| 1. |
- Jarebrant, Caroline, et al.
(författare)
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Ergonomic Value Stream Mapping (ErgoVSM). Tool and User Guide.
- 2016
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Ingår i: Nordic Council of Ministers, ANP 2016:731. - : Nordic Council of Ministers. ; :APN 2016:731
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Recent years Lean Production (”Lean”) has become a prevalent rationalization strategy in healthcare to create more efficient value streams. Research shows that this often results in impaired Ergonomics, i.e. impaired work content and physical work load (“physical ergonomics”). A common Lean tool used to rationalize value streams in healthcare is Value Stream Mapping (VSM). An ergonomic “add-in module” Ergonomic Value Stream Mapping (ErgoVSM) – has therefore been developed to be used as an integrated part of VSM in the analysis of value streams in healthcare. ErgoVSM as well as VSM are participative tools. All occupational groups performing tasks directly related to the investigated value stream should be represented when using the tool. This Guide includes description of methods and assessment templates for physical ergonomics and work content. An initial version of ErgoVSM for manufacturing industry was developed in Sweden. Later, this was further developed for the health-care sector. This tool was then evaluated in a Nordic Multicenter Study by national projects in Sweden, Denmark and Iceland. The Nordic evaluation showed that using the ErgoVSM tool may result in more focus on ergonomics in the Action Plans compared to just using VSM. This is obtained without jeopardizing performance aspects. Based on the field experiences from the Nordic Multicentre Study I, the ErgoVSM tool was further developed, resulting in this present English version.
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| 2. |
- Jarebrant, Caroline, et al.
(författare)
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ErgoVSM: A Tool for Integrating Value Stream Mapping and Ergonomics in Manufacturing
- 2016
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Ingår i: Human Factors and Ergonomics in Manufacturing & Service Industries. - : Wiley. - 1090-8471 .- 1520-6564. ; 26:2, s. 191-204
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Tidskriftsartikel (refereegranskat)abstract
- Value stream mapping (VSM) is a Lean tool aiming at waste reduction. Previous research suggests that the use of VSM may result in work intensification and thus an increased risk for the workers of developing work-related musculoskeletal disorders (MSD). In the current study, VSM was developed to also consider physical exposure in the analyzed production system (ErgoVSM). As the VSM, ErgoVSM is based on a participatory approach. ErgoVSM was tested in a Swedish manufacturing company. The results suggest that ErgoVSM catalyzes change processes to include intervention proposals emphasizing ergonomics in addition to waste reduction. Thus, ErgoVSM appeared useful for the investigated target group of production engineers and experienced operators. The performance improvements suggested when using the ordinary VSM seemed not to be hampered by adding the ergonomics complement. However, the use of ErgoVSM was somewhat more time-consuming than the use of VSM. In conclusion, ErgoVSM is suggested as a feasible tool to be used by production engineers and experienced operators for including ergonomics considerations in the rationalization process.
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| 3. |
- Johansson Hanse, Jan, 1954, et al.
(författare)
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The impact of servant leadership dimensions on leader–member exchange among health care professionals
- 2016
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 24:2, s. 228-234
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the current study was to investigate the impact of servant leadership dimensions on leader–member exchange (LMX) among health-care professionals. Background: Leadership support and the quality of the dyadic relationship between the leader and the employee are essential regarding the work environment and turnover intentions in health care. Method: A questionnaire-based cross-sectional study was undertaken at four hospital units in Sweden. The study sample included 240 employees. Results: Significant bivariate correlations were found between all servant leadership dimensions and LMX. The strongest correlations were found between ‘humility’ and LMX (r = 0.69, P < 0.001), and ‘empowerment’ and LMX (r = 0.67, P < 0.001). The hierarchical regression analyses indicated that ‘empowerment’, ‘humility’ and ‘stewardship’ explained about 55% of the variance in LMX. Conclusion: In our study servant leadership dimensions were strongly related to LMX. Implications for nursing management: The results identify specific servant leadership dimensions that are likely to be useful for developing a stronger exchange relationship between the leader (e.g. nursing manager) and individual subordinates in health care.
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| 4. |
- Thorslund, Karin Wallgren, 1973, et al.
(författare)
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Do parents of adolescents request the same universal parental support as parents of younger children? A random sample of Swedish parents
- 2017
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Ingår i: Scand J Public Health. - : SAGE Publications. - 1403-4948. ; 45:5, s. 492-502
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Tidskriftsartikel (refereegranskat)abstract
- Universal parental support intended to enhance parents' capacity for parenting is an important aspect of public health strategies. However, support has mostly been aimed at parents, especially mothers, of younger children. There is a gap in the research concerning parents of adolescents and fathers' interest in parenting support. Aim: To investigate and compare the interest in parenting support of parents of adolescents and younger children, potential differences between mothers and fathers, and their knowledge of what is being offered to them already, and to explore their requirements for future universal parental support. Methods: Telephone interviews were conducted with a random sample of 1336 parents. Quantitative methods were used to analyze differences between groups and qualitative methods were used to analyze open-ended questions in regard to parents' requirements for future universal parental support. Results: About 82% of the parents of adolescents interviewed think that offering universal parental support is most important during child's adolescence. There is a substantial interest, particularly among mothers, in most forms of support. Despite their interest, parents have limited awareness of the support available. Only 7% knew about the local municipality website, although 70% reported a possible interest in such a website. Similarly, 3% knew that a parent phone line was available to them, while 59% reported a possible interest. Conclusions: It poses a challenge but is nevertheless important for municipalities to develop support targeted at parents of adolescents which is tailored to their needs, and to reach out with information.
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| 5. |
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| 6. |
- Winkel, Jörgen, 1946, et al.
(författare)
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A Nordic evaluation of a work environment complement to Value Stream Mapping for increased sustainability of patient flows at hospitals - The NOVO Multicentre Study I
- 2015
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Ingår i: Abstract book, The 9th Novo symposium: Sustainable Health Care Production Systems. ; , s. 34-36
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Konferensbidrag (refereegranskat)abstract
- Conclusions: •Both the ErgoVSM and VSM tools seem mostly to result in intervention proposals causing improved or no change in the work environment without impaired performance. •Based on Swedish data only the use of ErgoVSM may result in some improvement of the work environment compared with VSM. Such an effect is weakly supported by the Icelandic data and not by the Danish data. Thus, only under some conditions the ErgoVSM tool may be used in favour of the VSM tool. •Most proposals were assessed to cause ergonomic improvements at system level (‘job content’ and ‘work situation’). This is in contrast to intervention proposals investigated in the ergonomic intervention literature mainly focusing task level and the individual (cf. Westgaard and Winkel, 2011).
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| 7. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Effect modifiers in intervention research at hospitals in three Nordic countries
- 2016
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Ingår i: Abstract book of the 10th NOVO symposium, Reykjavík, 10 – 11 November, 2016. s. 33. - 9789935926555
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The impact of ergonomic interventions may be offset by other changes at the work place, primarily rationalizations. These have previously been shown to imply a dominant negative effect on health and risk factors, thus causing effect modification (Westgaard & Winkel 2011). The present paper aims to present assessment of potential effect modifiers in intervention studies at hospital wards in Denmark, Iceland and Sweden. Material and methods: The effect modifiers were assessed by a newly developed method (the EMA method; Edwards & Winkel 2016). It is a type of group interview including 3-6 participants representing all occupational groups in the investigated organization. The group is asked to write down significant changes at the workplace during the investigated period. The method also includes a semi-qualitative assessment of the potential Work Environment (WE) impact of each modifier. It aims to capture both the individual and collective account of all significant events that may have caused a significant impact in relation to the specific aim of the investigated intervention. Thirteen hospital wards went through interventions based on either the lean tool VSM (Value Stream Mapping) (6 wards) or the ErgoVSM method (Jarebrant et al, 2010) where additional focus is on ergonomic issues (7 wards). Results: In total 120 interventions were implemented. However, 322 significant modifiers were assessed to have occurred during the intervention period. Of these, 120 were assessed to imply impaired WE, 166 a positive impact, 33 no impact and 3 were not assessable. The number of significant modifier events varied between wards from 8-48, while the number of implemented interventions varied from 0-28. The semi-qualitative assessments suggested a major impact on WE due to modifiers. At seven wards the dominating impact of the modifiers was estimated to improve WE; at two wards the modifiers were estimated mainly to impair WE while four wards showed a mixture of modifiers, some estimated to improve and other to impair WE. Conclusion: Numerous effect modifiers occurred parallel to the investigated interventions. This jeopardizes any inference regarding impact of the investigated interventions on WE. The study thereby highlights the significance of considering effect modifiers in ergonomic intervention research.
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| 8. |
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| 9. |
- Winkel, Jörgen, 1946, et al.
(författare)
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Value Stream Mapping in healthcare: ergonomic implications and the significance of adding an ergonomic module - The NOVO Multicentre Study I
- 2018
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Ingår i: The 12th NOVO symposium : Care integration, systems reform and sustainability in health care, Helsinki, 15-16 November. - Helsinki, Finland : Juvenus Print - Finnish University Print Ltd. - 2323-363X. - 9789523431959
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Konferensbidrag (refereegranskat)abstract
- Background: During the recent decade “Lean production” has become a prevalent rationalization methodology in healthcare. A commonly applied Lean tool is Value Stream Mapping (VSM). It is a participatory tool, i.a. used to identify non-Value-Adding-Work (non-VAW) in patient flows. The process results in an Action Plan suggesting interventions aiming at minimizing non-VAW in order to increase the proportion of value creation. Scientific evidence indicates that non-VAW often represents periods of physical and mental recovery. Reduction of non-VAW may therefore cause ”Work intensification”. On this background the VSM tool has been complemented by an ergonomic module (ErgoVSM) to be used in the healthcare sector (Jarebrant et al., 2010). The aim of the present study was to investigate differences in Action Plans regarding expected impact on ergonomics and performance issues when using ErgoVSM rather than VSM. Material and Methods: Fourteen hospital wards were investigated, six in Denmark, two in Iceland and six in Sweden (one VSM ward refused to complete). In each country half the wards used VSM according to their ordinary Lean routines and the other half used ErgoVSM. All action plans were collected and each proposal was analysed based on triangulations between different stakeholder assessments. Data were analysed using Fisher's exact test of contingency tables of impact on four factors: Work Environment (WE, +/0/-), task/job content/system and efficiency according to VSM/ErgoVSM. Results: Of a total of 175 proposals from all the investigated wards 106 were assessed as causing WE+, 8 WE-, 20 WE0, and 41 Not Assessable. Of the 106 WE+ proposals 78% aimed at system level changes (job content and work situation), the remaining at task level changes or not assessable. This is in contrast to the intervention proposals generally investigated in the ergonomic intervention literature focusing almost exclusively interventions at task and individual level. Using ErgoVSM rather than VSM in Sweden and Iceland resulted in a higher proportion of proposals aiming at reduction of ergonomic risks compared to the Danish wards (p=0.02). Using ErgoVSM did not result in fewer proposals aiming at improving efficiency (p=0.5). Conclusions: Integration of ergonomic criteria into the rationalization tool VSM seems to imply a potential for more comprehensive ergonomic improvements without inhibiting the development of proposals improving efficiency. However, this impact of ErgoVSM seems to be modified by contextual factors.
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