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Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.ORCID iD: 0000-0001-5879-2280
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.ORCID iD: 0000-0002-8457-679X
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
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2015 (English)In: International Journal of Human Factors and Ergonomics, ISSN 2045-7812, Vol. 3, no 3-4, p. 235-253Article in journal (Refereed) Published
Abstract [en]

Healthcare organisations in Sweden are reorienting toward horizontal organisation around care processes. This paper's aim was to investigate how implementation approaches for improvements of care processes in line with lean production (LP), at hospital strategic and operative levels, are associated with working conditions and stress-related health among the employees. Five hospitals working with improvements to care processes were studied using questionnaires to employees (n = 1,303) and interviews at strategic and operative levels at baseline and follow-up. The process redesign implementation strategies varied between the strategic and operative levels. There were associations between a higher degree of LP at operative level and increased work resources and decreased work demands. Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There was evidence of more beneficial or improved working conditions in relation to higher degree of LP at operative levels.

Place, publisher, year, edition, pages
InderScience Publishers, 2015. Vol. 3, no 3-4, p. 235-253
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:kth:diva-179304DOI: 10.1504/IJHFE.2015.073001OAI: oai:DiVA.org:kth-179304DiVA, id: diva2:882438
Note

QC 20160118

Available from: 2015-12-15 Created: 2015-12-15 Last updated: 2018-11-07Bibliographically approved
In thesis
1. Change agents and use of visual management tools in care process redesign: Implications on working conditions for operative managers and healthcare professionals
Open this publication in new window or tab >>Change agents and use of visual management tools in care process redesign: Implications on working conditions for operative managers and healthcare professionals
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish healthcare has been subject to change efforts to increase efficiency in care processes. In the 2000-2010’s lean production has influenced healthcare with change approaches such as visual management tools to increase patient flows and efficiency. Most previous research on lean healthcare has focused single hospitals or departments as case studies focusing lean production as successful for efficiency, or “mean” production affecting the work environment. Focus in this thesis though is instead on what strategies and approaches hospitals use in their care process redesign and their associations with working conditions and systems performance. This thesis’ overall aim was to assess change strategies and change approaches at strategic and operative levels during care process redesign at hospitals, focusing organization of change agents and use of visual management tools, and its implica-tions for alignment, working conditions and systems performance. Four studies were conducted at five Swedish hospitals, whereof three had lean-inspired change strategies. One qualitative cross-sectional study, one quantitative longitudinal study and two mixed method longitudinal studies are included in the thesis. Data was collected over three years with semi-structured interviews, structured interviews, staff questionnaires, manager questionnaires and photo document-ation. Qualitative data were analyzed by content analysis. Quantitative data were analyzed with Wilcoxon tests, mixed models of repeated measurements, ANOVA, and linear regression models. Results showed strategies involve operative manag-ers as change drivers, supported by change agent functions. Change agents’ contribution to change depends on e.g. closeness to operative managers due to the change agents place in the healthcare hierarchy, and also clarity regarding roles and responsibilities in change. Change agents with a close collaboration with operative managers, have better preconditions to contribute to alignment between change strategies and change approaches. Hospital care units in the 2010’s tend to use lean-inspired operative change approaches also without working with change strategies based on lean. Operative lean approaches show associations with positive working conditions for healthcare professionals. Visual management tools as change strategy has potential to support collaboration and communication within and between organizational levels and is considered to contribute to systems performance and alignment. Visual management tools as a cognitive job resource for operative managers show associations with e.g. lower burnout and more functioning collaboration as well as daily use among nurses show associations with cognitive, social and emotional benefits, perceived systems performance and buffering mental stress. Change agents and use of visual management tools are considered as contributors for operative managers’ and healthcare professionals’ sustainable work during care process redesign.

Abstract [sv]

Svensk sjukvård har länge varit föremål för omorganisationer för att öka effektiv-iteten i vården. Under 2000-2010-talen har sjukvården tagit intryck av lean produktion och prövat olika lean-metoder för att förbättra effektiviteten i patient-flöden. Forskning har studerat fram- eller motgångar vid enskilda vårdverksam-heters införande av lean, och hur införandet påverkat effektivitet och arbetsmiljö. Det kvarstår ett forskningsbehov avseende förändringsstrategier och tillvägagångs-sätt som används i sjukvården, och hur sambanden mellan strategi, tillvägagångs-sätt och arbetsförhållanden ser ut över tid. Syftet med denna avhandling var att undersöka strategier och tillvägagångssätt, som används vid vårdprocessutveckling på sjukhus. Syftet fokuserade organisering av förändringsledare och användningen av visualiseringsverktyg, och undersökte vilken innebörd det har för arbetsförhål-landen och upplevd effektivitet i arbetet för operativa chefer och sjukvårdsprofess-ionella, samt undersökte vilken innebörd det har för samsyn inom sjukhus gällande processutveckling. Fyra delstudier genomfördes vid fem svenska sjukhus, varav tre sjukhus hade lean som huvudinspiration vid vårdprocessutveckling. En kvalitativ tvärsnittsstudie, en kvantitativ longitudinell studie och två blandat kvalitativa och kvantitativa longitudinella studier har gjorts. Datainsamling genomfördes under tre år och bestod av; delvis strukturerade intervjuer, strukturerade intervjuer, med-arbetar- och chefsenkäter och observationer. Kvalitativa data analyserades med innehållsanalys, och kvantitativa data analyserades genom jämförelser inom och mellan grupper med Wilcoxon-tester, mixed models of repeated measurements, ANOVA, och linjär regressionsanalys. Resultaten visade att förändringsstrategier ofta innebär att ansvar för att driva vårdprocessutveckling läggs på operativa chef-er. Dessa kan ha stöd från förändringsledare vars möjligheter att stötta beror bland annat på den organisatoriska närheten till de operativa cheferna och på hur tydlig roll- och ansvarsfördelning man har i processutvecklingen. Förändringsledare i nära samarbete med operativa chefer, har bättre förutsättningar att bidra till sam-verkan mellan strategier och operativa tillvägagångssätt inom och mellan organisa-toriska nivåer på ett sjukhus. Vårdenheter på 2010-talet använder lean-inspirerade tillvägagångssätt i sitt praktiska processutvecklingsarbete, även utan en sjukhus-övergripande strategi att införa lean. Lean-inspirerade tillvägagångssätt visar sig ha samband med positiva arbetsförhållanden för sjukvårdsprofessionella. Visualiser-ing har potential att stötta samverkan mellan strategier och operativa tillväga-gångssätt, och därmed även kunna bidra till systemprestanda inom sjukhus. Vis-ualisering kan tolkas fungera som arbetsresurs för operativa chefer, då de med stöd av visualisering i sitt dagliga arbete generellt har lägre utmattning och bättre fungerande samarbeten. Under- och sjuksköterskors dagliga användning av visual-iseringsverktyg hade samband med upplevda kognitiva, sociala och emotionella fördelar samt något bättre upplevd systemprestanda. Visualisering visade även en tendens till att skydda mot mental stress. Förändringsledare och användning av visualiseringsverktyg tolkas som bidragande till operativa chefers och sjukvårds-professionellas hållbara arbete vid vårdprocessutveckling på sjukhus.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2018. p. 108
Series
TRITA-CBH-FOU ; 2018:53
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Production Engineering, Human Work Science and Ergonomics Work Sciences
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-238660 (URN)978-91-7729-995-0 (ISBN)
Public defence
2018-12-07, T1 Emmy Rappe-salen, Hälsovägen 11, HUDDINGE, 13:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2010‐ 0376AFA Insurance, 120321
Note

QC 20181107

Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-07Bibliographically approved

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