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- Ulhassan, Waqar, et al.
(författare)
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Does lean implementation interact with group functioning?
- 2014
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Ltd.. - 1477-7266 .- 1758-7247. ; 28:2, s. 196-213
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time.DESIGN/METHODOLOGY/APPROACH: Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n = 133) and 2011 (n = 130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis.FINDINGS: At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p = 0.02) and the Ward-II (p = 0.04), but not at Ward-I (p = 0.11).RESEARCH LIMITATIONS/IMPLICATIONS: Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.PRACTICAL IMPLICATIONS: Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members' relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging.ORIGINALITY/VALUE: This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.
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| 2. |
- Ulhassan, Waqar, et al.
(författare)
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How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff : A Case Study
- 2015
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Ingår i: Quality Management in Health Care. - : Lippincott Williams and Wilkins. - 1063-8628 .- 1550-5154. ; 24:4, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.
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| 3. |
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| 4. |
- Ulhassan, Waqar, et al.
(författare)
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Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study
- 2014
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 14, s. 480-
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Tidskriftsartikel (refereegranskat)abstract
- Background: As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. Methods: The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Results: Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. Conclusions: The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention's harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.
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| 5. |
- Ulhassan, Waqar
(författare)
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Lean, team and psychosocial factors : a longitudinal investigation at a Swedish hospital
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: As health care struggles to meet increasing demands with limited resources, Lean Management is becoming a popular management approach. More is known about operational aspects of Lean application than about the socio-technical aspects such as how Lean interacts with teamwork and the psychosocial work environment. It is also unclear why and how organizations adopt Lean. Aim: This project, including four sub-studies, aimed to identify the antecedents and characteristics of Lean implementation at a Swedish Hospital. The research for this thesis also examined longitudinal changes in certain socio-technical aspects of Lean (i.e., teamwork and the psychosocial work environment). Methods: The thesis used a case study design (with data from interviews, observations and documents) to examine information about the Lean implementation at two cardiac inpatient wards and at an emergency care department at a Swedish hospital (Studies I & IV). Using employee questionnaires during the Lean implementation, teamwork and the psychosocial work environment were measured in two time periods (T1 & T2), a year and a half apart. To avoid post-hoc explanations, qualitative data about the intervention and the context was used to predict expected change patterns in teamwork and the psychosocial work environment from T1 to T2. These predictions were compared with the questionnaire data using linear regression analysis (Studies II & III). Findings: A previous history of quality improvement was an antecedent for the hospital’s adoption of Lean. Contextual factors seemed to influence both Lean implementation and its sustainability. For example, adoption of Lean varied with the degree to which staff saw a need for change. Continuous improvement, supported by visual management, when adopted successfully, kept the staff engaged and committed. Employee involvement in the Lean implementation may minimize the intervention’s harmful effects on psychosocial work factors. Lean may influence teamwork, particularly in relation to structural and productivity issues. Conclusions: The success of Lean implementation depends on its adaptation to contextual factors. In addition to the traditional focus of Lean on operational performance, the employee perspective is also important in designing, implementing and sustaining Lean. Engaging the employees in the Lean change process not only helps to sustain initial Lean success but also helps avoid harmful effects of Lean on the work environment. An initial Lean success may be sustained by engaging the staff in the change process using continuous improvement supported by visual management. Practitioners should note that, with groups struggling at initial stages of group functioning, the introduction of Lean may pose a significant challenge.
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