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Creating a Force of Development in Swedish Healthcare: A Contribution from the First-Line Managers’ Perspective When Driving Improvement Work Based on Lean
Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Management and Mechanical Engineering.
2019 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is about the healthcare managers, working at operational levels, defined as the first-line managers. These managers often are given the role and responsibility to integrate improvements into daily work. A stronger development ability of Swedish healthcare requires first-line managers with a developed ability to lead change. Thereby efforts must be made to provide these managers with supportive work conditions when leading and developing organizations. One approach to organizational development is Lean, which refers to a strong improvement culture based upon a supportive and highly engaged leadership as well as a strong customer focus. The purpose of this thesis is to contribute to knowledge about and an understanding of the conditions that influence first-line healthcare managers’ abilities to drive improvement work based on Lean. Some of the conditions investigated are; time, receiving support from the own manager, feeling joy in improvement work and being assured about the effects of Lean.

The thesis is based on three separate analyses of a web-based survey, which relate to the two research questions. The study was conducted in a Swedish healthcare organization two years after the initiation of Lean. The analyses are presented in three separate papers. The first research question considers; How can an instrument be developed that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? The second question is; What can be learned from using the instrument that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? A qualitative study based on a hermeneutic, inductive, qualitative research approach was conducted in order to meet the research purpose and answer the research questions.

The thesis is mainly based on three papers. In paper 1 it is stated that the assuredness about the effects of Lean was quite high among the managers when the survey was conducted, such as that Lean contributes to a greater patient focus and to the development of an improvement culture. In paper 2 it is noted that the first-line managers view their role as crucial in improvement work based on Lean. Time, support from coworkers, and a clear vision and clear goals were the three conditions they considered to be most important for their ability. The results presented in paper 3 show that to initiate improvement work based on Lean, they ask for own managers who are assured about Lean and include them in discussions. They view their role and responsibility in relation to their coworkers as extensive, for instance increating a culture where problems and mistakes are viewed as possibilities to improve and for encouraging that new work procedures are tested. The findings indicate a need for a deeper understanding of Lean. It is concluded that a thorough understanding of Lean is a main condition for the first-line managers´ ability to drive improvement work based on the approach. Developing a common view of Lean takes time, which is important to emphasize in the practical setting to motivate for a long-term perspective. This development takes highly motivated, assured and persistent leaders with a continuous improvement attitude and a mission to improve healthcare together.

There is also an applied research question; How can the use of the instrument contribute to developing first-line managers’ role, conditions, and ability to drive improvement work based on Lean? In its essence, Lean is concerned with improving a system and since the instrument raises questions about relationships between organizational members, it sets focus on the system and calls on a system view. The responsibility for one management level must continuously be set I relation to another, when putting the pieces together in the “improvement puzzle”. Change depends on adjustments in human behavior and the instrument establishes a focus on the people in the processes necessary for development and results. The instrument also provides opportunity and structure to investigate and talk about the soft conditions important for the ability, such as receiving support from the own manager, and feeling inspiration and being assured. The practice of Lean requires changes in attitudes, new habits, new skills in the whole system, meaning in each individual from the executive management to the front-line workers. Thereby self-reflection becomes important, which requires forums for dialogue. It is concluded that such forums can influence first-line healthcare managers’ abilities to drive improvement work based on Lean. In dialogue forums improvement work can be reflected upon and learned from together.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University , 2019. , p. 82
Series
Mid Sweden University licentiate thesis, ISSN 1652-8948 ; 162
Keywords [en]
healthcare, first-line managers, organizational development, improvement work, Lean
National Category
Reliability and Maintenance
Identifiers
URN: urn:nbn:se:miun:diva-37216ISBN: 978-91-88947-18-5 (print)OAI: oai:DiVA.org:miun-37216DiVA, id: diva2:1359549
Presentation
2019-10-09, O213, Östersund, 10:00 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för framläggningen av avhandlingen var följande delarbeten opublicerade: delarbete 2 (accepterat), delarbete 3 (inskickat).

At the time of the defence the following papers were unpublished: paper 2 (accepted), paper 3 (submitted).

Available from: 2019-10-09 Created: 2019-10-09 Last updated: 2019-10-09Bibliographically approved
List of papers
1. Lean from the First-line Managers’ Perspective: Assuredness about the Effects of Lean as a Driving Force for Sustainable Change
Open this publication in new window or tab >>Lean from the First-line Managers’ Perspective: Assuredness about the Effects of Lean as a Driving Force for Sustainable Change
2017 (English)In: Management and Production Engineering Review, ISSN 2080-8208, E-ISSN 2082-1344, Vol. 8, no 2, p. 49-56Article in journal (Refereed) Published
Abstract [en]

The purpose of this article is to present the results from a survey concerning first-line managers’ assuredness about the effects of Lean after two years of Lean application in a Swedish healthcare organization. The purpose is also to reflect about assuredness as a driving force for sustainable change. Questionnaires were sent to all first-line managers in a healthcare organization in order to investigate how these managers consider their role, ability and conditions to create change according to Lean. One of the questions included 17 statements about how assured these managers were about the effects of Lean. The results from this question will be presented in this paper. The study showed that the majority of the first-line managers in this particular healthcare organization were assured that developmental work supported by Lean contributes to a higher patient focus, supports first-line managers with useful tools and methods, contributes to the development of an improvement culture and that the Lean concept in general is a support in improvement work. The question can either be used separately or as a part of an entire questionnaire in healthcare organizations. Asking first-line managers about their assuredness about the effects of Lean on a regular basis is one way to follow the Lean process from their perspective. The survey question might encourage discussions about the process of Lean and hopefully contribute to a greater understanding about the importance of assuredness and about the desired effects when applying Lean.

Keywords
Lean, Lean healthcare, leadership, improvement work, first-line managers, assuredness
National Category
Reliability and Maintenance
Identifiers
urn:nbn:se:miun:diva-31548 (URN)10.1515/mper-2017-0017 (DOI)000411225000006 ()2-s2.0-85024828778 (Scopus ID)
Available from: 2017-09-07 Created: 2017-09-07 Last updated: 2019-10-09Bibliographically approved
2. Creating a development force in Swedish healthcare: a focus on the first-line managers’ perspective when applying Lean
Open this publication in new window or tab >>Creating a development force in Swedish healthcare: a focus on the first-line managers’ perspective when applying Lean
2019 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 32, no 8, p. 1132-1144Article in journal (Refereed) Published
Abstract [en]

Purpose The purpose of this paper is to present the results from a study that investigates first-line healthcare managers' views on their role and the conditions that influence their ability to drive improvement work based on Lean. Design/methodology/approach A questionnaire was sent to all first-line managers in a healthcare organization to investigate their views on their role, conditions and ability to create change according to Lean. The results from four of the questions are presented, which focus on how crucial they consider their role to be for managing improvement work based on Lean, what work tasks their time is spent on, what factors they consider to be important to their ability to drive change and what factors best describe what Lean provides. Findings The results show that first-line managers claim that their role is crucial in improvement work, but when they defined their work tasks, the time spent on improvements was not frequently described. Time, support from coworkers, and a clear vision and clear goals were the three factors that they considered to be most important to their ability to drive improvement work. Considering their leadership, Lean contributed to the structure with tools and supportive methods. Originality/value The questions can be used separately or as part of the entire questionnaire before and along a Lean process to obtain a better understanding of how to create a sustainable Lean approach in healthcare. Understanding the factors that first-line managers consider supporting their ability in improvement work and what they consider Lean provides is important in creating a development force in Swedish healthcare.

Keywords
Healthcare, Lean; Leadership, First-line managers, Improvement work
National Category
Reliability and Maintenance
Identifiers
urn:nbn:se:miun:diva-37217 (URN)10.1108/IJHCQA-01-2019-0017 (DOI)000488244900002 ()31566512 (PubMedID)2-s2.0-85072745663 (Scopus ID)
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-11-14Bibliographically approved
3. "Stuck in the middle” Healthcare first-line managers´ responsibilities and needs of support when applying Lean
Open this publication in new window or tab >>"Stuck in the middle” Healthcare first-line managers´ responsibilities and needs of support when applying Lean
(English)In: Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:miun:diva-37218 (URN)
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-10-09Bibliographically approved

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