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  • 1.
    Andersson, Johanna
    et al.
    Nordic School of Public Health NHV.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Bihari Axelsson, Susanna
    Nordic School of Public Health NHV.
    Eriksson, Andrea
    Nordic School of Public Health NHV.
    Åhgren, Bengt
    Nordic School of Public Health NHV.
    Samverkan inom arbetslivsinriktad rehabilitering: En sammanställning av kunskaper och erfarenheter inom området2010Report (Other academic)
  • 2.
    Andersson, Johanna
    et al.
    Nordic School of Public Health.
    Åhgren, Bengt
    Nordic School of Public Health NHV.
    Bihari Axelsson, Susanna
    Nordic School of Public Health NHV.
    Eriksson, Andrea
    Nordic School of Public Health NHV.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Organizational approaches to collaboration in vocational rehabilitation: An international literature review2011In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 11Article in journal (Refereed)
    Abstract [en]

    Introduction: Collaboration between welfare organizations is an important strategy for integrating different health and welfare services. This article reports a review of the international literature on vocational rehabilitation, focusing on different organizational models of collaboration as well as different barriers and facilitating factors.

    Methods: The review was based on an extensive search in scientific journals from 1995 to 2010, which generated more than 13,000 articles. The number of articles was reduced in different steps through a group procedure based on the abstracts. Finally, 205 articles were read in full text and 62 were included for content analysis.

    Results: Seven basic models of collaboration were identified in the literature. They had different degrees of complexity, intensity and formalization. They could also be combined in different ways. Several barriers and facilitators of collaboration were also identified. Most of these were related to factors as communication, trust and commitment.

    Conclusion: There is no optimal model of collaboration to be applied everywhere, but one model could be more appropriate than others in a certain context. More research is needed to compare different models and to see whether they are applicable also in other fields of collaboration inside or outside the welfare system.

  • 3.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Ahlstrom, Linda
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes2017In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.

  • 4.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health care managers' views on and approaches to implementing models for improving care processes2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2Article in journal (Refereed)
    Abstract [en]

    Aim: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. Background: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. Method: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. Results: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Conclusion and implications for nursing management: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

  • 5.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Andreasson, Jörgen
    KTH.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Nyorientering av svensk sjukvård: Verksamhetstjänande implementeringslogiker bygger mer hållbart engagemang och utveckling - i praktiken2016Report (Other academic)
  • 6.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    ETT ARBETSMATERIAL FÖR ATT STÖDJA Hållbart och hälsofrämjande ledarskap i vardag och förändring2016Report (Other academic)
  • 7.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health-Promoting Managerial Work: A Theoretical Framework for a Leadership Program that Supports Knowledge and Capability to Craft Sustainable Work Practices in Daily Practice and During Organizational Change2017In: Societies, E-ISSN 2075-4698, Vol. 7, no 2, article id 12Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to describe a theoretical framework, i.e., theoretical underpinnings and pedagogical principles, for leadership programs that support managers' evidence-based knowledge of health-promoting psychosocial work conditions, as well as their capability to apply, adapt, and craft sustainable managerial work practices. First, the theoretical framing is introduced, i.e., a system theory that integrates key work conditions with a practical perspective on managerial work and organization. Second, pedagogical principles and measures for leaders' training in integrated handling across system levels are described. Last, we present summarized results from an intervention study applying the theoretical framework and pedagogical principles. The complexity of interactions among different factors in a work system, and the variety in possible implementation approaches, presents challenges for the capability of managers to craft sustainable and health-promoting conditions, as well as the evaluation of the program components. Nevertheless, the evaluation reveals the strength of the program, in providing holistic and context-sensitive approaches for how to train and apply an integrative approach for improving the work environment.

  • 8.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Hållbart ledarskap - I vardag och förändring2016Report (Other academic)
  • 9.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Fredman, Margareta
    Kullén Engström, Agneta
    Lean i hälso- och sjukvården2013In: Lean i Arbetslivet / [ed] Per Sederblad, Stockholm: Liber, 2013, 1, p. 142-161Chapter in book (Other academic)
  • 10.
    Dellve, Lotta
    et al.
    University of Borås, Sweden.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Andreasson, Jörgen
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics. University of Borås, Sweden.
    Holden, Richard
    Lean implementation approaches at different levels in Swedish hospitals: the importance for working conditions, worker engagement, health and performance2014Conference paper (Refereed)
    Abstract [en]

    Background

    Swedish healthcare organizations are investing heavily in internal reforms. Lean has been frequently used as an overall concept to improve care processes and decrease costs. Some evidence shows positive results, especially if work environment issues are considered in parallel with other desired outcomes. However, there are considerable difficulties in evaluating lean as a concept since its application and interpretation seem to vary widely. Further, like for other management concepts, lean outcomes crucially depend on the implementation process.

    Aim

    This program investigates implementations of lean and lean-like developments of processes of care, and how these affect the working conditions, health, and performance of healthcare employees. We also investigated organizational factors and conditions that mediated specific outcomes.

    Method

    Mixed method design: questionnaire to employees (n=880) and managers (n=320), qualitative interviews (n=55) and observations with follow up during three years. Five hospitals were selected, and within them five units that were connected by their flow of acute care patients, i.e. the emergency unit, the medical and surgical emergency ward (or ICU at small hospital) as well as one medical and one surgical ward. Initially we used qualitative-driven analyses and thereafter quantitative-driven mixed method analysis.

    Results

    The implementation strategies varied between the hospitals and between the strategic and operative levels. Strategic managers also used different approaches to overcome the gap between strategic and operative levels. Operative managers shared similarities in their stepwise and coaching approaches encouraging participation among employees, but differences regarding how assignments were delegated. Social capital and attitudes among health care profession were of importance for employees’ work engagement and active engagement in development work.

  • 11.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH). Gothenburg University, Sweden.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Holden, Richard J.
    School of Informatics and Computing, Indiana University, Indianapolis, US.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health care clinicians' engagement in organizational redesign of care processes: Health care clinicians' engagement in organizational redesign of care processes2018In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 68, p. 249-257Article in journal (Refereed)
    Abstract [en]

    The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.

  • 12.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health care professionals’ motivation, engagement and collaboration in organizational developments of processes of care2012Conference paper (Other academic)
  • 13.
    Dellve, Lotta
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Holden, Richard
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress2015In: International Journal of Human Factors and Ergonomics, ISSN 2045-7812, Vol. 3, no 3-4, p. 235-253Article in journal (Refereed)
    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.

  • 14.
    Eriksson, Andrea
    Nordiska högskolan för folkhälsovetenskap.
    Health-Promoting Leadership: A study of the Concept and Critical Conditions for Implementation and Evaluation2011Doctoral thesis, comprehensive summary (Other academic)
  • 15. Eriksson, Andrea
    et al.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Bihari Axelsson, Susanna
    Nordic School of Public Health NHV.
    Development of health promoting leadership: Experiences of a training programme2010In: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 110, no 2, p. 109-124Article in journal (Refereed)
  • 16. Eriksson, Andrea
    et al.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Bihari Axelsson, Susanna
    Nordic School of Public Health NHV.
    Health promoting leadership: Different views of the concept2011In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 40, no 1, p. 75-84Article in journal (Refereed)
  • 17. Eriksson, Andrea
    et al.
    Bihari Axelsson, Susanna
    Nordic School of Public Health NHV.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Collaboration in workplace health promotion: A case study2012In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 5, no 3, p. 181-193Article in journal (Refereed)
    Abstract [en]

    Purpose - The aim of this article is to describe and analyze a case of interorganizational and intersectoral collaboration on workplace health promotion involving nine municipalities in a Swedish region. Design/methodology/approach - A holistic case study design was chosen. The work of a project group responsible for developing plans for collaboration in the target area of health promoting leadership was studied. Observations at project meetings, interviews with project members, and written project documents were analyzed by qualitative methods. Findings - Collaboration on health promoting leadership was seen as a strategy to reduce the sickness rate among the employees in the municipalities. The best way to develop such leadership was considered to be through supporting good leadership in general and improving the general working conditions of managers in the municipalities. Moreover, it was regarded as a critical condition to have structural arrangements and resources to continue this collaboration. Practical implications - An implication of the study is that collaboration on workplace health promotion should be organized initially on a small scale, giving time and opportunities for the participants to develop mutual trust with one another. It is also important to involve participants with different knowledge and experiences in the field. Thus, it may be possible to develop strategies for health-promoting leadership contributing to the overall aim of a decreased sickness rate. Originality/value - There is limited research on barriers and facilitating factors for interorganizational and intersectoral collaboration on workplace health promotion. This study contributes an analysis of important conditions for this kind of collaboration.

  • 18.
    Eriksson, Andrea
    et al.
    Nordic School of Public Health, Sweden.
    Bihari Axelsson, Susanna
    Axelsson, Runo
    Implementation and Evaluation of Health Promoting Leadership2010In: Proceeding of the International Conference: Towards Better Work and Well-being / [ed] Hannu Anttonen, Päivi Husman, Tomi Hussi, Timo Leino, Matti Ylikoski, 2010, p. 28-33Conference paper (Refereed)
    Abstract [en]

    The evaluation of health-promoting workplaces is believed to form an integralpart of the planning and implementation of interventions. Recent approachesto workplace health promotion include how to organize work, andthe integration of health needs into management and leadership principles.The objective of this paper is to discuss the implementation and evaluationof interventions aimed at developing health-promoting leadership. Thepaper presents results from two case studies, the interventions of whichfocused on developing health-promoting leadership in Swedish municipalities.However, a wider participatory approach was lacking in both cases, andtherefore relevant courses of action for the specific workplaces were onlyidentified and addressed to a limited extent. In order to succeed with similarprogrammes it seems necessary to integrate health-promoting activitiesinto the daily work of managers, and to provide them with opportunities toinfluence environmental conditions of importance. The results show thatsuccessful interventions need to be adapted and integrated into the ongoingactivities and developments of the workplace. This paper will be presented apossible outline of the self-evaluation of health-promoting leadership.

  • 19.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Samverkan i förbättringsarbete inom sjukvård2014In: Om samverkan: för utveckling av hälsa och välfärd / [ed] Runo Axelsson och Susanna Bihari Axelsson, Lund: Studentlitteratur, 2014, 1, p. 91-106Chapter in book (Other academic)
  • 20.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    Strömgren, Marcus
    KTH.
    Emma, Edström Bard
    Utveckling av hållbart och hälsofrämjande ledarskap –  i vardag och förändring: Utvärdering av interaktiv metodik för företagshälsovårdsdrivna interventioner2016Report (Other academic)
  • 21.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Holden, Richard J.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    A Case Study of Three Swedish Hospitals' Strategies for Implementing Lean Production2016In: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 6, no 1, p. 105-131Article in journal (Refereed)
    Abstract [en]

    Many hospitals have recently implemented the management concept lean production. The aim of this study was to learn how and why three Swedish hospitals selected and developed their hospital-wide lean production strategies. Although previous research shows that the concept is implemented in various ways, there is limited research on how and why different hospitals choose different implementation strategies and if the chosen strategies contribute to sustainable participation in organizational development. A case study of three different Swedish hospitals implementing lean production was thus performed. We studied the content of the hospitals' selected implementation strategies, conditions and rationales behind their strategy selection, and how different organizational actors participated in the implementation. Qualitative interviews with 54 key actors at the studied hospitals were performed. In addition, a self-administered survey questionnaire to employees was answered at T1 (2012, n = 557), T2 (2013, n = 554), and T3 (2014, n = 366). The three studied hospitals chose different strategies for implementing lean production due to different contextual conditions and for different reasons. The hospital-wide implementation strategies were related to employees' interest and participation in lean production. The results show that many different actors at different organizational levels need to participate in lean production in order to sustain and diffuse change processes. Furthermore, broad motives including quality of care seem to be needed for engaging different professional groups.

  • 22. Eriksson, Andrea
    et al.
    Jansson, Bjarne
    Institutionen för folkhälsovetenskap, Karolinska Institutet.
    Haglund, Bo J A
    Institutionen för folkhälsovetenskap, Karolinska Institutet.
    Axelsson, Runo
    Nordic School of Public Health NHV.
    Leadership, organization and health at work: A case study of a Swedish industrial company2008In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 23, no 2, p. 127-133Article in journal (Refereed)
  • 23.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Ergonomics.
    Lindencrona, Fredrik
    Olsson, Ingela
    Puskeppeleit, Monika
    Intersektoriell samverkan i utvecklingsprojekt: En jämförande analys2007In: Folkhälsa i samverkan mellan professioner, organisationer och samhällssektorer / [ed] Runo Axelsson och Susanna Bihari Axelsson, Studentlitteratur, 2007, p. 87-121Chapter in book (Other academic)
  • 24.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Orvik, Arne
    The management’s possibilities for facilitating sustainable workplaces: Workshop on  “How can health promotion facilitate sustainable workplaces?”2013Conference paper (Refereed)
  • 25.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Orvik, Arne
    Strandmark, Margaretha
    Nordsteien, Anita
    Torp, Steffen
    Management and Leadership Approaches to Health Promotion and Sustainable Workplaces: A Scoping Review2017In: Societies, E-ISSN 2075-4698, Vol. 7, no 2, article id 14Article, review/survey (Refereed)
    Abstract [en]

    Whole-system approaches linking workplace health promotion to the development of a sustainable working life have been advocated. The aim of this scoping review was to map out if and how whole-system approaches to workplace health promotion with a focus on management, leadership, and economic efficiency have been used in Nordic health promotion research. In addition, we wanted to investigate, in depth, if and how management and/or leadership approaches related to sustainable workplaces are addressed. Eighty-three articles were included in an analysis of the studies' aims and content, research design, and country. For a further in-depth qualitative content analysis we excluded 63 articles in which management and/or leadership were only one of several factors studied. In the in-depth analysis of the 20 remaining studies, four main categories connected to sustainable workplaces emerged: studies including a whole system understanding; studies examining success factors for the implementation of workplace health promotion; studies using sustainability for framing the study; and studies highlighting health risks with an explicit economic focus. Aspects of sustainability were, in most articles, only included for framing the importance of the studies, and only few studies addressed aspects of sustainable workplaces from the perspective of a whole-system approach. Implications from this scoping review are that future Nordic workplace health promotion research needs to integrate health promotion and economic efficiency to a greater extent, in order to contribute to societal effectiveness and sustainability.

  • 26.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Skagert, Katrin
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Utveckling av hälsofrämjande ledarskap och medarbetarskap: Erfarenheter av att arbeta med interventioner utifrån ett arbetsmaterial2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6Article in journal (Refereed)
    Abstract [sv]

    Forskning pekar på är att ledarskap har stor betydelse för anställdas välmående och att ledarskapsutveckling därför bör vara huvudfokus för framtida interventioner inom arbetsmiljö- och hälsoarbete. Den här artikeln syftar till att beskriva våra erfarenheter och lärdomar från att arbeta med hälsofrämjande ledarskapsinterventioner. Interventionerna utgår från arbetsmaterialet ”Hälsofrämjande ledarskap och medarbetarskap”. I arbetsmaterialet presenteras olika forskningsbaserade metoder och verktyg som kan användas för analys, reflektion och utveckling av hälso- och arbetsmiljöarbetet på den enskilda arbetsplatsen eller för hela organisationen. Utvärderingar av interventioner utifrån arbetsmaterialet pekar på att chefer som deltagit fått ökade förmågor att vara hälsofrämjande ledare, men att organisatoriskt stöd är avgörande för långsiktigta resultat.

  • 27.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Experiences of Implementing Occupational Health Services Driven Intervention Methods for Sustainable Leadership in Health Care2016In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 28, p. 50-51Article in journal (Other academic)
  • 28.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Strömgren, Marcus
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Experiences of implementing OHS driven intervention methods for sustainable leadership in health care2015Conference paper (Refereed)
  • 29.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Implementation of the organizational concept lean production: Case studies of two Swedish hospitals2012In: NOVO Symposium: Hållbar hälso- och sjukvård, 2012, p. 25-25Conference paper (Other academic)
  • 30.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Ergonomics (Closed 20130701).
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Ergonomics (Closed 20130701).
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Ergonomics (Closed 20130701).
    Motivations and strategies for why and how to implement the organizational concept lean – a case study of a Swedish hospital2012Conference paper (Refereed)
    Abstract [en]

    The aim of this study was to analyze motivations and strategies of a Swedish hospital for why and how to implement lean. A case study, including interviews with key actors, observations and document analysis, was performed. Lean was in the studied hospital viewed as tools to deal with suggestions from employees on how to improve the delivery of care. Process leaders employed for a limited time were responsible for implementing lean in the different units. The hospitals future choices of implementation strategies, including training of managers, can be seen ascritical for motivating unit-level managers to sustain lean over time.

  • 31.
    Eriksson, Andrea
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Three Swedish hospitals’ lean strategies and their contribution to organizational development2014In: ODAM/NES, 2014, p. 657-658Conference paper (Other academic)
  • 32.
    Holden, Richard J
    et al.
    Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Andreasson, Jörgen
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Williamsson, Anna
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals2015In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 46, p. 181-192Article in journal (Refereed)
    Abstract [en]

    As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.

  • 33.
    Håkansson, Malin
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Holden, R. J.
    Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, L.
    University of Gothenburg, Department of Sociology and Work science.
    Managerial practices that support lean and socially sustainable working conditions2017In: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 7, no 3, p. 63-84Article in journal (Refereed)
    Abstract [en]

    Despite decades of using lean, there is little knowledge of how lean managerial practices affect working conditions. Thus, the aim of this study was to investigate in what ways managerial practices support socially sustainable working conditions (SSWCs) during a lean transformation. A mixed methods approach was used in this multiyear case study in a midsize Swedish manufacturing company. Assessment of work characteristics was combined with employee questionnaires and interviews with managers. Four practices were identified as instrumental for SSWCs: 1) a coherent lean approach with clear direction, 2) a value-creating leadership style comprising a participatorypromoting and caring leadership approach with joint focus on production and well-being, 3) conscious involvement of employees in a stepwise fashion, and 4) a focus on promoting meaningful jobs and health, aided by work environment management. Thus, managerial practices actively supporting important job resources as an integral part of the lean system seemed to support SSWCs.

  • 34.
    Lindskog, Pernilla
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Hemphälä, Jens
    KTH, School of Industrial Engineering and Management (ITM), Machine Design (Dept.), Integrated Product Development.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Lean in healthcare: Engagement in development, job satisfaction or exhaustion?2016In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 5, no 5, p. 91-105Article in journal (Refereed)
    Abstract [en]

    Conclusions about implementing the management concept lean in healthcare are contradictory and longitudinal studies are scarce. In particular, little is known of how working conditions contribute to the sustainability of lean in healthcare. The aim of this article is to identify to what extent lean tools (visual follow-up boards, standardised work, 5S [housekeeping], and value stream mapping [VSM]) promote working conditions for employees and managers in healthcare organisations (outcomes: engagement in development, job satisfaction and exhaustion), while considering the context (i.e., job resources and job demands) and aspects of the implementation process. A longitudinal quantitative study was conducted that involved employees and managers in two hospitals and one municipality (n = 448). Applying the job demands-resources model, multiple linear regression models were used. VSM, standardised work and 5S promoted employees and managers’ working conditions when supported by job resources. When no support was provided, visual follow-up boards were inhibiting employees and managers’ job satisfaction. VSM and standardised work were seen as central lean tools. In this sample, the application of lean cannot be considered sustainable as employees and managers’ working conditions deteriorated under the implementation of lean.

  • 35.
    Lindskog, Pernilla
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Hemphälä, Jens
    KTH, School of Industrial Engineering and Management (ITM), Machine Design (Dept.), Integrated Product Development.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Lean Tools Promoting Individual Innovation in Healthcare2016In: Creativity and Innovation Management, ISSN 0963-1690, E-ISSN 1467-8691Article in journal (Refereed)
    Abstract [en]

    Lean is a management concept that has been implemented in different sectors, including healthcare. In lean, employees continuously improve the work processes, which is closely associated with small step innovation. In moving away from the ambiguity surrounding lean in healthcare, this empirical study expands upon lean tools and innovation enabling job resources, as a contextual prerequisite, promoting healthcare employees’ individual innovation at work. Three public sector entities in Sweden participated in a longitudinal quantitative study (n=281). Idea generation and idea implementation, as individual innovation, were analysed using four-level multiple linear regression models. 5S and value stream mapping facilitated employee individual innovation. Hence, these lean tools are considered job resources for such innovation in the initial phase of implementing lean. After controlling for the lean context, job resources and job demands, visual follow-up boards and standardised work had no significant influence upon individual innovation, while development resources and information as participation promoted individual innovation. This study contributes to the understanding of how individual innovation is associated with lean tools and other innovation-related resources in healthcare. These results add to the knowledge of methods and resources promoting individual innovation when initiating a lean implementation.

  • 36. Mattsson, Janet
    et al.
    Östlund, Britt
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Technology in Health Care.
    Björling, Gunilla
    Williamsson, Anna
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Eriksson, Andrea
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Interprofessional Learning for Enhanced Patient Safety: Biomedical Engineering Students and Nursing Students in Joint Learning Activities.2019In: Journal of Research in Interprofessional Practice and Education, ISSN 1916-7342, E-ISSN 1916-7342, Vol. 9, no 1Article in journal (Refereed)
    Abstract [en]

    Background: In the last decade, research has highlighted the importance of interprofessional approaches to education and practice. Collaboration between medical practice and engineering has been identified as particularly relevant to developing accountable models for sustainable healthcare and overcoming increased specialization leading to professional barriers. This study aims to analyze insights and understanding expressed by nursing students and biomedical engineering students following a joint learning activity regarding a medical device used in the hospital setting.

    Method: A qualitative approach deriving from a phenomenological view examined an interprofessional learning activity where the focus was on active integration and knowledge exchange.

    Conclusion: The activity was expressed as a positive opportunity for getting insights into perspectives from other professional groups as well as insights into the importance of a system perspective in patient safety. The learning and insights listed in the evaluations included ideas about how the two professional groups could collaborate in the future.

  • 37. Orvik, Arne
    et al.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics. University of Borås, Sweden.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Organisatorisk hälsa och värdebaserat ledarskap – Behovet av systemperspektiv för en hållbar styrning och ledning av hälso- och sjukvården2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6Article in journal (Refereed)
    Abstract [sv]

    Anställda inom hälso- och sjukvården rapporterar ökade hälsoproblem. Syftet med denna artikel är att ge exempel på systemperspektiv på hälsoutmaningar inom hälso- och sjukvården utifrån begreppen organisatorisk hälsa och värdebaserat ledarskap. En tillämpning av begreppet organisatorisk hälsa inom hälso- och sjukvården innebär att hälsoproblem hos anställda och chefer ses i relation till de värdekonflikter som är kopplade till rådande styrningsideal.  Organisatorisk hälsa är ett exempel på ett begrepp som har ett tydligt systemperspektiv och kan definierats som en organisations förmåga att hantera spänningar mellan olika konkurrende värden på ett sätt som gynnar både patienter och anställda, och därmed organisationen som helhet. En tillämpning av begreppet organisatorisk hälsa inom sjukvården skulle kunna hjälpa chefer inom sjukvård att syna de värdekonflikter som finns och kunna bidra till reflektion kring hur dessa värdekonflikter skulle kunna hanteras. Vi menar att ett hälsofrämjande och hållbart ledarskap inom hälso- och sjukvården i större utsträckning kräver ett värdebaserat ledarskap som medvetet, tydligt och öppet hanterar de värdekonflikter som finns i vården.

  • 38.
    Palm, Kristina
    et al.
    Karolinska Univ, Dept Learning Informat Management & Eth, Solna, Sweden.;KTH Royal Inst Technol, Dept Sustainable Prod Dev, Sch Ind Engn & Management, Sodertalje, Sweden..
    Eriksson, Andrea
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Understanding salutogenic approaches to managing intensive work: Experiences from three Swedish companies2018In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 61, no 4, p. 627-637Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent research has highlighted the risks involved in work intensification; i.e. the risk of human resources being consumed, incurring higher risks of emotional ill health such as burnout among employees. At the same time, there are some indications that individual employees are being left to themselves to manage work tasks in intensive work environments. OBJECTIVE: This article explores how strongly engaged people master intensive work through coping and job crafting in a salutogenic way. METHODS: The article is based on 34 in depth interviews of persons in various professions within research and development departments in three Swedish companies. RESULTS: The interviews indicated that employees generally experienced work as almost constantly intense. We identified two strategies for mastering intensive work; i.e. an active strategy and a cognitive strategy, involving elements of both coping and job crafting. The specific elements of these strategies determine whether salutogenic processes are present. CONCLUSIONS: The results suggest that it is the specific elements of the coping and job-crafting strategies that determine whether or not salutogenic processes occur, and that organisational support is an important supplement to the individual processes for mastering intensive work.

  • 39.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health promoting leadership – a structure to build capacity for health in a healthcare organization2014Conference paper (Refereed)
  • 40.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Ergonomics (Closed 20130701).
    Hälsofrämjande arbetsmiljö–en framgångsfaktor för god vård2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 2, p. 175-188Article, review/survey (Refereed)
    Abstract [en]

    Work environment issues in health care have importance not only for employees but also for patients. The aim of this article is to describe important conditions for a health-promoting work environment, the significance of this for health care service, and how health-promoting work conditions can be developed. The results from our, as well as from others’, previous research show that employees’ work environment, health and engagement are critical for the improvements of quality of care and patient safety. Important factors are social capital (i.e. recognition, reciprocity and trust between humans), as well as practice-oriented approaches to developments based in system theory perspectives. The social capital can be compared to the fuel in a cycle creating work satisfaction, engagement and new ways of working and a practice-oriented and a servant leadership facilitates the development and the sustainability of this cycle.

  • 41.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH).
    Ahlstrom, Linda
    Högskolan i Borås, Sweden.
    Bergman, David
    Karolinska Institutet, Sweden.
    Dellve, Lotta
    KTH, School of Technology and Health (STH).
    The importance of Leadership for social capital among healthcare professionals2015Conference paper (Refereed)
    Abstract [en]

    Introduction

    Social capital, operationalized as perceived trust, reciprocity and recognition has in earlier research shown to be important for employees´ job satisfaction and to health care staffs´ engagement in clinical improvements of patient safety and quality of care as well as job satisfaction, health and wellbeing. Since social capital has an impact, it is of interest to investigate which factors that influence workplace social capital. Research findings shows that leadership has great importance to staffs´ health and wellbeing, and affects a number of factors in the work environment factors as job satisfaction and work engagement. If and how leadership is associated with social capital is rarely described in previous research. However the few studies performed indicate that there are associated correlations between leadership and social capital, and leadership quality and social capital. Leadership within healthcare sector has been in focus when working with redesign of care processes and it would be of interest to investigate the role of leadership and the quality of leadership with respect to social capital. The aim was to assess the importance of leadership for workplace social capital in hospital settings.

     

    Materials and methods

    This study was a longitudinal cohort study. Questionnaires to physicians, nurses, assistant nurses at five Swedish midsize hospitals was used to collect data (T0, n=865, T1, n=908). Bivariate, multivariate analyses was used and a mixed model repeated measurement for the longitudinal analyses (n=477) were performed.

     

    Results

    Relationship between staffs perceived quality of leadership and staffs´ social capital was found (R = 0.58, p-value <0.0001). Results of the analysis showed significant differences in levels of social capital between the groups of low, medium and high levels in quality of leadership. The differences between the groups sustained over time where the group with high levels in quality of leadership remained higher in levels of social capital than the other groups. Same pattern were seen in the other groups.

     

    Conclusion

    Leadership quality were related to-, had importance for- and influenced workplace social capital among health care staff.

  • 42.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Ahlstrom, Linda
    Bergman, David Kristofer
    Dellve, Lotta
    Leadership quality: a factor important for social capital in healthcare organizations2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 2, p. 175-191Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to investigate the relation between leadership and social capital and what qualities of leadership are important for social capital among employees in hospital settings over time. Design/methodology/approach - A cohort of employees in hospitals answered a questionnaire at three occasions. Five small (approx. 100-bed) or mid-sized (approx. 500-bed) hospitals were included. The response rate was 54 percent at baseline (n = 865), 59 percent at one-year follow-up (n = 908) and 67 percent at two-year follow-up (n = 632). Findings - Repeated measures over time showed differences between groups in levels of social capital with respect to levels of leadership quality. Relation-oriented leadership had the strongest association with social capital. There was evidence that leadership was associated with social capital over time and that different kinds of leadership qualities were associated with social capital. Research limitations/implications - This study conducted and analyzed quantitative data, and therefore, there is no knowledge of managers' or employees' own perceptions in this study. However, it would be interesting to compare managers' decreased and increased leadership quality and how such differences affect social capital over time. Practical implications - The findings feature the possibility for healthcare leaders to build high quality leadership as an important resource for social capital, by using different leadership orientations under different circumstances. Originality/value - The paper showed that leadership was an important factor for building social capital and that different leadership qualities have different importance with respect to certain circumstances.

  • 43.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Bergman, David
    Karolinska Institutet, Sweden.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics. University of Borås, Sweden.
    Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 53, p. 116-125Article in journal (Refereed)
    Abstract [en]

    Background: Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. Objectives: To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. Design: A prospective cohort design was used. Settings: Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Participants: Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. Methods: The participants answered a questionnaire at two occasions, NN = 1602 at baseline and NN = 1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Results: Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Conclusion: Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff.

  • 44.
    Strömgren, Marcus
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Social capital and its associations to employees active work with clinical development and health2013Conference paper (Refereed)
  • 45. Strömgren, Marcus
    et al.
    Lotta, Dellve
    Eriksson, Andrea
    Hälsofrämjande arbetsmiljö–en framgångsfaktor för god vård. 2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 2, p. 177-185Article in journal (Refereed)
  • 46. Tjulin, Åsa
    et al.
    Landstad, Bodil
    Vinberg, Stig
    Eriksson, Andrea
    Hagqvist, Emma
    Managers’ learning process during a health-promoting leadership intervention2019In: Health Education, ISSN 0965-4283, E-ISSN 1758-714XArticle in journal (Refereed)
  • 47.
    Williamsson, Anna
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics. University of Borås, Sweden.
    Organization of change agents during care process redesign in Swedish health care2016In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 5, no 3, p. 20-32Article in journal (Refereed)
    Abstract [en]

    Background: Swedish health care organizations (HCOs) are changing using management concepts such as Lean, in attempts of improving efficiency, quality of care and work environment. Since there are pre-conditional challenges for operative managers to engage in change, HCOs tend to assign supportive functions such as change agents (CAs) to facilitate change. Research on the use of CAs in HCOs is sparse, thus the aim of this study explores role assignments and conditions of formally appointed CAs contributing to care process redesign.

    Methods: A purposive sample of three Swedish hospitals initiating Lean-inspired care process redesign during 2010–2011 was done. In-depth interviews were held with fifty-one key functions during change. Focus group interviews were conducted with thirty-eight health care professionals. Data were analysed by content analysis.

    Results: Top managers’ goal was to have operative management responsible for change during care process redesign, with support from assigned CAs. Organizing of CAs varied concerning, e.g. their hierarchical positions, job descriptions and practices, and conditions to act as driving forces towards change. Being granted formal power, having earned legitimacy and credibility, clarity regarding roles and responsibilities in change; a good sense of timing and ability to build relationships and trust, were identified as beneficial for CAs to support change.

    Conclusions: Role assignment and organizing of CAs varies. A position closer to the operative levels, formalized and clarified responsibilities, earned legitimacy and timing support adaptation and alignment of planned change, such as Lean-inspired care process redesign.

  • 48.
    Williamsson, Anna
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    The organization and work practice of change agents in health care organizations; effects on health care professionals’ engagement and participation in improvement work2014Conference paper (Refereed)
  • 49.
    Williamsson, Anna
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Who are the change agents when hospitals are implementing Lean?2013Conference paper (Refereed)
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