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Kan lean bli hållbart i svensk sjukvård?: Om betydelsen av delaktighet och tydlighet
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
2014 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Something is happening within healthcare. An increased pressure for change towards increased efficiency and effectiveness has made Swedish healthcare organizations focusing on organizational change strategies – where expressions such as continuous improvements and to do more with less are frequently used. Lean production (lean) is a commonly used organizational development strategy within Swedish healthcare. However, many organizations today fail when trying to implement lean as a means to change the organization.

The purpose of this thesis is to increase the knowledge level about sustainable development work and working conditions within Swedish healthcare. Another purpose is to make this knowledge applicable to on-going development work of today.

In this thesis, the approach has been interactive research, where a method triangulation has been used including a literature study, a qualitative study, and a quantitative study. The empirical data are from two Swedish hospitals.

By using an interactive research approach, joint learning among the researcher and first-line management within Swedish psychiatric care has been reached. This joint learning concerns how to strengthen the sustainability of organizational development work within Swedish healthcare. Specifically, the findings show that participation, as a democratic principle and an important organizational development factor, needs to be promoted among first-line management in the development work. For the development work to be sustainable, all parties within the organization need to participate in the work.

Finally, the findings show that clear organizational structures, i.e. objectives and responsibilities, correlate to participation in the organization. The prerequisites for sustainable development work within Swedish healthcare are believed to be strengthened due to the Scandinavian organizational tradition of participation.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2014. , 61 p.
Series
TRITA-STH : report, ISSN 1653-3836
National Category
Engineering and Technology
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-141108ISBN: 978-91-7595-012-9 (print)OAI: oai:DiVA.org:kth-141108DiVA: diva2:694686
Presentation
2014-02-28, 4-215, Alfred Nobels Allé 12, Huddinge, 13:15 (Swedish)
Opponent
Supervisors
Note

QC 20140207

Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2014-02-26Bibliographically approved
List of papers
1. Organizational Change through Interactive Research or a Consultant’s Intervention: Reflections about pros and cons
Open this publication in new window or tab >>Organizational Change through Interactive Research or a Consultant’s Intervention: Reflections about pros and cons
2011 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

This abstract is written at the start up of an interactive oriented research project. The author has previous experience as a consultant and is reflecting upon possible differences between being a consultant and being a researcher. In the paper, a reflection is made on possible differences when using an academic or a consultant approach in an organizational intervention.  The consultants are seen as the change agents, fully devoting themselves to the needs of the clients in performing an organizational intervention. The consultant’s role, as being a change agent, is sometimes compared to the role of an action researcher. However, the action researchers should not only satisfy the organizations but should also add critical knowledge to existing research. In interactive research, the emphasis is even larger on the importance of separating the role of a researcher from a developer in order to carefully consider issues of validity. As opposed to the action researcher’s role, an interactive researcher is expected to perform a joint analysis with the involved actors of the organization instead of taking responsibility of the change process. Even so, both interactive and action research can be seen as new production of knowledge in addition to traditional research. The question which is reflected upon is: If there is a difference between the role of a consultant and an action researcher in an organizational intervention, is there really a difference between interactive and action research? Aspects such as participation, learning and sustainability are considered. The empirical data is collected from the author’s involvement in two parallel research projects as an interactive researcher. One project is within the public sector and the other is within the public psychiatric care sector. Both involve change projects aimed towards the development of lean production.

Keyword
Lean production, action research, organizational change and consultant
National Category
Engineering and Technology
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-141100 (URN)
Conference
“A practice about practice” The Nordic Academy of Management conference, NFF, Stockholm, 20‐24 August 2011
Note

QC 20140207

Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2014-02-07Bibliographically approved
2. Managerial Challenges in Creating Sustainable Development Work (Lean): An interactive case study from socio-technical perspectives
Open this publication in new window or tab >>Managerial Challenges in Creating Sustainable Development Work (Lean): An interactive case study from socio-technical perspectives
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose - At present, healthcare organizations are facing both quality and financial challenges. Consequently, organizations in this sector have started to introduce Lean inspired production concepts in order to become more efficient and effective. The implementation of Lean in healthcare is not unproblematic, especially not within psychiatry, the context of which differs greatly from other sectors where it is more usual to see Lean implemented. The aim of this article is to identify managerial preconditions for the implementation of a sustainable Lean organization at a psychiatry division in a Swedish university hospital.

Design/methodology/approach – An interactive case study approach was chosen with the purpose of gaining deeper knowledge and understanding of the first-line managers’ role during implementation of Lean. Focus group interviews together with 24 first-line managers were conducted. In the analysis, a socio-technical perspective was used due to the characteristics of the psychiatry healthcare context but also from a sustainability perspective. The empirical data from the focus group interviews were also complemented with a semi-structured interview with a key actor.

Findings – Development work is context dependent and so is the implementation of Lean. This particular case study points out that clarity of the organizational structures within the Lean work, i.e. objectives and roles, affects the level of participation and consequently the sustainability of the Lean implementation. The empirical findings also show that a managerial lack of power and authority make it difficult for first-line managers (the majority being nurses) to prioritize engagement and time spent in Lean work.

Originality/value – At present there are few studies on the implementation of Lean within the psychiatry healthcare sector and in a socio-technical context. In this article a model is presented, visualizing managerial preconditions for sustainable Lean in the context presented.

Keyword
Lean production, Lean work, psychiatry, first-line managers, sustainable development, objectives, roles, participation, socio-technics
National Category
Engineering and Technology
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-141104 (URN)
Note

QS 2014

Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2014-02-07Bibliographically approved
3. Sustainable Development Work (Lean) in Swedish Healthcare: A longitudinal and quantitative study concerning effects of goal settings on participation
Open this publication in new window or tab >>Sustainable Development Work (Lean) in Swedish Healthcare: A longitudinal and quantitative study concerning effects of goal settings on participation
2013 (English)Conference paper, Oral presentation only (Other academic)
Keyword
Sustainable development work, lean, healthcare, participation
National Category
Engineering and Technology
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-141105 (URN)
Conference
“Innovative Practices in Work, Organization and Regional Development” The international Helix conference, Linköping, 12‐14 June 2013
Note

QC 20140207

Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2014-02-07Bibliographically approved

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