| 1. |
- Dellve, Lotta, et al.
(author)
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Health care clinicians' engagement in organizational redesign of care processes : Health care clinicians' engagement in organizational redesign of care processes
- 2018
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In: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 68, s. 249-257
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Journal article (peer-reviewed)abstract
- The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.
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| 2. |
- Dellve, Lotta, et al.
(author)
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Health care clinicians’ engagement in organizational redesign of care processes : Health care clinicians’ engagement in organizational redesign of care processes
- 2018
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In: Applied Ergonomics. - : Elsevier BV. - 0003-6870. ; 68, s. 249-257
-
Journal article (peer-reviewed)abstract
- The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.
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| 3. |
- Dellve, Lotta, et al.
(author)
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Lean implementation approaches at different levels in Swedish hospitals : the impor¬tance for working conditions, worker engagement, health and performance.
- 2014
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Conference paper (peer-reviewed)abstract
- This paper reports result from one-year follow up in a research program with the overall aim to investigate how implementations of lean in health care affect working conditions, health, and performance of employees at five Swedish hospitals. This paper summarizes the implementation approaches, and their importance at short-term follow up for performance (with regard to active work with improvements), perceived working conditions and stress-related health among the healthcare workers. The implementation strategies and pace varied between the hospitals and between the strategic and operative levels. This short-term follow up showed that physical stress-related symptoms had increased overall but the cognitive stress had increased only in hospitals implementing lean. In hospitals with high implementation pace, there were more improvement work among the employees, but higher quantitative demands and lower job satisfaction.
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| 4. |
- Dellve, Lotta, 1965-, et al.
(author)
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Lean implementation approaches at different levels in Swedish hospitals : the importance for working conditions, worker engagement, health and performance
- 2014
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Conference paper (peer-reviewed)abstract
- BackgroundSwedish healthcare organizations are investing heavily in internal reforms. Lean has been frequently used as an overall concept to improve care processes and decrease costs. Some evidence shows positive results, especially if work environment issues are considered in parallel with other desired outcomes. However, there are considerable difficulties in evaluating lean as a concept since its application and interpretation seem to vary widely. Further, like for other management concepts, lean outcomes crucially depend on the implementation process.Aim This program investigates implementations of lean and lean-like developments of processes of care, and how these affect the working conditions, health, and performance of healthcare employees. We also investigated organizational factors and conditions that mediated specific outcomes.MethodMixed method design: questionnaire to employees (n=880) and managers (n=320), qualitative interviews (n=55) and observations with follow up during three years. Five hospitals were selected, and within them five units that were connected by their flow of acute care patients, i.e. the emergency unit, the medical and surgical emergency ward (or ICU at small hospital) as well as one medical and one surgical ward. Initially we used qualitative-driven analyses and thereafter quantitative-driven mixed method analysis.ResultsThe implementation strategies varied between the hospitals and between the strategic and operative levels. Strategic managers also used different approaches to overcome the gap between strategic and operative levels. Operative managers shared similarities in their stepwise and coaching approaches encouraging participation among employees, but differences regarding how assignments were delegated. Social capital and attitudes among health care profession were of importance for employees’ work engagement and active engagement in development work.
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| 5. |
- Dellve, Lotta, 1965-, et al.
(author)
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Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress
- 2015
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In: International Journal of Human Factors and Ergonomics. - : InderScience Publishers. - 2045-7804 .- 2045-7812. ; 3:3-4, s. 235-253
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Journal article (peer-reviewed)abstract
- Health care organizations in Sweden are recently reorienting toward horizontal organization around care processes. The aim was to investigate how implementation approaches for improvements of care processes in line with lean production (LP), at strategic and operative levels, in hospitals are associated with the consequences for working conditions and stress-related health among the employees. Five hospitals working with improvements to care processes were tracked: questionnaires to employees (n=1326) and interviews at strategic and operative levels at baseline and follow-up. The process redesign implementation strategies varied between the strategic and operative levels. There were associations between a higher degree of LP at operative level and increased work resources and decreased work demands. Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There was evidence of more beneficial or improved working conditions in relation to strategic or operative initiatives, approaches to degree of LP.
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| 6. |
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| 7. |
- Dellve, Lotta, 1965-, et al.
(author)
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The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up
- 2015
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Conference paper (peer-reviewed)abstract
- Introduction The public sector has during the last decades been struggling with the challenge of how to increase the efficiency, the quality of performance, as well as with problems related to work environment and recruitments. Hospitals have struggled with increased focuses on costumer orientation, rationalizations and care processes redesign, and have often used Lean production (LP) as management model.Aim to assess the long-term importance of implementing LP in hospitals for the psychosocial work conditions. Based on earlier research (e.g. Westgaard & Winkel, 2011), the following hypothesis were tested (1) Strategic large scale implementation of LP is associated with negative impact on mental health; (2) Implementation of LP is associated with weak negative impact on psychosocial work conditions; (3) The association between implementation of LP and psychosocial conditions is moderated by profession and participatory approaches.Method Five hospitals working with improvements of care processes were studied 2012-2014 using questionnaires to employees (T1 n=1303) and interviews at strategic and operative levels. Analyzes with mixed models repeated measurements were performed. The explaining variables for the models were implementation of lean at strategic resp operative level, and time (T1, T2, T3). The outcome variables were work-related health (SRH, work ability, stress-symptoms) and psychosocial work conditions.Results Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There were no overall differences in self rated health and work ability with regard to implementation of LP. A higher degree of LP at operative level was associated with decreased work demands. There was, especially initially, more beneficial or improved working conditions in relation to higher degree of LP at operative levels. The long-term follow-up showed that quantitative demands increased and predictability as well as leadership decreased in the non-lean hospitals. There were different patterns with regard to profession and participatory approaches that will be presented.
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| 8. |
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| 9. |
- Eriksson, Andrea, et al.
(author)
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Experiences of implementing OHS driven intervention methods for sustainable leadership in health care
- 2015
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Conference paper (peer-reviewed)abstract
- Introduction:Development processes in health care often narrowly focuses on more efficient work processes even though health care employees’ report an increased strained working environment. Furthermore, Occupational Health Services (OHS) in Sweden have been criticized for not contributing to improved organizational health and for not always having competence on leadership and health. In this context an ongoing research project has developed and implemented OHS-driven leadership interventions on sustainable leadership in health care. The interventions focused on supporting managers to integrate health promoting processes into ongoing quality developments at their workplaces.Aim: To explore experiences of the implementation of g different kind of OHS-driven methods for sustainable leadership within health care. The aim includes analyzing key actors’ and managers’ experiences of the content and different forms of intervention methods, as well conditions important for a successful implementation.Method:Researches developed in a first step a working material on sustainable leadership as well as five different intervention methods including web-based methods in collaboration with practitioners. Represents from OHS were given education on leading interventions based on the developed material. In a second step leadership interventions were implemented at 32 different workplaces within health and elderly care. Qualitative interviews with key actors and managers were performed for studying the implementation process. Latent and manifest content analysis was applied.Results and Conclusions:A dedicated and functional collaboration between OHS and Human Resources, as well as with the researchers, was one important success factor for the implementation of the interventions. Support from and collaboration between researchers and different strategic key actors within the participating health care organizations was further more critical for succeeding with the interventions. Web-based interventions required more engaged managers compared to interventions with physical meetings. In-depth results comparing the implementation of different interventions methods in the different organizational context will be presented at the conference.
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| 10. |
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| 11. |
- Eriksson, Andrea, 1977-, et al.
(author)
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Utveckling av hållbart och hälsofrämjande ledarskap – i vardag och förändring. Utvärdering av interaktiv metodik för företagshälsovårdsdrivna interventioner. TRITA-STH-PUB, 2016:03
- 2016
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Reports (other academic/artistic)abstract
- Syfte Det övergripande syftet med projektet var att vidareutveckla FHV-metodik (företagshälsvårdsmetodik) för hälsofrämjande processer på arbetsplatser inom vård och omsorg. Genomförande I steg 1 utvecklades arbetsmaterialet ”Hållbart och hälsofrämjande ledarskap i vardag och förändring” genom en interaktiv forskningsansats med deltagare från ett pilotprojet. I steg 2 genomfördes FHV-drivna interventioner där det utvecklade arbetsmaterialet gav struktur och innehåll för interventionerna. Olika metodiker för att arbeta med arbetsmaterialet testades inklusive dialogbaserad ledarskapsutbildning i grupp och webbaserad interaktiv ledarskapsutbildning. Personer anställda vid FHV och HR var i första hand processledare för interventionsgrupperna. Projektets specifika frågeställningar utvärderades genom kvalitativa intervjuer och enkäter till chefer och medarbetare. Resultat Projektet bidrog till utveckling av FHVs roll genom att de processledare från FHV som deltog fick en ökad kompetens i att driva processinriktat och arbetsplatsnära hälsoarbete. Enkätresultaten pekar vidare på förbättringar av ledarskap, arbetsmiljö- och verksamhetsutvecklingsarbete, arbetstillfredställese och arbetsengagemang vid de arbetsplatser med chefer som aktivt hade arbetat utifrån interventionerna. Resultaten pekar på värdet för chefer att delta i dialogbaserade chefsgrupper där de få stöd och inspiration att utveckla ett hälsofrämjande arbetsmiljöarbete. Spridning Det arbetsmaterial som projektet har utvecklat har spridits till en lång rad verksamheter. Arbetsmaterialet och resultaten från projektet har spridits genom bl a suntliv.nu samt genom deltagande ett stort antal nätverk, seminarier och konferenser med praktiker, forskare och studenter. En genomgång av den kunskap som arbetsmaterialet bygger på finns i rapportform och projektets metodik samt resultat kommer att spridas genom minst två internationella vetenskapliga artiklar.
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| 12. |
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| 13. |
- Strömgren, Marcus, et al.
(author)
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Hälsofrämjande arbetsmiljö–en framgångsfaktor för god vård
- 2017
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In: Socialmedicinsk Tidskrift. - 0037-833X. ; 94:2, s. 177-185
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Journal article (peer-reviewed)abstract
- Hälso- och sjukvårdens arbetsmiljö är viktig för både medarbetare och patienter. Syftet med denna artikel är att beskriva vad som karaktäriserar en hälsofrämjande arbetsmiljö, varför den är viktig inom hälso- och sjukvården och hur en hälsofrämjande arbetsmiljö kan utvecklas. Resultat från vår forskning och tidigare forskning, visar att medarbetares arbetsmiljö, hälsa och engagemang är viktigt för att ge bästa möjliga förutsättningar för att främja patienters hälsa. Viktiga arbetsmiljöfaktorer är i detta sammanhang ett starkt socialt kapital i form av erkännande, ömsesidighet och tillit mellan människor, ett verksamhetsnära ledarskap samt verksamhetsnära utveckling utifrån en systemteoretisk bas där man stödjer och förstår flera faktorer och förhållanden. Det sociala kapitalet kan liknas vid bränslet i ett kretslopp som skapar arbetstillfredsställelse, engagemang och nya arbetssätt. Det verksamhetsnära ledarskapet är viktigt för att skapa förutsättningar för hållbarhet i kretsloppet.
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| 14. |
- Strömgren, Marcus
(author)
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Intention to leave among health care professionals : The importance of working conditions and social capital
- 2017
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In: Journal of Hospital Administration. - : Sciedupress. - 1927-6990 .- 1927-7008. ; 6:3, s. 58-66
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Journal article (peer-reviewed)abstract
- Hospitals in Sweden are redesigning their care processes to increase efficiency. However, related to these changes, there is a risk of increased staff intention to leave and turnover due to increased workload and work pace. The literature on work engagement and job demands and resources suggests that specific job resources can buffer negative effects; i.e., intention to leave because of job demands. Social capital is suggested to have the potential to be a resource associated with staff intention to leave. The aim of this study was to investigate the associations between social capital and intention to leave and to test if social capital moderates the relationship between job demands and intention to leave. A sample of five hospitals working under conditions of improvements of care processes were studied using a questionnaire administered to the healthcare clinicians (n = 849). High levels of social capital were associated with low levels of intention to leave. However, the moderating effect of social capital was not confirmed. Intention to leave among occupational groups was influenced differently by social capital, other job resources, and job demands.
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| 15. |
- Strömgren, Marcus, et al.
(author)
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Leadership quality: a factor important for social capital in healthcare organizations
- 2017
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In: Journal of Health, Organisation and Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:2, s. 175-191
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Journal article (peer-reviewed)abstract
- © 2017, © Emerald Publishing Limited. Purpose: The purpose of this paper is to investigate the relation between leadership and social capital and what qualities of leadership are important for social capital among employees in hospital settings over time. Design/methodology/approach: A cohort of employees in hospitals answered a questionnaire at three occasions. Five small (approx. 100-bed) or mid-sized (approx. 500-bed) hospitals were included. The response rate was 54 percent at baseline (n=865), 59 percent at one-year follow-up (n=908) and 67 percent at two-year follow-up (n=632). Findings: Repeated measures over time showed differences between groups in levels of social capital with respect to levels of leadership quality. Relation-oriented leadership had the strongest association with social capital. There was evidence that leadership was associated with social capital over time and that different kinds of leadership qualities we re associated with social capital. Research limitations/implications: This study conducted and analyzed quantitative data, and therefore, there is no knowledge of managers’ or employees’ own perceptions in this study. However, it would be interesting to compare managers’ decreased and increased leadership quality and how such differences affect social capital over time. Practical implications: The findings feature the possibility for healthcare leaders to build high quality leadership as an important resource for social capital, by using different leadership orientations under different circumstances. Originality/value: The paper showed that leadership was an important factor for building social capital and that different leadership qualities have different importance with respect to certain circumstances.
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| 16. |
- Strömgren, Marcus, et al.
(author)
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Social capital among healthcare professionals : A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements
- 2016
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 53, s. 116-125
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Journal article (peer-reviewed)abstract
- Background: Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. Objectives: To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. Design: A prospective cohort design was used. Settings: Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Participants: Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. Methods: The participants answered a questionnaire at two occasions, NN = 1602 at baseline and NN = 1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Results: Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Conclusion: Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff.
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| 17. |
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| 18. |
- Strömgren, Marcus
(author)
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Social capital in healthcare : A resource for sustainable engagement in organizational improvement work
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Social capital, work engagement, working conditions, and leadership are concepts that have been studied previously, but there is lack of knowledge about what processes promote sustainable organizational improvement work in hospitals, and specifically, what leads healthcare professionals to engage in clinical developments.The overall aim of this thesis is to increase knowledge of how social capital and engagement contribute to sustainable organizational improvement work in hospitals and how social capital and engagement are created during organizational improvement work. Data were collected by a questionnaire at three times over a period of two years at five hospitals and all studies are quantitative.The results show that improved working conditions and employees’ attitudes to engagement in improvement work are associated with and have importance for healthcare professionals’ work engagement and clinical engagement in improving care processes (Study I). Job demands, social capital, and other job resources are associated with healthcare professionals’ intention to leave their jobs, whereas high levels of social capital are associated with low levels of intention to leave (Study II). Increased social capital predicted healthcare professionals’ job satisfaction, work engagement, and engagement in patient safety (Study III). Leadership is shown to be important for healthcare professionals’ social capital, and levels of leadership quality correlate with levels of social capital over time (Study IV).In conclusion, social capital, increased job resources, and decreased job demands are important conditions for healthcare professionals’ engagement in organizational improvement work. To develop social capital, leadership quality is an important precondition. Social capital can be regarded as a resource for sustainable organizational improvement work in healthcare, because of its importance for healthcare professionals’ engagement, job satisfaction, and intention to leave.
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| 19. |
- Strömgren, Marcus, et al.
(author)
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The importance of Leadership for social capital among healthcare professionals
- 2015
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Conference paper (peer-reviewed)abstract
- IntroductionSocial capital, operationalized as perceived trust, reciprocity and recognition has in earlier research shown to be important for employees´ job satisfaction and to health care staffs´ engagement in clinical improvements of patient safety and quality of care as well as job satisfaction, health and wellbeing. Since social capital has an impact, it is of interest to investigate which factors that influence workplace social capital. Research findings shows that leadership has great importance to staffs´ health and wellbeing, and affects a number of factors in the work environment factors as job satisfaction and work engagement. If and how leadership is associated with social capital is rarely described in previous research. However the few studies performed indicate that there are associated correlations between leadership and social capital, and leadership quality and social capital. Leadership within healthcare sector has been in focus when working with redesign of care processes and it would be of interest to investigate the role of leadership and the quality of leadership with respect to social capital. The aim was to assess the importance of leadership for workplace social capital in hospital settings. Materials and methodsThis study was a longitudinal cohort study. Questionnaires to physicians, nurses, assistant nurses at five Swedish midsize hospitals was used to collect data (T0, n=865, T1, n=908). Bivariate, multivariate analyses was used and a mixed model repeated measurement for the longitudinal analyses (n=477) were performed. ResultsRelationship between staffs perceived quality of leadership and staffs´ social capital was found (R = 0.58, p-value <0.0001). Results of the analysis showed significant differences in levels of social capital between the groups of low, medium and high levels in quality of leadership. The differences between the groups sustained over time where the group with high levels in quality of leadership remained higher in levels of social capital than the other groups. Same pattern were seen in the other groups. ConclusionLeadership quality were related to-, had importance for- and influenced workplace social capital among health care staff.
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| 20. |
- Strömgren, Marcus, et al.
(author)
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The importance of Leadership for workplace social capital among healthcare professionals
- 2015
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Conference paper (peer-reviewed)abstract
- IntroductionSocial capital, operationalized as perceived trust, reciprocity and recognition has in earlier research shown to be important for employees´ job satisfaction and to health care staffs´ engagement in clinical improvements of patient safety and quality of care as well as job satisfaction, health and wellbeing. Since social capital has an impact, it is of interest to investigate which factors that influence workplace social capital. Research findings shows that leadership has great importance to staffs´ health and wellbeing, and affects a number of factors in the work environment factors as job satisfaction and work engagement. If and how leadership is associated with social capital is rarely described in previous research. However the few studies performed indicate that there are associated correlations between leadership and social capital, and leadership quality and social capital. Leadership within healthcare sector has been in focus when working with redesign of care processes and it would be of interest to investigate the role of leadership and the quality of leadership with respect to social capital. The aim was to assess the importance of leadership for workplace social capital in hospital settings. Materials and methodsThis study was a longitudinal cohort study. Questionnaires to physicians, nurses, assistant nurses at five Swedish midsize hospitals was used to collect data (T0, n=865, T1, n=908). Bivariate, multivariate analyses was used and a mixed model repeated measurement for the longitudinal analyses (n=477) were performed. ResultsRelationship between staffs perceived quality of leadership and staffs´ social capital was found (R = 0.58, p-value <0.0001). Results of the analysis showed significant differences in levels of social capital between the groups of low, medium and high levels in quality of leadership. The differences between the groups sustained over time where the group with high levels in quality of leadership remained higher in levels of social capital than the other groups. Same pattern were seen in the other groups. ConclusionLeadership quality were related to-, had importance for- and influenced workplace social capital among health care staff.
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| 21. |
- Strömgren, Marcus, et al.
(author)
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The importance of leadership quality for social capital
- 2016
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In: Wellbeing at work. - Amsterdam : Wellbeing at work.
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Conference paper (other academic/artistic)abstract
- Objectives Social capital (trust, reciprocity and recognition) has in earlier research shown to be important for employees´ job satisfaction and to health care staffs´ engagement in clinical improvements of patient safety and quality of care. Since that it would be of interest to investigate which factors influences workplace social capital. Research findings shows that leadership has importance to staffs´ health and wellbeing and affects factors in the work environment factors as job satisfaction and work engagement. If and how leadership is associated with social capital is rarely described in previous research. However the few studies performed indicate that there are associated correlations between leadership and social capital, and leadership quality and social capital. The aim was to assess the importance of leadership quality for workplace social capital in hospital settings. Methods This study was a longitudinal cohort study. Questionnaires to physicians, nurses, assistant nurses at five Swedish hospitals was used to collect data (T0, n=865, T1, n=908, T2, n=602). Leadership quality was assessed from Copenhagen psychosocial questionnaire (COPSOQ) and social capital was assessed from both COPSOQ and modern work life questionnaire. Bivariate analyses was used and a mixed model repeated measurement for the longitudinal analyses were performed. Logistic regression were performed to investigate the impact of leadership quality on social capital. Results Relationship between quality of leadership and social capital was found (R = 0.58, p-value <0.0001). Differences in levels of social capital between the groups of low, medium and high levels in quality of leadership was found. Differences between the groups sustained over time. Results of the logistic regression showed that when leadership quality increased social capital increased by three times( 3.0 [1.9 - 4.6] ). Conclusion Leadership qualities were related to-, had importance for- and influenced workplace social capital among health care staff. Managers with high levels of leadership quality have greater possibilities to engage employees in organizational development than managers with medium or low levels of leadership quality. Accordingly it is relevant for managers to maintain or develop these skills with respect to leadership quality.
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