| 1. |
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| 2. |
- 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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| 3. |
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- 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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| 8. |
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| 9. |
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| 10. |
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| 11. |
- 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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| 12. |
- 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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| 13. |
- 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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| 14. |
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| 15. |
- 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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| 16. |
- 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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| 17. |
- 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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| 18. |
- Kadefors, Roland, 1939, et al.
(författare)
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Employers’ Attitudes Toward Older Workers and Obstacles and Opportunities for the Older Unemployed to Reenter Working Life
- 2012
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Ingår i: Nordic Journal of Working Life Studies. - 2245-0157. ; 2:3, s. 29-47
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Tidskriftsartikel (refereegranskat)abstract
- The present study aimed at identifying the attitude-related barriers that older unemployed, jobseeking workers (50+) face when they endeavor to reenter the labor market and to investigate employers’ attitudes and perceptions of older workers. Two studies were conducted. In study 1, interviews were undertaken with 26 unemployed persons and 24 representatives of other stakeholders, including social partners and officials representing the Social Insurance Agency (FK) and the Public Employment Service (AF). In study 2, the attitudes among private sector employers were studied by carrying out a questionnaire survey (N = 147). The interview results showed that many unemployed job seekers had experienced negative age-related attitudes among employers. This observation was supported by other stakeholders. Perceived attitudes to older workers and lack of updated competence were considered crucial. The questionnaire study showed a mixed picture concerning employer attitudes. There was a statistical difference between older (>50 years) and younger employers; older employers believed that older women wanted competence development to a greater extent. There was also a significant difference between female and male employers’ opinions; female employers, in particular the older ones, assessed that older women wished competence development to a greater extent. These differences were not found with respect to views on older men. About half (52%) of the employers had the opinion that there was no difference between older and younger employees with respect to the ability to cope with changes or learning new things. However, younger female employers (but not older female employers) considered that older employees had greater difficulties with changes or learning new things. It is concluded that negative attitudes to older workers with respect to competence development tend to be most common among younger employers.
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| 19. |
- Lilja, Josefine, et al.
(författare)
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Five Facets Mindfulness Questionnaire-Reliability and Factor Structure : A Swedish Version
- 2011
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Ingår i: Cognitive Behaviour Therapy. - Abingdon : Routledge. - 1650-6073 .- 1651-2316. ; 40:4, s. 291-303
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Tidskriftsartikel (refereegranskat)abstract
- Two studies were conducted to assess the Swedish version of the Five Facets Mindfulness Questionnaire (FFMQ), which was originally created by Baer et al. (2006). The aim of Study 1 was to examine the psychometric properties of the FFMQ using data from 495 individuals. Quantitative and qualitative analyses resulted in a reduction of the scale by 10 items. Psychometric properties, including internal consistency of the revised instrument, were examined. The Swedish FFMQ provides results comparable to those obtained by Baer. Cronbach’s alphas were high for all the facets. The Swedish FFMQ appears to be a potentially useful tool in measuring mindfulness among Swedish participants. The aim of Study 2 was to test the suggested hierarchical five-factor solution and construct validity, using a confirmatory factor analysis (CFA). Similar to findings for the English version of the FFMQ, the CFA showed that the Observing facet was not a significant part of an overall self-reported mindfulness structure in a Swedish population with little meditation experience. © 2011 Copyright Swedish Association for Behaviour Therapy.
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| 20. |
- Regber, Susann, 1956-
(författare)
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Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood : A Focus on Parents, Results from the IDEFICS Study
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Childhood obesity has increased dramatically during the past thirty years. Parents are key persons in their children’s lives and their efforts to create healthy lifestyles are very important. However, social and economic determinants of health also affect parents’ opportunities to promote a healthy lifestyle.Aims: To explore barriers and facilitators in promoting healthy lifestyles and preventing childhood obesity, focusing on parental roles.Methods and main findings: Three studies originated from the Identification and Prevention of Dietary- and Lifestyle-induced health Effects in Children and InfantS (IDEFICS) study of determinants for two to nine-year-old children’s health in eight European countries. The fourth study was a qualitative interview study conducted in southwest Sweden.Paper I: In focus group discussions (20 focus groups with children and 36 with parents), parents described lack of time, financial constraints, availability and food marketing techniques as barriers for promoting healthy eating. School policies about food varied; only Sweden and Estonia provided free school lunches. Children described great variation in the availability of unhealthy foods and beverages in their homes.Paper II: Objectively measured Body Mass Index (BMI) of children (n=16 220) were compared to parents’ perception of and concern for their children’s health and weight status. In all weight categories and all countries, a substantial proportion of parents failed to accurately judge their child’s weight status. In general, parents considered their children to be healthy, irrespective of their weight status. Parents of children with overweight or obesity systematically underestimated their children’s weight status across eight European countries. Accurate parental weight perception in Europe differed according to geographic region.Paper III: Swedish IDEFICS participants (n=1825) were compared with an age- and sex-matched referent population (n=1825), using registers from Statistics Sweden and the Swedish Medical Birth Register. Longitudinal child growth data (n=3650) were collected from child health centers and school health services. Families with low income, less education, foreign background or single parenthood were underrepresented in the IDEFICS study. BMI at inclusion had no selection effect but, at eight years of age, the obesity prevalence was significantly greater among referents.Paper IV: A qualitative content analysis was used to interpret the findings from interviews with nurses (n=15) working at child health centers in the southwest of Sweden. The BMI Chart to identify overweight and obesity in children facilitated greater recognition but nurses used it inconsistently, a barrier to prevention. Other barriers were obesity considered a sensitive issue and that some parents wanted overweight children.Conclusion: Parents may not perceive their child’s growth trajectory from overweight to obesity, and the preschool years may pass without effort to change lifestyle. Therefore, objective measurement and information of children’s BMI weight status by healthcare professionals is of great importance. To reach all parents and avoid selection bias, health surveys or health promoting activities must be tailored. Health promoting activities at the family level as well as the societal level should start early in children’s lives to prevent childhood obesity.
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| 21. |
- Regber, Susann, et al.
(författare)
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Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers
- 2013
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Ingår i: BMC Nursing. - London : BioMed Central. - 1472-6955. ; 12:27, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity. Methods: We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N’Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis. Results: Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child’s weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child’s deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child’s overweight or obesity. Conclusion: CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child’s weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.
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| 22. |
- Thorslund, Karin, et al.
(författare)
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Universal parental support-How to reach out: A cross-sectional random sample of Swedish parents
- 2014
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- © 2014 Thorslund et al.; licensee BioMed Central Ltd. Methods. The study was based on a random sample of parents in 15 municipalities in Sweden. Telephone interviews were conducted with 1744 parents. The information collected included the parent's gender, number of children, age of children, what municipality-based support parents would be interested in, and information about the use of the Internet as an information source in their parenting.Results: The results showed that there was a significant difference between mothers and fathers regarding interest in parental support, with mothers being more interested in all forms of parental support except a webpage for parents. Additionally, the results show that high frequent use of the Internet as an information source in their parenting was associated with high interest in municipality-based parental support.Background: Young children in Sweden have good general health in comparison to children in other European countries. In contrast, teenagers display poorer mental health. Parental support is now being made available on a universal level in Sweden in order to promote youngsters general psychological health. The aim of this study was to examine (1) to what extent the parents were interested in various forms of municipality-based parental support programs; (2) whether there were any differences between mothers and fathers as regards their interest in municipality-based parental support programs; and (3) if there were any differences between high to non-users of the Internet as an information source in their parenting, regarding their interest in municipality-based parental support programs.Conclusions: Parents who are active in seeking web-based information about their child and parenting are also parents interested in various kinds of parental support. The municipality is generally better at evoking the interest of mothers than fathers concerning all forms of support, except a webpage with information for parents. Municipalities should develop attractive and informative webpages for parents, with some information specifically addressing fathers.
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| 23. |
- Wallgren, Lars Göran, et al.
(författare)
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A Two-Wave Study of the Impact of Job Characteristics and Motivators on Perceived Stress among Information Technology (IT) Consultants
- 2012
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Ingår i: International Journal of Technology and Human Interaction (IJTHI). - : IGI Global. - 1548-3908 .- 1548-3916. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this two-wave study was to test whether job characteristics (job demand, job control), with ‘motivators’ (e.g., recognition, achievement, possibility for growth) as the mediating variable, can predict perceived stress (e.g., stressed, tense). These relationships were tested simultaneously using structural equation modeling analyses. A web-based questionnaire survey was conducted among 320 information technology (IT) consultants in Sweden. Data were collected at two time points, over a six-month follow-up period. Cross-sectional studies have been presented earlier but one of the contributions of this study is that it is a two-wave data set. The present two-wave study uses a model which covers more information than a cross-sectional design and the results add another aspect to existing work motivation and stress research, by using a longitudinal data set, and relating job characteristics to perceived stress directly and indirect. These findings emphasize the importance of job demand and illuminate the role of motivators in the experience of job stress among IT consultants. The presented model can be used to examine potential causes of job stress among IT consultants and may generate important lessons for managing the general workforce of tomorrow
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| 24. |
- Wallgren, Lars Göran, et al.
(författare)
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The Impact of Job Characteristics and Motivators on Perceived Stress Among Information Technology (IT) Consultants
- 2010
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Ingår i: The Ergonomics Open Journal. ; 3, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to test the relationship between job characteristics (job demands, job control) and perceived stress (e.g., stressed, pressured, tense) with motivators (e.g., recognition, achievement, the work itself, the possibility for growth and work significance) as the mediating variable. In this cross-sectional study a web-based questionnaire survey was conducted among 380 information technology (IT) consultants at ten IT consultancy companies in Sweden. The results showed that job demand was positively related to perceived stress and that motivators mediate the relationship between job control and perceived stress. The results point to the importance of motivators among IT consultants in the framework of job stress and performance. The managers’ impact on the work characteristics in the work environment is also discussed.
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| 25. |
- Wallgren, Lars Göran, et al.
(författare)
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The Motivation of Information Technology Consultants: The Struggle With Social Dimensions and Identity
- 2011
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Ingår i: Human Factors and Ergonomics in Manufacturing & Service Industries. ; 21:6, s. 555-570
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Tidskriftsartikel (refereegranskat)abstract
- Increasingly, customer companies hire external information technology (IT) consultants, often on a special project basis. These consultants are employees of professional service firms, although they receive their assignments fromthe hiring companies, report to them, and are supervised by them. Using semistructured interviewswith 12 IT consultants in Sweden,we examine the factors that influence their work motivation, including the effect of this dual allegiance—to the service firm and to the customer company. The data indicate that the primary motivators are the variety in tasks and the opportunity to influence and/or manage an entire project. Neither monetary incentives nor the consultancy firm norms are strong motivators. A factor that affects work behavior and motivation is the subordinate identity that IT consultants must assume with their powerful clients. The article concludes with practical suggestions for managers who seek to understand what motivates employees who work at a distance, under external control.
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| 26. |
- 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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| 27. |
- 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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| 29. |
- 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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| 30. |
- 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.
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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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| 32. |
- 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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