| 1. |
- Marcusson, Jan, et al.
(author)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Journal article (peer-reviewed)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 2. |
- Cronemyr, Peter, et al.
(author)
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Assessing the Quality of Elderly Care – Can Survey Incomparability be Solved by Vignettes?
- 2014
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In: Proceedings of the 21st EurOMA conference, Palermo, Italy. - Palermo, Italy..
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Conference paper (peer-reviewed)abstract
- User and customer surveys are the most commonly used instruments to evaluate the efficiency and quality of public services, but an important question is whether the data collected by the surveys are of sufficient quality to support decision making and improvements of public services. One of the mentioned problems is the interpersonal incomparability of survey responses, which may be biased if individuals interpret the questions in different ways and use response scales in systematically different ways. The purpose of the present study is therefore to investigate how the use of anchoring vignettes could improve the quality of survey results. Our results show that anchoring vignettes remove some noise from survey results and allow the correction of otherwise interpersonally incomparable survey responses. The suggested methodology has the potential to contribute to better evaluations of the quality of elderly care and, thereby, to better decisions on how to improve elderly care services.
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| 3. |
- Dannapfel, Petra, et al.
(author)
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Dissemination strategy for Lean thinking in health care
- 2014
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In: International Journal of Health Care Quality Assurance. - 0952-6862 .- 1758-6542. ; 27:5, s. 391-404
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.Design/methodology/approach – The Östergötland county council, Sweden (CCÖ ) was chosenas a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark.Findings – The Lean improvement programme was introduced to tackle challenges such as anageing society, rising care expectations and budgetary and economic constraints. It was designedas a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHS attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable.Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
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| 4. |
- Drotz, Erik, et al.
(author)
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Lean in healthcare from employees' perspectives
- 2014
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In: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 28:2, s. 177-95
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.DESIGN/METHODOLOGY/APPROACH: The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.FINDINGS: The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.PRACTICAL IMPLICATIONS: Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance.ORIGINALITY/VALUE: In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.
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| 5. |
- Drotz, Erik, 1985-, et al.
(author)
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Lean in healthcare from the employee perspective
- 2012
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Conference paper (other academic/artistic)abstract
- PurposeSeveral studies may be found on how Lean production is implemented in healthcare. Most articles include single case studies and are often published in medical journals. There is however a different tradition on how research is performed in medical and management sciences. The medical studies describe the state before and after an intervention or improvement program, but rarely pay attention to the implementation process and consider such important issues such as leadership, management processes and employee's role. There is a need for more management studies on Lean healthcare that focus not only on outcomes, but also on the context and factors that influence outcomes.The purpose of the article is to contribute to the knowledge on how Lean production influences the daily work and routines of healthcare staff.What does it mean to employees to work in a Lean healthcare unit?How does a Lean implementation affect the role and responsibilities of the employees?Methodology/Approach:The data described in this paper comes from three case studies performed in healthcare organizations: two district care centres and one hospital unit. The data was collected through interviews, both with managers and employees, observations and document studies. The case organizations were described as successful Lean organizations and had worked with Lean for at least three years.FindingsThe implementation of Lean production often implies increased responsibility of employees for management of daily activities and increased participation in the improvement work. The influence of Lean on the daily work is however to great extent a matter of how the implementation is managed. In one case, Lean had been implemented by discrete projects, mainly conducted by the manager group with little effort on empowering the employees, increasing two-way communication and involvement in improvement work. Therefore, the role of the employees did not change much in conjunction with the Lean implementation. On the contrary, at another case the managers put a lot effort on coaching, developing and empowering the employees, and the improvement work had become an important working task for all employees. This led to a substantial improvement in the social climate, since the former barriers between different professions were weakened and the teamwork had increased.The conclusion is that there are great potential benefits with a Lean implementation for the employees, but this can only be realized if the implementation is managed with a focus on the development of employees and a more open social structure. An important method to facilitate this is improvement groups with employees from different professions and functions within the organization that has an explicit ownership of the improvements, from idea to realization. Originality/Value of paper:Lean Healthcare is relatively a new phenomenon and more research work is needed to determine the full range of implications of the concept. The paper increases the understanding of what Lean production actually means to the healthcare staff. This knowledge is vital for the success and sustainability of Lean improvement programs in healthcare. The paper is also an inspiring source for both researchers and healthcare professional who are interested in the application of lean production in healthcare.
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| 6. |
- Drotz, Erik, et al.
(author)
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Lean in social services : possibilities and limitations
- 2014
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Other publication (other academic/artistic)abstract
- Purpose – With this paper we aim to explore the opportunities and limitations of implementing Lean production in the social service context.Methodology/approach – This paper is based on an ongoing longitudinal case study performed in the municipal social services. Several data collection methods have been used. First, we performed interviews with employees and managers in January-June 2012. Second, a questionnaire was sent out to all employees (n=303, response rate = 56%) in June - August 2013. Third, we have participated in numerous education events, improvement meetings, feedback seminars and strategic meetings. Fourth, we have studied protocols from project group meetings and other meetings that were relevant for the Lean work, as well as internal and external information about the Lean work.Findings – This paper shows that there are big differences on how Lean can be applied in front-office and back-offices processes. The application of Lean production have a limited value for the improvement of front-office processes that imply a high degree of service characteristics. The limitation of Lean is the absence of principles that can be used to enhance the value creation in the meeting and interaction with users. In back-office processes where service characteristics are less evident, the Lean principles are more suitable and easy to apply. By engaging employees in improvement work Lean helped the social service organization to achieve more coordinated and consistent workflows and thereby shorten handling times and reduce costs.Practical implications – Since Lean production was not intended to assure the functional quality of services it needs to be complemented by other improvement activities to enhance the value co-creation with the user. In respect to the current trend of greater involvement of users, citizens and the wider community in public services an important question for the social service providers is not just how to improve the organization, but how to better work with users and other involved persons.Originality/value – The current research on Lean in public services is limited to a number of case studies describing success stories from implementing some Lean methods and tools. In our study we take different approach and analyze Lean production from the distinctive context and purpose of the social service. We discuss how the service characteristics and the technical and functional dimensions of service quality influenced the choice of Lean principles, methods and tools, and what implications it has for improving municipal social services.
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| 7. |
- Drotz, Erik, 1985-
(author)
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Lean in the Public Sector : Possibilities and Limitations
- 2014
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Licentiate thesis (other academic/artistic)abstract
- The demands on efficiency and quality in the public sector have increased over the past few years, which have raised the need for strategies on how the public sector can be improved (Denhardt and Denhardt, 2000). Consequently, the concept of Lean production, or just Lean, have become increasingly spread, especially in health care, but also in government agencies, police, military and social services. Lean production is an integrated operational and socio-technical system with the aim of creating value and reducing waste in operations. Some research has been conducted on Lean in the public sector, but it has been too focused on the a few operational tools and results of these, and there is lack of a comprehensive critical review of Lean from a holistic perspective.The aim of this thesis is to increase understanding of how Lean production is used in different contexts. The thesis particularly focuses on the public sector, and investigates the possibilities and limitations of Lean production in this context. A total of seven organizations have been studied, including two manufacturing companies, three care units and two local businesses. In particular, qualitative methods have been used, along with some quantitative.The thesis shows several possibilities and limitations of Lean in public sector. One possibility is the improved flow orientation that reduces the lead time and efficiency in back office processes. Moreover, the new roles and responsibilities can lead to improved job characteristics for public sector employees. One limitation is that Lean is more commonly used to improve the technical quality than the functional, which means that the focus has been placed on improving the instrumental performance of the service, rather than how the service is provided. There is also often a focus on efficiency in the back office rather than the front office processes. This means that Lean initiatives may become too focused on internal efficiency and thereby miss important aspects of user perceived quality.
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| 8. |
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| 9. |
- Elg, Mattias, et al.
(author)
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Co-creation and learning in health-care service development
- 2012
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In: Journal of Service Management. - : Emerald Group Publishing Limited. - 1757-5818 .- 1757-5826. ; 23:3, s. 328-343
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Journal article (peer-reviewed)abstract
- Purpose - The purpose of this study is to develop and evaluate a model for patient co-creation and learning based on diaries for use in health-care service development. In particular, the study aims to investigate the process of patient co-creation and different mechanisms through which health-care service providers can learn from the patient. Design/methodology/approach - The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care. Findings - The study suggests a model for co-creation and learning in health-care service development through three learning methods. First, the model may be used as a means for generating and collecting patient ideas; second, a single patient's story can be illustrated and can serve as incentive for health-care service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services. Originality/value - This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. First, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Second, the study suggests a co-creation approach of involving patients in health-care service development through patient diaries.
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| 10. |
- Elg, Mattias, 1968-, et al.
(author)
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Solicited Diaries as a Means of Involving Patients in Development of Healthcare Services
- 2011
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In: International Journal of Quality and Service Sciences. - : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 3:2, s. 128-145
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to develop an understanding of how patients experience their health problems and how they can generate innovative ideas about health care services. The research questions that guide the present study are: how can solicited diaries be used for capturing patient ideas? What type of data is generated from solicited diaries used for generating patient ideas? And what are the potential benefits and shortcomings of using patient diaries in generating ideas for improvement of health care services? Design/methodology/approach – The paper is based on an exploratory case study using patient diaries to solicit ideas about how health care services in Sweden can be improved. From the methodological viewpoint, the diaries are used as a tool for patient co-creation of health care services. Findings – When analyzing dairies written by patients four different types of diaries emerged from the study: brief, reporting, descriptive and reflective diaries. Furthermore, 102 ideas for improvements within nine areas were identified from the contents of dairies. Research limitations/implications – Adopting patients' diaries as a way to activate and promote co-creation of values is at an embryo stage, and hence more research is needed. Originality/value – One of the strengths of the paper includes its potential for practical implications, either clinical or methodological, by using patients' dairies. It focuses both on the content generated from the diaries for improving health services, as well as the use of the diaries for practicing the idea of patients as co-creators in health care service.
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| 11. |
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| 12. |
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| 13. |
- Fialkowska, Malgorzata, et al.
(author)
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Lean in primary care - a critical appraisal from the service perspective
- 2014
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In: Proceedings of the 17th QMOD conference on Quality and Service Sciences ICQSS. - Prague, Czech Republic.
-
Conference paper (peer-reviewed)abstract
- Purpose –The paper aims to investigate how Lean is applied in the primary care settings and to discuss what implications can be drawn for improving quality of primary care.Methodology/approach – The paper presents results from a survey on the Lean application in primary care units from the perspective of managers. Data for this study was collected using a web based questionnaire, which measures the application of Lean in five aspects: improvement work, daily control, process orientation, patient focus and Lean tools. Additional part of the survey covers information about outcomes of Lean. The data has been analysed by applying a service perspective, with focus on technical and functional determinants of service quality.Findings –The study shows that the application of Lean in the primary care focuses on employee involvement in improvement work, increased responsibility for the coordination of daily work, teamwork, process orientation, patient focus and problem solving activities. Hard practices of Lean (e.g. Just-in-time) are not practiced and have a limited relevance for the primary care organizations. The study shows also that Lean has the highest impact on accessibility and time dimension of quality of care but marginal impact on the patient involvement in decisions about care and treatment. Thus Lean, which was originally designed to ensure the technical quality of manufacturing, has a limited influence on the functional quality of primary care.Practical implications – Practitioners who consider to implement Lean into primary care organizations should consider how important for them is to apply an improvement concept called ‘Lean’, when the actual application of Lean in primary care context is limited to basic Quality Management principles and tools. When Lean is already applied, it should be remembered that manufacturing significantly differs from services and some aspects important in the health care service context such as for example patient experience need to be enhanced by additional improvement activities.Originality/value – There are many case studies presenting the Lean application in hospital units, but there are few studies from primary care organizations. More than that, there is a lack of quantitative studies on Lean in primary care, which this paper provides. This paper makes also contribution by discussing the relevance and consequences of applying Lean to improve services in primary care settings.
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| 14. |
- Kurilova, Jelena, et al.
(author)
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Remanufacturing challenges and possible lean improvements
- 2018
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In: Journal of Cleaner Production. - : ELSEVIER SCI LTD. - 0959-6526 .- 1879-1786. ; 172, s. 3225-3236
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Journal article (peer-reviewed)abstract
- Remanufacturing is a viable way to prolong the useful life of an end-of-use product or its parts. Despite its economic, environmental, and social benefits, remanufacturing is associated with many challenges related to core (used product or its part) availability, timing and quality. The aim of this paper is to study how lean production could be used to tackle remanufacturing process challenges and contribute to shorter lead times. To meet this aim, we conducted a literature review and case studies of four remanufacturing companies. The case companies remanufacturing challenges were: (1) a lack of material requirements planning system, (2) poor core information, (3) a lack of core material, (4) poor spare parts information, (5) a lack of spare parts material, (6) insufficient quality management practices, (7) large inventories, (8) stochastic remanufacturing processes, (9) a lack of supply-demand balance, and (10) insufficient automation. These challenges contribute to long and variable remanufacturing process lead times. To tackle remanufacturing challenges, seven lean-based improvements with a major effect on improvements in lead time were suggested: standard operations, continuous flow, Kanban, teamwork, employee cross-training, layout for continuous flow, and supplier partnership. Providing that the suggested improvements are implemented, a possible lead time reduction of 83-99 per cent was projected.
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| 15. |
- Kurilova-Palisaitiene, Jelena, 1985-
(author)
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Lean Remanufacturing : Reducing Process Lead Time
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Remanufacturing is a product recovery option in which used products are brought back into useful life. While the remanufacturing industry stretches from heavy machinery to automotive parts, furniture, and IT sectors, it faces challenges. A majority of these challenges originate from the remanufacturing characteristics of having little control over the core (the used product or its part), high product variation, low product volumes, and a high proportion of manual work, when compared to manufacturing. Some remanufacturing challenges appear to be process challenges that prolong process lead time, making remanufacturing process inefficient.Lean is an improvement strategy with roots in the manufacturing industry. Lean helps to increase customer satisfaction, reduce costs, and improve company’s performance in delivery, quality, inventory, morale, safety, and other areas. Lean encompasses principles, tools and practices to deal with e.g. inefficient processes and long process lead times. Therefore, in this thesis lean has been selected as an improvement strategy to deal with long remanufacturing process lead times.The objective of this thesis is to expand knowledge on how lean can reduce remanufacturing process lead time. This objective is approached through literature studies and a case study conducted at four remanufacturing companies. There are five challenges that contribute to long process lead time: unpredictable core quality, quantity, and timing; weak collaboration, information exchange, and miscommunication; high inventory levels; unknown number of required operations in process and process sequence; and insufficient employee skills for process and product upgrade. When analysing the case companies’ process lead times it was found that there is a need to reduce waiting times, which account for 95 to 99 per cent of process lead times at three of the four companies.To improve remanufacturing process efficiency and reduce remanufacturing process lead time six lean practices are suggested: product families; kanban; layout for continuous flow; cross functional teams; standard operating procedures; and supplier partnerships. The suggested lean practices have a key focus on reducing waiting time since it prolongs the process lead time. This thesis contributes to lean remanufacturing research with the case study findings on lean practices to reduce remanufacturing process lead time and increase process efficiency.
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| 16. |
- Kurilova-Pališaitienė, Jelena, 1985-
(author)
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Toward Lean Remanufacturing : Challenges and Improvements in Material and Information Flows
- 2015
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Licentiate thesis (other academic/artistic)abstract
- Remanufacturing is an environmentally sound material recovery option which is essential to compete for sustainable manufacturing. The aim with remanufacturing at a majority of companies is to prolong physical product performance by delivering the same or betterthan-original product quality. In general, remanufacturing is an industrial process that brings used products back to useful life by requiring less effort than is demanded by the initial production process. Consequently, from a product life-cycle perspective, remanufacturing generates great product value.Remanufacturers lag behind manufacturers since they often face complex and unpredictable material and information flows. Based on a review of remanufacturing research, remanufacturing challenges in material and information flows can be classified into three groups: insufficient product quality, long and unstable process lead times, and an unpredictable level of inventory. While some remanufacturing researchers state that manufacturing and remanufacturing are significantly different, they have more in common than many other processes operations. Therefore, to sustain competitive remanufacturing, companies investigate an opportunity for improvement through the employment of lean production that generates significant benefits for manufacturers.In order to investigate the potential to address remanufacturing challenges by lean production, a Minimum time for material and information flow analysis (MiniMifa) method was developed. This method originates from the value stream mapping (VSM) method, broadly practiced to bring lean to manufacturing companies. The focus of MiniMifa was to collect empirical data on the identified groups of remanufacturing challenges from the remanufacturing perspective, and to provide a basis for the development of improvements originating from lean principles.Lean production was selected for this research due to its system perspective on material and information flows. Among the defined lean principles in remanufacturing, a pull principle was investigated at the case companies. The suggested principle demonstrated a reduction in lead time, followed by improvements in inventory level and product quality. However, in order to become lean, remanufacturers have to overcome three levels of lean remanufacturing challenges: external and internal challenges as well as lean wastes.Finally, this research reduces the gap between academia and industry by contributing with a possible solution to the identified remanufacturing challenges in material and information flows.
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| 17. |
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| 18. |
- Langstrand, Jostein, 1977-, et al.
(author)
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Practise what you preach : quality of education in education on quality
- 2015
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In: Total Quality Management and Business Excellence. - : Routledge. - 1478-3363 .- 1478-3371. ; 26:11-12, s. 1202-1212
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Journal article (peer-reviewed)abstract
- The quality of teaching should be the central theme in the education on quality management (QM). Delivering bad courses about QM would reduce the legitimacy of the subject, since we do not practise what we preach. The purpose of this paper is to discuss how the quality of education can be enhanced through effective course design based on quality thinking and higher education theory. The study covers three university courses in the field of QM; an introductory course in QM, and courses in Six Sigma and Lean Production, respectively. Each course has been analysed and described in terms of factors affecting student learning and the perceived quality of the courses. The impact of course design on examination results and student evaluation has been studied and compared to historical data. The study demonstrates that course design can have a profound impact on student learning as well as course evaluation. Analysis of the three examples provided in this paper indicates that the QM principles can effectively be used in course design processes. Attention to the principles presented in this paper facilitates the design of courses that enhance learning and ensure higher student satisfaction. The application of QM principles in higher education has a long theoretical tradition. This paper provides three strong examples of how this can be done in practise.
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| 19. |
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| 20. |
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| 21. |
- Poksinska, Bozena Bonnie, et al.
(author)
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Does Lean healthcare improve patient satisfaction? : A mixed-method investigation into primary care
- 2017
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In: BMJ Quality and Safety. - : BMJ Publishing Group Ltd. - 2044-5415 .- 2044-5423. ; 26:2, s. 95-103
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Journal article (peer-reviewed)abstract
- Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.
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| 22. |
- Poksinska, Bozena Bonnie
(author)
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Lean healthcare : what is the contribution to quality of care?
- 2015
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In: Management innovations for health care organizations. - New York : Routledge. - 9781138825697 ; , s. 209-226
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Book chapter (peer-reviewed)abstract
- This chapter aims to present how Lean has been adopted by healthcare provider organizations in hospital and primary care settings, and to discuss the implications for quality of care. Could Lean be the management innovation that helps healthcare organizations tackle their current challenges? How is Lean adopted in healthcare? What are the opportunities and limitations of adopting a production-based system to an advanced service system such as healthcare? The findings and conclusions presented in this chapter are based on six years of research on the practices and outcomes of adopting Lean in hospital units and primary care centers in Sweden.
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| 23. |
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| 24. |
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| 25. |
- Poksiʹnska, Bożena
(author)
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Behind the ISO 9000 and ISO 14000 certificates : an investigation of quality and environmental management practices in Swedish organisations
- 2003
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Licentiate thesis (other academic/artistic)abstract
- The past decade witnessed a remarkable growth in the number of organisations worldwide seeking to implement the ISO 9000 and ISO 14000 series. More than 160 countries have adopted ISO 9000 and the number of certificates grew by around 70,000 per annum in the last five years. Also ISO 14001 is one of the most accepted environmental management systems worldwide. The growth is even more remarkable, because research hasn't provided any consistent evidence of the benefits achieved from the standards. There is a general confusion and uncertainty regarding the effectiveness of the standards and their long-term contribution to the organisations.This research project is an attempt to look behind the certificates and explore the practice of implementing and operating the quality- and environmental management systems (QMS and EMS) in Swedish organisations. The thesis aims to contribute to the improvement of the practices of operating QMS and EMS. From the scientific point of view, this research should help to explain the partially contradictory results on the systems' effects found in literature.The study consists of three stages. First, a questionnaire survey was aimed at exploring the motivation, implementation factors and benefits of ISO 9000 and ISO 14000 in Swedish organisations. Second, an analysis of the requirements aimed to build an understanding of the management practices implied in the standard Third, the aim of the case studies was to investigate the practice of operating a QMS/EMS within an organisational context.The study showed that the standards are very often viewed as a tool for improving company image, and not as a means of adding value to the organisational processes. The requirements are very general and organisations decide themselves what kind of practice complies with them Organisations do not need to change their practice, but they can claim that their processes already comply with the standards. Furthermore, auditors, which are only focused on finding nonconformities in the documented system, may become an obstacle to the improvement work Finally, an important conclusion drawn from this study is that questionnaire surveys might not be an appropriate method to study the effects of ISO 9001 or ISO 14001 systems.This project is financially supported by the Centre for Studies of Humans, Technology and Organization (CMTO) and International Graduate School of Management and Industrial Engineering (IMIE).
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| 26. |
- Poksinska, Bozena, 1973-, et al.
(author)
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Building capability for Employee-Driven Innovation
- 2011
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Conference paper (other academic/artistic)abstract
- Employee-Driven Innovation (EDI) is a companywide approach where ideas are generated and implemented by a single employee or by the joint efforts of two or more employees who have not been deliberately assigned to carry out innovative work. This paper aims to contribute to knowledge about the underlying mechanisms necessary for building EDI capability in an organisation. Two types of organisational structures supporting EDI were identified: participation through suggesting improvements, and participation through teams. The key managerial approaches for enabling EDI are: creating motivation, empowerment and autonomy; collaboration and teamwork; open climate and communication; management support; and organisational learning.
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| 27. |
- Poksinska, Bozena, et al.
(author)
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Does Lean healthcare lead to improvement of patient-perceived quality of care?
- 2014
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In: Proceedings of the 17th QMOD conference on Quality and Service Sciences ICQSS. - Prague, Czech Republic.
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Conference paper (peer-reviewed)abstract
- Background – Lean healthcare is claimed to contribute to improved patient value, but there is a limited research whether the application of Lean practices leads to improvement of patient perceived quality of care.Methods –We used the data from the Swedish National Patient Survey to investigate if there are significant differences in patient-perceived quality of care between primary care units working with Lean and the control group, and if the patient-perceived quality improved over time. Moreover, to gain more in-depth understanding, we have performed two case studies in primary care units and investigate how the case organisations operationalized Lean principles with regards to definition and creation of value.Results – The application of Lean healthcare practices doesn’t lead to improvement of patient perceived quality of care. In fact, the patients perceived a deterioration of quality of care in respect to informing them and meeting their needs. Providing timely and efficient care, which means reducing disturbances, waits and delays both for those who receive and those who give care, was an important principle characterizing Lean improvement work at case organisations. Little attention is paid to patient value and involving patients in improvement activities.Conclusions –The implementation of Lean production in the guiding principles of service: customer value and value co-creation. Consequently, improvements tend to focus on internal efficiency and have a limited impact on patient experience. An important strategy is therefore to develop systematic approaches to specify patient value that integrate both the knowledge and clinical expertise of caregivers and the patients’ preferences and experiences in the application of Lean in healthcare.
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| 28. |
- Poksinska, Bozena, 1973-
(author)
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Does standardization have a negative impact on working conditions?
- 2007
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In: Human Factors and Ergonomics in Manufacturing. - : Wiley. - 1090-8471 .- 1520-6564. ; 17:4, s. 383-394
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Journal article (peer-reviewed)abstract
- The aim of this article was to contribute to the discussion about whether standardization has a positive or negative impact on working conditions. The case studies of organizations certified to the quality management standard ISO 9000 served as the empirical base. The article shows that there is no clear and obvious answer about the impact of standardization on working conditions. The consequences for working conditions depend on many variables and may differ considerably from organization to organization. Three primary variables influencing the outcomes for working conditions were identified and discussed: (1) content of the standard, (2) the standardization process, and (3) the degree of standardization. © 2007 Wiley Periodicals, Inc.
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| 29. |
- Poksinska, Bozena
(author)
-
Framgångsrikt leanledarskap sätter människan i centrum
- 2013
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In: Leda mot det nya. - Stockholm : Vinnova. - 9789187537059 ; , s. 89-104
-
Book chapter (pop. science, debate, etc.)abstract
- Lean production har en stor potential att bidra till organisationers innovationsförmåga. Tyvärr fokuseras många leanimplementeringar på enstaka verktyg och inte på att skapa en kultur som präglas av respekt för människan och kontinuerliga förbättringar. Förändrade roller för medarbetare och chefer är en central aspekt av filosofin som ofta inte beaktas, men som är avgörande för att uppnå långsiktigt hållbara resultat med lean.
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| 30. |
- Poksinska, Bozena, et al.
(author)
-
From compliance to value-added auditing - Experiences from Swedish ISO 9001 : 2000 certified organisations
- 2006
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In: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3363 .- 1478-3371. ; 17:7, s. 879-892
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Journal article (peer-reviewed)abstract
- This paper presents the results of a questionnaire survey of the auditing practices and the value of certification audits in 269 Swedish ISO 9001:2000 certified organisations. Certification audits help to improve the quality management system and increase the motivation for quality work. Certified organisations want auditors not only to issue a certificate, but also to share their own experiences and give suggestions for improvements. Audit conclusions, which imply consultancy work, are a common practice among auditors. Furthermore, there exist great differences regarding the required conditions for certification. The differences primarily depend on the auditors, but also on the certification bodies. Finally, the study also indicates that the audit procedure has improved after the ISO 9000 revision in 2000. © 2006 Taylor & Francis.
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| 31. |
- Poksinska, Bozena, et al.
(author)
-
From Successful to Sustainable Lean Production : The Case of a Lean Prize Award Winner
- 2018
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In: Total Quality Management and Business Excellence. - : Taylor & Francis. - 1478-3363 .- 1478-3371. ; 29:9-10, s. 996-1011
-
Journal article (peer-reviewed)abstract
- Many improvement programmes often fail to sustain over an extended period of time. Previous research suggests that a similar set of factors influence the success and sustainability of an improvement programme. The purpose of this paper is to make a distinction between the success and sustainability of improvement programmes, and to identify mechanisms that specifically contribute to the sustainability. In this paper, we study a sustainable improvement programme from the perspective of complexity theories that stress the importance of studying change as a dynamic process of interacting elements and events unfolding in time. We conducted a longitudinal, in-depth case study of a Swedish Lean Prize Award Winner where a Lean improvement programme was studied over 9 years. An improvement programme is successful if goals are achieved and the targeted problems are resolved. Furthermore, the first-order sustainability means the ability to sustain results and the second-order sustainability means the ability to keep an improvement programme alive. The lessons identified from complexity theories, such as destabilising the organisation, ensuring novelty and constant flow of change or self-organisation at the team level, are examples of mechanisms important to achieve the sustainability of the improvement programme.
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| 32. |
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| 33. |
- Poksińska, Bozena, 1973-
(author)
-
ISO 9000 : business as usual or radical change?
- 2006
-
Doctoral thesis (other academic/artistic)abstract
- The ISO 9000 series of standards was written to provide guidelines to assist organisations in implementing and operating a Quality Management System (QMS). With hundreds of thousands of certified companies around the world, ISO 9000 has become the most widely accepted and soughtafter quality management system. The aim of this research is to contribute to the improvement of quality management systems by increasing the understanding of the practices of implementing, operating and auditing ISO 9000. More specifically, the research aims to identify and explain the conditions under which ISO 9000 is likely to have positive effects on organisational performance and employee development.The research was performed in three stages. First, an initial questionnaire survey was aimed at exploring the motives, implementation factors and benefits of ISO 9000. Second, case studies investigated and evaluated the practice of implementing and operating a QMS within an organisational context. Third, an auditing survey provided knowledge about auditing practices and about how the certification audits and auditors were perceived by the certified organisations.The value of ISO 9000 differs between organisations and depends on several organisational and external conditions, such as motivation for ISO 9000 implementation, maturity level of quality management, implementation strategy, certification audits, and involvement of people. Organisations lacking motivation to manage and improve their quality system and placing too much value on the certificate limit their efforts to satisfying of the minimum necessary requirements. ISO 9000 describes what requirements need to be met, not how they are to be met. Consequently, organisations may claim that their processes already comply with the standard and do not change anything in their practice. Hence, it is possible to become certified without changing anything in the organisation. Organisations may also have different maturity levels of quality management. For some organisations, ISO 9000 requirements may mean a radical change; for others, it is just the usual way of running the business. The maturity level determines to what extent organisations can standardise the practice or practise the standard. Not without importance are also certification audits, which under the right conditions can provide valuable input to the QMSeffectiveness and improvement. Finally, to achieve positive effects from the QMS all employees, from the top to the bottom, need to be involved in the quality work.
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| 34. |
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| 35. |
- Poksinska, Bozena, 1973-
(author)
-
ISO 9000 is not an economic disease
- 2007
-
In: 10th International QMOD Conference,2007.
-
Conference paper (other academic/artistic)abstract
- The aim of this paper is to discuss and explain the conditions under which ISO 9000 is likely to have positive effects on organisational performance and employee development. The results described in this paper are coming from a research project looking at ISO 9000 in a more integrated manner using the different research strategies. Both questionnaire surveys and case studies investigating the processes related to ISO 9000 implementation and operation in the organisational settings were used. The value of ISO 9000 differs between organisations and depends on several organisational and external conditions, such as motivation for ISO 9000 implementation, maturity level of quality management, implementation strategy, certification audits, and involvement of people. For this reason benefits achieved from ISO 9000 are not the same for every organisation. They depend on the quality objectives set and the level of commitment to achieve business excellence.
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| 36. |
- Poksinska, Bozena, 1973-, et al.
(author)
-
ISO 9001 : 2000 in small organisations
- 2006
-
In: International Journal of Quality & Reliability Management. - : Emerald. - 0265-671X .- 1758-6682. ; 23:5, s. 490-512
-
Journal article (peer-reviewed)abstract
- Purpose - The aim of the study is to investigate and to understand the practice of implementing and operating the QMS in an organisational context, providing an analysis of the way ISO 9001:2000 was implemented and operated and focusing on identifying factors which have negatively or positively influenced the effects of the quality management system (QMS). Design/methodology/approach - Three case studies of small organisations were examined. The methodological approach was based on Porras and Robertson's model. The data collection methods included interviews, a questionnaire survey of all employees and document studies. Findings - ISO 9001:2000 was implemented and operated with minimum effort and little change was experienced. QMS was not perceived as a tool for managing processes, but as a tool for handling documentation. Consequently, this was reflected in the benefits achieved. Despite the external benefits which followed from obtaining the certificates, only minor internal benefits were found. Internal motivation, engaged and trained employees, a competent quality manager, committed CEO and development-oriented auditors were identified as critical, influencing the effects from ISO 9000. In general, in the way ISO 9001:2000 was implemented and operated many opportunities for improvement were lost. Research limitations/implications - The choice of small organisations for the case studies has important implications for the results. Small organisations often lack resources, which limits the initiatives that they can take. Practical implications - The QMS and its effects are not determined by the ISO 9001 requirements, but by the organisational context and the way the system is implemented and operated. Originality/value - The paper provides an explanation why organisations achieve very different results from ISO 9001 implementation. It also shows that certification bodies may have an important role for the effectiveness of the QMS. © Emerald Group Publishing Limited.
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| 37. |
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| 38. |
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| 39. |
- Poksinska, Bozena
(author)
-
Lean Healthcare - opportunities and challenges
- 2009
-
In: 12th International QMOD and Toulon-Verona Conference on Quality and Service Sciences (ICQSS). - Verona.
-
Conference paper (peer-reviewed)abstract
- Abstract: Purpose – The purpose of this paper is to provide some insights and discuss opportunities and challenges of applying the Lean principles in the healthcare sector. Design/methodology/approach – The papers presents the experiences gathered during the Swedish national development programme “Lean healthcare”. 60 persons from the management of the 20 county councils participate in the development programme initiated by the Swedish Association of Local Authorities and Regions (SKL). The purpose of the programme is to critically review and discuss how the Lean principles can be applied in healthcare. The results presented in this paper are the compilation of the discussions and work done within the programme. Findings – “Lean production” represents a fresh way to look at work systems within healthcare. Several key tools and principles have proved to be effective in improving healthcare processes. Lean focuses on removing waste in any form and relentlessly strives to eliminate problems. The current healthcare systems are designed with a focus on the doctors, nurses and other clinical staff and are not optimized for the patients. Healthcare services are often ‘batch and queue’ with patients spending most of their time waiting. This approach is contradictory to Lean: it is like designing processes with a focus on the employees rather than the product they make. However some Lean principles are not easily transferred. With high variations in demand, which many healthcare organisations face, the application of the principles “pull” and “one piece flow” provide a real challenge. To achieve sustainable results with Lean, a paradigm shift has to take place in the minds of people. Lean involves a different way of thinking, communicating, making decisions and managing. Swedish healthcare managers need to make a major shift and development in people management.
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| 40. |
- Poksinska, Bozena, et al.
(author)
-
Listening to the voice of the patient: new insights in health care service development
- 2011
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In: Proceedings QMOD Conference on Quality and Service Sciences 2011. - 8480812117
-
Conference paper (other academic/artistic)abstract
- Background and Purpose – The patient is usually the only one with a full understanding and experience of an entire health care episode, yet this experience and knowledge is seldom used in health care service development. It is not an understatement to say that lip service is often paid to the patient’s view. This paper aims to draw attention to the possibilities of user-driven innovation in the health care sector. The research question that guides the present study is: How can patients participate in health care development, depending on the degree of co-production in care processes? Design/methodology/approach – The empirical data was collected through the use of patient diaries. Participants belonged to either one of two categories of care – chronic disease (rehabilitation, gastro) and episodic disease (orthopaedic surgery). The participants were asked to write about everyday situations which were related to their own health care problem and contacts with health care providers, and write down ideas for improvements. In total, 53 diaries have been collected and analysed. The analysis was made through a process where patient ideas were identified and classified by the researchers. Descriptive statistics on the characteristics of the ideas and their relation to service development were then made. Findings – Our results show that patients can make varying contributions to the development of health care services, depending on the degree of co-production and the context of idea generation. Based on these two variables we describe four different roles for the contribution of patients to the development of health care services: patient as provider of information (patient with episodic disease at caregiver); patient as an expert (patient with chronic disease at caregiver); patient as co-developer (patient with chronic disease at home); and patient as sole developer (patient with episodic disease at home). Research implications –The patient diary opens new, interesting opportunities in the field of patient co-creation. Much more work is needed in this direction. Practical implications – We stress that the patient is an under-used resource and listening to the voice of the patient can generate great benefits for health care service development.
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| 41. |
- Poksinska, Bozena, et al.
(author)
-
Measuring quality in elderly care: possibilities and limitations of the vignette method
- 2017
-
In: Total Quality Management and Business Excellence. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 1478-3363 .- 1478-3371. ; 28:9-10, s. 1194-1207
-
Journal article (peer-reviewed)abstract
- Listening to citizens is seen as an important source of information about public service performance. In Sweden, to secure the quality of elderly care, the National Board of Health and Welfare conducts a yearly survey of in-home elderly care services and nursing homes. A central problem of the existing survey methodology is the interpersonal incomparability of survey responses due to differences in preferences and health conditions. One way to deal with this problem is to use the survey methodology with anchoring vignettes. The purpose of the paper is to investigate the possibilities and limitations of using anchoring vignettes as a general survey method and specifically to test the method for measuring elderly care quality. The vignettes were developed interactively with professionals working in elderly care and evaluated with 1600 users of in-home elderly care services and nursing homes. The results showed that anchoring vignettes reduce the impact of respondents personal characteristics on survey results. In general, anchoring vignettes give more robust answers that reduce the problem of incomparability. However, anchoring vignettes increase the complexity of the questionnaire and have limited value in elderly care. Our results indicate that the method might be applicable when using healthier and younger respondents.
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| 42. |
- Poksinska, Bozena, 1973-
(author)
-
På väg mot ständiga förbättringar med ISO 9001:2000
- 2007
-
In: Att lyckas med förbättringsarbete -förbättra, förändra, förnya. - Lund : Studentlitteratur. - 9789144029986 ; , s. 49-72
-
Book chapter (other academic/artistic)abstract
- Ständiga förbättringar (SF) är ett väsentligt mål i kvalitetsarbete. Det är en filosofi som bevisas utifrån pågående aktiviteter för att förbättra produkter, processer och system, även då inga kända problem existerar. Idén är att förbättringar alltid är möjliga. Ökat värde för kunden genom nya och förbättrade produkter och tjänster; förbättrat processutförande; och reducerade avvikelser, spill och antalet defekta är bara några av de mer betydande målen som litteraturen inom kvalitet belyser angående ständiga förbättringar. Även om konceptet är mycket välkänt och vanligen använt, finns det olika definitioner och uppfattningar om ständiga förbättringar.
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| 43. |
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| 44. |
- Poksinska, Bozena, et al.
(author)
-
Quality Improvement activities in Swedish industry : Drivers, approaches and outcomes
- 2010
-
In: International Journal of Quality and Service Sciences. - : Emerald. - 1756-669X .- 1756-6703. ; 2:2, s. 206-216
-
Journal article (peer-reviewed)abstract
- Purpose – This paper aims to present and discuss the current state of quality-improvement activitiesin Swedish companies. The paper focuses on the drivers for quality improvement; types of approaches,tools and techniques, and organizational aspects influenced by quality improvement; and potentialareas for improvement.Design/methodology/approach – This paper presents results from a survey on qualityimprovement work in Swedish industry. Data for this paper were collected using a web-basedquestionnaire that was distributed to 800 production managers working in Swedish service andmanufacturing organizations. Of the 800 questionnaires sent, a total of 118 questionnaires were filledout, which resulted in a response rate of 16 percent.Findings – The result shows that the major drivers for quality improvement work in Swedishindustry are economical aspects as the need for cost reduction, the need to become more competitiveand the wish to increase market share. Drivers such as pressure from shareholders and trendsin management have a minor role. The underlying approaches for quality improvement work arestandards such as ISO 9000 and ISO 14000. A total of 72 percent of respondents stated that they workwith quality management systems; 59 percent, with environmental management systems. The aspectsthat were most positively influenced by the improvement work were employee motivation, customersatisfaction, employee satisfaction, product/service quality, and flow in internal processes.Research limitations/implications – Empirical results obtained in Sweden may differ to someextent in other countries.Practical implications – This paper is intended as a source of inspiration for researchers,consultants, and managers who are interested in the current trends and future developments in thequality field.Originality/value – The paper provides valuable insights into the current state of quality improvementactivities in Swedish industry, as seen from the perspective of the production manager.
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| 45. |
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| 46. |
- Poksinska, Bozena
(author)
-
The current state of Lean implementation in health care : literature review
- 2010
-
In: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 19:4, s. 319-329
-
Journal article (peer-reviewed)abstract
- PURPOSE:The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care.DESIGN/METHODOLOGY/APPROACH:A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions.FINDINGS:Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.
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| 47. |
- Poksinska, Bozena, et al.
(author)
-
The Daily Round of Lean Leaders - a Go to Gemba Study
- 2012
-
In: Proceedings of the 15th QMOD-ICQSS conference. - 9788389333469
-
Conference paper (other academic/artistic)abstract
- The aim of this paper is to contribute to a better understanding of managerial practices and leadership in Lean organisations. The results presented in this paper are based on five case studies. The manager’s role changed radically with the implementation of Lean production. The focus in managerial tasks changed from managing processes to developing and coaching people. Supporting structures were developed to empower employees and give them more responsibility for the daily management activities. These supporting structures included visual control, goal deployment, short daily meetings, two-way communication flow, and a system of continuous improvement. Many leadership behaviours exhibited by Lean managers can be classified as transformational leadership behaviours. However, the need for transformational leadership behaviours was smaller, if the supporting management structure was strong. Our final conclusion is that the more successful case is a leader supported by the system than a system supported by leader.
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| 48. |
- Poksinska, Bozena, et al.
(author)
-
The daily work of Lean leaders – lessons from manufacturing and healthcare
- 2013
-
In: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3363 .- 1478-3371. ; 24:7-8, s. 886-898
-
Journal article (peer-reviewed)abstract
- The aim of this paper is to contribute to a better understanding of managerial practices and leadership in Lean organisations. The results presented here are based on five case studies. The manager's role changed radically with the implementation of Lean production. The focus in managerial tasks changed from managing processes to developing and coaching people. Supporting structures were developed to empower employees and give them more responsibility for daily management activities. These supporting structures included visual control, goal deployment, short daily meetings, two-way communication flow, and a system of continuous improvement. Many leadership behaviours exhibited by Lean managers can be classified as transformational leadership behaviours. However, the need for transformational leadership behaviours was smaller, if the supporting management structure was strong.
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| 49. |
- Poksinska, Bozena, et al.
(author)
-
The state of ISO 9000 certification : A study of Swedish organizations
- 2002
-
In: TQM Magazine. - : Emerald. - 0954-478X .- 1758-6887. ; 14:5, s. 297-306
-
Journal article (peer-reviewed)abstract
- It seems today to be an indisputable fact that ISO 9000 is a powerful instrument, which cannot be disregarded. It is, far and away, the most influential initiative that grew from the quality movement of the late 1980s. This paper contains an evaluation of results from a survey on ISO 9000 certified companies and aims to present some aspects of the current state of the standard in Swedish industry. This study is focused on motives for implementation, perceived benefits and key implementation factors. The predominant reasons identified for seeking certification were the desire to improve corporate image and quality. Like many previous studies this study underlines the need for management commitment and participation. The very important conclusion drawn from this survey is that the motivation for certification may influence the performance of ISO 9000. The overall benefits which the companies gain from the standard showed dependence on the motivation which initiated the drive for the certification.
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| 50. |
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