Purpose: The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the complexity of the health- and elderly care systems provides challenges in improving system efficiency. Hence, the system-level understanding of the main obstacles to integration care needs further exploration. In order to better integrate health- and elderly care, the study needs to identify the actual misalignments underpinning the issue. This study provides the theoretical foundations for resource misalignments and provides empirical examples of these. Design/methodology/approach: Semi-structured interviews with multiple stakeholders on various hierarchical levels were carried out to create a more complete view of the system and resources deployed in health- and elderly care. The application of user-centered design methods and co-creation with employees have also been crucial to the outcomes of the study. Findings: Results show that health- and elderly care is a large-scale complex system. The overlapping and mutually reinforcing misalignments are: (1) regulation and policy differences, (2) stakeholder quantity and variation, (3) external control of health- and elderly care, (3) decreasing collaboration and (4) communication channels and IT development. Originality/value: This qualitative study builds on institutional theory and resource integration theory and contributes with empirical descriptions of misalignments in the health- and elderly care system. These descriptions will serve as points of departure for systems design to improve the efficiency and effectiveness of health- and elderly care.

This Research Full Paper explores different implementations of and teachers’ experiences from challenge-driven education and similar learning approaches in engineering education and other higher education contexts. Through an action research approach key concerns among the teachers and similarities and differences between the studied courses can be identified. The study highlights the potential in these learning approaches, as means for breaking and going beyond the traditional boundaries of higher education, enhancing and cross-fertilizing engineering education with other disciplines, and empowering students both as professionals and humans. It also indicates potential barriers and in-built tensions that are crucial to handle for successful implementation. The study further shows on great opportunities for mutual learning and collaboration between teachers from diverse contexts and backgrounds. The findings are discussed in relation to research within domains such as sustainability education, transformative learning, and futures studies, and opportunities for further research and development are outlined.

In a turbulent environment, increased flexibility and efficiency are essential for most firms to survive. Many organizations have responded to the need for greater efficiency and productivity by building more Agile structures and shifting to the implementation of Agile software (SW) methodologies. Although the adoption of Agile methodologies is becoming widespread, robust empirical evidence on their effectiveness is lacking as is evidence of the improvements brought by Agile compared to other methods. This chapter provides empirical evidence on the impact of Agile on organizational product and process innovation and learning. Authors investigate the following research question: How does use of Agile methods impact on product and process related innovation and learning in teams? While the relationship between the investment in knowledge and innovation output has been studied extensively, little work focuses on the role of Agile in growing the organization’s knowledge base through team learning. The data collected include traditional R&D innovation indicators and also in-depth measures of organizational performance and overall team outcomes, which allow us to study not only the extent to which Agile impacts on the firm’s innovation and learning performance but also the dynamic team learning process.

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.

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.

Purpose - This paper aims to contribute to the exploration of micro-foundations for innovation in autonomous team-based firms. It describes how different types of management control systems influence the innovation performance of teams through an extensive field study of a large scale agile implementation. It reveals the moderating role played by different kinds of managerial control systems and by perceived time pressure on teams in the relationship between a team's absorptive capacity and its innovation performance. Design/methodology/approach - A total of 44 individual semi-structured interviews were used to collect data over three separate data collection stages conducted from August to November 2013. All data were triangulated with the qualitative content analysis results of free comments from 121 people, covering different agile roles in the same organizations as above, and embedded in a survey performed in August 2013. Due to the complexity of the topic and the lack of prior studies investigating the effect of agile implementation on team learning and innovation capabilities, an abductive research approach (Peirce, 1931) was selected as a suitable method. Originality/value - The empirical results indicate that a team's beliefs on the importance of learning strongly influence its self-regulated learning behaviours. They represent the configuration of AC meta-routines underlying the concept of absorptive capacity (Lewin et al., 2011) at the team-level, conducive to teams' exploration activities. Moreover, the antecedents for a team's exploitative and exploratory innovation activities are presented and two types of managerial controls for driving exploitative innovation activities are identified. Additionally, team-level absorptive capacity was analysed, since it is a less explored, but important construct, leading to a team's exploitative product innovation. Practical implications - This study's findings have a number of implications for practice. The results imply that autonomous team-based organizations may be better off not using one single standard control system to manage all their teams. In fact, beyond securing a team's access to knowledge, management needs to provide teams with differentiated means to develop necessary competencies and capacities for understanding, assimilating and using the knowledge they retrieve. In addition, management should influence a team's beliefs by valuing the tasks requiring innovation and transmitting sustainable values to teams through their mission and vision statements.