| 1. |
- Dellve, Lotta, 1965, et al.
(författare)
-
Development Work in Swedish Eldercare: Resources for Trustworthy, Integrated Managerial Work During the COVID-19 Pandemic
- 2022
-
Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- The extensive needs for developments of eldercare addressing working conditions, care quality, influence, and safety was highlighted during the pandemic. This mixed-method study contribute with knowledge about capability-strengthening development work and its importance for trustworthy managerial work, before and during the COVID-19 pandemic. Questionnaire data and narratives from first-line managers immediately before (n = 284) and 16 months into the pandemic (n = 189), structured interviews with development leaders (n = 25), and documents were analyzed. The results identify different focuses of development work. Strategic-level development leaders focused the strengthening of old adults' capabilities. While operational-level leaders approached strengthening employees' capability. First-line managers' rating of their trustworthy managerial work decreased during the pandemic and was associated with their workload, development support and capability-strengthening projects focusing employees' resources. The study demonstrates the gap between strategic and the operational levels regarding understanding of capability set and needed resources for strengthening capabilities and trustworthy, integrated managerial work regarding safety, influence, and quality conditions for old adults and employees.
|
|
| 2. |
- Dellve, Lotta, et al.
(författare)
-
Health care clinicians' engagement in organizational redesign of care processes : Health care clinicians' engagement in organizational redesign of care processes
- 2018
-
Ingår i: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 68, s. 249-257
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 3. |
- Dellve, Lotta, et al.
(författare)
-
Health care clinicians’ engagement in organizational redesign of care processes : Health care clinicians’ engagement in organizational redesign of care processes
- 2018
-
Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870. ; 68, s. 249-257
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 4. |
|
|
| 5. |
- Dellve, Lotta, et al.
(författare)
-
Lean implementation approaches at different levels in Swedish hospitals : the impor¬tance for working conditions, worker engagement, health and performance.
- 2014
-
Konferensbidrag (refereegranskat)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.
|
|
| 6. |
- Dellve, Lotta, 1965-, et al.
(författare)
-
Lean implementation approaches at different levels in Swedish hospitals : the importance for working conditions, worker engagement, health and performance
- 2014
-
Konferensbidrag (refereegranskat)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.
|
|
| 7. |
- Dellve, Lotta, 1965-, et al.
(författare)
-
Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress
- 2015
-
Ingår i: International Journal of Human Factors and Ergonomics. - : InderScience Publishers. - 2045-7804 .- 2045-7812. ; 3:3-4, s. 235-253
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 8. |
|
|
| 9. |
- Dellve, Lotta, 1965-, et al.
(författare)
-
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
-
Konferensbidrag (refereegranskat)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.
|
|
| 10. |
|
|
