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  • 1.
    Andreasson, Jörgen
    et al.
    University of Borås, School of Health Science.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, School of Health Science.
    Health care manager’s views on and approaches to implementing models for care processes.2014Conference paper (Refereed)
  • 2.
    Andreasson, Jörgen
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Health care managers' views on and approaches to implementing models for improving care processes.2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Article 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.

  • 3.
    Andreasson, Jörgen
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Åhlström, Linda
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Andrea
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    The importance of nurse managers’ preconditions and support resources for their attitude and work with improved quality of care2015Conference paper (Refereed)
  • 4.
    Dellve, Lotta
    et al.
    University of Borås, School of Health Science.
    Andreasson, Jörgen
    University of Borås, School of Health Science.
    Jutengren, Göran
    University of Borås, School of Health Science.
    Hur kan stödresurser understödja hållbart ledarskap bland chefer i vården?2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6, 866-877 p.Article in journal (Refereed)
    Abstract [sv]

    Chefer kan ha stor betydelse för anställdas hälsa, stress, engagemang i arbetet och prestation. Få tidigare studier har undersökt vilket stöd chefer behöver för ett hållbart och bra ledarskap. Artikeln presenterar resultat från en prospektiv studie om betydelsen av chefers stödresurser för hållbart ledarskap. I studien, som är en del av Chefios-projektet, ingår chefer i kommunal vård och omsorg (n=344). Data från enkätstudier med instrumentet ”Gothenburg Manager Stress Inventory” har analyserats. Resultatet visar att ett stödjande privatliv och en personlig inställning till chefsuppdrag har stor betydelse för chefers hållbarhet över tid. Chefens kontrollspann och erfarenhet som chef påverkade betydelsen av stödresurser. För chefer med kortare chefserfarenhet eller fler underställda (>30) har även stöd från ledning, chefskollegor och externt stöd betydelse.

  • 5.
    Dellve, Lotta
    et al.
    University of Borås, School of Health Science.
    Eriksson, Andrea
    Williamsson, Anna
    Holden, Richard
    Strömgren, Marcus
    Andreasson, Jörgen
    University of Borås, School of Health Science.
    Lean implementation approaches at different levels in Swedish hospitals: the impor¬tance for working conditions, worker engagement, health and performance.2014Conference paper (Refereed)
    Abstract [en]

    This paper reports result from one-year follow up in a research program with the overall aim to investigate how implementations of lean in health care affect working conditions, health, and performance of employees at five Swedish hospitals. This paper summarizes the implementation approaches, and their importance at short-term follow up for performance (with regard to active work with improvements), perceived working conditions and stress-related health among the healthcare workers. The implementation strategies and pace varied between the hospitals and between the strategic and operative levels. This short-term follow up showed that physical stress-related symptoms had increased overall but the cognitive stress had increased only in hospitals implementing lean. In hospitals with high implementation pace, there were more improvement work among the employees, but higher quantitative demands and lower job satisfaction.

  • 6.
    Dellve, Lotta
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Williamsson, Anna
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Strömgren, Marcus
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Holden, Richard
    University of Indiana, US.
    Åhlström, Linda
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andreasson, Jörgen
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Eriksson, Andrea
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up2015Conference paper (Refereed)
    Abstract [en]

    Introduction The public sector has during the last decades been struggling with the challenge of how to increase the efficiency, the quality of performance, as well as with problems related to work environment and recruitments. Hospitals have struggled with increased focuses on costumer orientation, rationalizations and care processes redesign, and have often used Lean production (LP) as management model.

    Aim to assess the long-term importance of implementing LP in hospitals for the psychosocial work conditions.  Based on earlier research (e.g. Westgaard & Winkel, 2011), the following hypothesis were tested (1) Strategic large scale  implementation of LP is associated with negative impact on mental health; (2) Implementation of LP is associated with weak negative impact on psychosocial work conditions; (3) The association between implementation of LP and psychosocial conditions is moderated by profession and participatory approaches.

    Method  Five hospitals working with improvements of care processes were studied 2012-2014 using questionnaires to employees (T1 n=1303) and interviews at strategic and operative levels. Analyzes with mixed models repeated measurements were performed. The explaining variables for the models were implementation of lean at strategic resp operative level, and time (T1, T2, T3). The outcome variables were work-related health (SRH, work ability, stress-symptoms) and psychosocial work conditions.

    Results  Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There were no overall differences in self rated health and work ability with regard to implementation of LP. A higher degree of LP at operative level was associated with decreased work demands. There was, especially initially, more beneficial or improved working conditions in relation to higher degree of LP at operative levels. The long-term follow-up showed that quantitative demands increased and predictability as well as leadership decreased in the non-lean hospitals. There were different patterns with regard to profession and participatory approaches that will be presented.

  • 7. Holden, Richard
    et al.
    Eriksson, Andrea
    Andreasson, Jörgen
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Williamsson, Anna
    Dellve, Lotta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    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. 47, 181-192 p.Article 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.

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