includes working environment issues. In addition, workplaces in the Nordic countries seem to offer good opportunities for realizing a true participatory approach considering also working environment issues when rationalizing a value stream (Guðmundsson, 1993; Westgaard & Winkel, 2011). VSM has been shown to be a powerful rationalization tool in the elimination of non-value-adding tasks (non-VAT). Several studies show that non-VAT generally offer less risky physical and mental exposures (e.g. Kazmierczak et al, 2005; Østensvik et al, 2008; Palmerud et al, 2012; Jonker et al, 2013). According to this, non-VAT is usually named “the porosity of the working day” (Marx, 1867; Westgaard & Winkel, 2011; Winkel & Westgaard, 2001). Strong political demands to maximize efficiency in healthcare may thus potentially result in an excessive rationalization causing a too large reduction in porosity and thus too risky work intensification. In practice Lean is often perceived as a “threat” by employees at hospitals (Härenstam et al, 2000; many personal communications). In contrast, most Lean consultants generally describe Lean as an opportunity for improvements also in terms of the working environment (numerous personal communications). On this background an ergonomic complement to VSM, the ErgoVSM, has been developed based on existing scientific evidence and in close co-operation with Swedish industry and the healthcare sector (Jarebrant et al, 2013). The ErgoVSM also considers health issues, i.e. risk factors for musculoskeletal and mental health in addition to reduction of waste (Jarebrant et al, 2004; 2009). In this paper we present some preliminary data based on 1st line managers’ assessments of expected impact of action plans based on VSM and ErgoVSM. The presented data are retrieved from a larger NOVO Multicenter Study (Winkel et al, 2012). Design/Methodology Fourteen hospital wards in Denmark, Iceland and Sweden are investigated. Seven of these are using VSM and the remaining the ErgoVSM to improve the efficiency of their patient flows. Current and future states are assessed and action plans presented. 1st line managers are then interviewed and asked to assess expected impact of each suggested intervention in the action plan in terms of efficiency, treatment quality, physical and psychosocial working environment. So far five of the fourteen 1st line managers have been interviewed. Two of the wards have used the VSM tool and 3 the ErgoVSM tool. Results and Discussion All together 103 amendments for improved performance have been assessed in the five action plans. Eighty-one of these were assessed also to imply improvements in the working environment. Three suggestions were expected to imply a negative impact and four no impact on the working environment. Fifteen suggestions were not rated as they were decided not to be realized. Using VSM or ErgoVSM did not influence the assessment of expected impact of amendments in the action plan. The dominance of expected positive impact on the working environment of the amendments will be discussed in terms of potential bias and real opportunities. The Multicenter Study includes follow-up investigations of realized impact on the working environment as well as potential national differences between the three investigated countries (cf. Birna & Gunnarsdóttir, 2012; Edwards & Winkel, 2012; Jarebrant et al, 2012).
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| 47. |
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| 48. |
- Winkel, Jörgen, 1946, et al.
(författare)
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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
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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
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 49. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Value Stream Mapping in healthcare: ergonomic implications and the significance of adding an ergonomic module - The NOVO Multicentre Study I
- 2018
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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.
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