Mid Sweden University

Purpose – The purpose of this paper is to examine what happens with the internal view an organisation has on information management when a holistic view is diminished into a blinkered view and the consequences it conveys for the customer. The customer consequences are divided into two parts – creation of external customers’ values and creation of value for the internal customer explored in terms of efficiency.

Methodology/approach – Interviews with both outsourced co-workers and project leaders still in the organization.

Findings – The organisations lack of listening to the external customer affects all three areas lifted in the analysis. The studied organisations have great opportunities for developing their process for producing TI, both regarding their mutual relationship as well as in regards to the external customer with the help of Lean and by applying a more holistic view on the production of Technical Information.

Keywords – Information management, Lean, Customer value, Technical Information, Efficiency

Paper type – Case study

Purpose - The purpose was to examine the relationship between Lean values, Lean leadership and perceived co-worker health.Methodology/approach – A questionnaire used at a Swedish municipality that has been working with quality improvements for 20 years and with Lean for seven years was analyzed. More than 800 co-workers were asked to fill in the questionnaire which had been designed and earlier tested to measure the presence of a number of Lean values and Lean leadership as well as self-reported perceived health.Findings – The results show a medium positive relationship between Lean values, Lean leadership and the co-workers’ perception of their health. Customer focus presents the highest mean value, the lowest standard deviation and the highest correlation with co-worker health, which is interesting as the investigated organization is a municipality.

Many Quality Management approaches, such as Lean, are deficit-based and focus on problems and how to overcome them and another way to approach this could be to focus on possibilities.  When focusing on problems instead of possibilities, organizations are prevented from using their full potential which leads to decreased organizational capacity. Appreciative Inquiry is, in contrast to a deficit-based approach, a positive approach to change. The problems should not be ignored but, by focusing on strengths, this approach could be more effective when it comes to promoting better workplace health. 

Earlier research has examined if Lean values affect co-workers’ perceived health and found a connection. Even though the relationships between co-workers’ perceived health and Lean leadership and also Lean values were not very strong, they are all positively correlated. What happens however if we introduce Appreciative Inquiry to see in what way it links to Lean values and co-worker perceived health?

Purpose - The purpose of this paper is to explore if and how Appreciative Inquiry correlates with Lean values and co-workers’ perceived health.

Methodology/approach – To investigate the relationship between Lean, Appreciative Inquiry and perceived co-worker health, a questionnaire was developed based on two previously tested questionnaires.  The new questionnaire was filled in by 841 co-workers at a Swedish municipality and was then analysed to explore in what way Appreciative Inquiry correlates with a number of Lean values as well as perceived co-worker health.

Findings – All variables were found to be significantly correlated with the variable ‘Appreciative Inquiry’. The variable ‘Continuous improvements’ relates most to ‘Appreciative Inquiry’ followed by ‘Eliminating Waste’ as those variables can be considered to have a large positive relationship. ‘Supportive Leadership’ and ‘System view’ have a medium positive relation to ‘Appreciative Inquiry’ and the variables ‘Health’ and ‘Customer focus’ have a small relation to Appreciative Inquiry in this context.  

Keywords Supportive leadership, Lean values, co-worker health, Appreciative Inquiry

Paper type Case study

Purpose: The purpose of this article is to examine the relationship between Lean values, Lean leadership and perceived co-worker health both from an empirical and theoretical perspective. Methodology/Approach: A questionnaire used at a Swedish municipality that has been working with quality improvements for 20 years and with Lean for seven years was analyzed. 841 co-workers answered the questionnaire which had been designed and pre-tested to measure the presence of a number of Lean values and Lean leadership as well as self-reported perceived health.  Findings: The results show a moderately positive relationship between Lean values, Lean leadership and co-workers’ perceptions of their health. Customer focus presents the highest mean value, the lowest standard deviation and the highest correlation with co-worker health, which is interesting as the investigated organization is a municipality.

Purpose: The purpose of this paper is to present a developed questionnaire which measure Appreciative Inquiry, Lean values and co-workers health. The purpose is also to explore if and how Appreciative Inquiry correlates with Lean values and co-workers’ perceived health in an organisation working with Lean. Methodology/Approach: To investigate the relationship between Lean, Appreciative Inquiry and perceived co-worker health, a questionnaire was developed based on two previously tested questionnaires. The new questionnaire was answered by 841 co-workers at a Swedish municipality and was then analysed to explore in what way Appreciative Inquiry correlates with a numberof Lean values as well as perceived co-worker health. Findings: All variables were found to be significantly correlated with the variable ‘Appreciative Inquiry’. The variable ‘Continuous improvements’ relates most to ‘Appreciative Inquiry’ followed by ‘Eliminating Waste’ as those variables can be considered to have a large positive relationship. ‘Supportive Leadership’ and ‘System view’ have a medium positive relation to ‘Appreciative Inquiry’ and the variables ‘Health’ and ‘Customer focus’ have a small relation to Appreciative Inquiry in this context.

The purpose of this paper was to present a model for creating a shared picture of customer expectations within an organization based on both internal and external perspectives.

Methodology: A model was developed in a joint research project between a municipality and the university in a series of workshops followed by discussions and analysis with researchers and project members. The model and its components were designed, tested, and redesigned throughout the whole project. 

Main Findings: A model based on the PDSA-cycle with components including instructions and templates how to work with capturing perceived customer value, customer expectations and missing value and conduct value analysis, gap analysis and continuous improvements.

Practical implications: A model that can be adapted to every organization who wants to create a shared picture of the customer, customer expectations and then base the work with improvements from customers’ expectations.

Originality/value: A model for none profit organizations to identify values they provide to the citizens, as well as examine if they fulfill citizens expectations. Through the model find areas for continuous improvement in the endeavor to create value for customers. 

Increasing the efficiency of patient treatment as well as improving patient care quality and reducing waiting times are challenges facing healthcare systems around the world (Fine, et al., 2009). Furthermore, there is a challenge to increase the number of patients treated and to cut waiting times while retaining costs under control as well as becoming a more attractive employer (van Rossum et al., 2016). In order to meet the challenges in healthcare, different Quality Management (QM) initiatives have been applied (Seidl and Newhouse,2012). Lean and Six Sigma are popular QM initiatives originating from manufacturing but also used in the healthcare sector. Six Sigma and Lean can be used to detect value adding processes and also confirming control and sustainability of change through establishing plans (ibid). The purpose of this paper is to describe a shared picture of the situation and to identify general possibilities for improvements focusing on the transitions between wards.

Projektet har fokuserat på att skapa ny kunskap om och hur förbättrade vårdprocesser och vårdkulturer kan resultera i minskade återinläggningar, färre oönskade händelser i samband med förflyttning samt medföra för närstående en förbättrad upplevelse vid patient omflyttningar. Det övergripande syftet med projektet har varit att skapa ny kunskap om hur kvalitet och effektivitet i hälso- och sjukvårdens vårdkedja kan förbättras med specifikt fokus på ledarskap, vårdkontinuitet, säkerhetskultur och lärande.

Abstract

Purpose – The purpose of this paper is to compare health related values within Quality Management with Key Principles of Communicative Leadership in order to see if Communicative leaders also promote healthy co-workers.

Methodology/approach – A literature review was conducted within the area of Communicative Leadership and within the values of health related Quality Management. The principles within Communicative leadership were compared with the underlying dimensions within the health related values ‘Leadership Commitment’ and Participation of everybody’.

Findings – The analysis shows that the underlying dimensions within both of the health related Quality Management values ‘Participation of everybody’ and ‘Leadership commitment’ were related to some of the Key Principles of Communicative Leadership. Practical implications – The results can help Communicative Leaders to emphasize the Key Principles that also promote healthy co-workers. The results can also help leaders that already have healthy co-workers to increase leaders’ communication competence within organizations.

The purpose of this paper is to compare health related values within Quality Management with Key Principles of Communicative Leadership in order to see if Communicative leaders also promote healthy co-workers.  A literature review was conducted within the area of Communicative Leadership and within the values of health related Quality Management. The principles within Communicative leadership were compared with the underlying dimensions within the health related values ‘Leadership Commitment’ and Participation of everybody’. The analysis shows that the underlying dimensions within both of the health related Quality Management values ‘Participation of everybody’ and ‘Leadership commitment’ were related to some of the Key Principles of Communicative Leadership. The results can help Communicative Leaders to emphasize the Key Principles that also promote healthy co-workers. The results can also help leaders that already have healthy co-workers to increase leaders’ communication competence within organizations.

Purpose - The purpose of this paper is to describe leaders’ views on how Communicative Leadership influences co-worker health by comparing their opinions with the health-related values within Quality Management.

Design/methodology/approach - A multinational manufacturing organization that has been working with Communicative Leadership for several years was investigated. 21 managers trained in Communicative Leadership were interviewed and asked about their views on how their communication influences both the well-being of their co-workers and the working environment. Various communication behaviors and communication methodologies emerged from the interviews and were then analyzed versus the health-related Quality Management dimensions.

Findings - The result shows concrete communication behavior and methodologies that influence co-worker well-being and the working environment positively and negatively. Another result is a description of the prerequisites for managers to be able to communicate in a way that influences co-worker well-being and the working environment. The analysis of the communication behaviors and communication methodologies versus the health-related Quality Management values shows that several of the health-related Quality Management dimensions were present.

Research limitations/implications – A limitation of this research is that it is just managers’ view that has been investigated and analyzed.

Practical implications – Managers acting and behaving in accordance with the communicative behaviors and methodologies described in the results can influence co-worker health and the working environment in a positive way. The level of awareness of the prerequisites could help managers to influence co-worker well-being and create a good working environment.

Originality/value – The connection between Communicative Leadership and health-related Quality Management values is rarely made. This research can contribute to greater understanding in both areas.

Keywords Health-related Quality Management, co-worker health, Communicative Leadership, well-being, working environment.

Paper type Research paper. 

Purpose – The purpose of this paper explore effects of a communicative leadership development program in an organization and to present and discuss results from assessing Quality Culture and co-worker health in the same organization.

Methodology/approach –  In a company conducted a communicative leadership developing program, a questionnaire measuring QM values and co-worker health has been handed out to leaders and co-workers. Leaders conducted a communicative leadership developing program have been interviewed and observation studies have been conducted. 

Findings – The interviewed and observed leaders are working with communicative leadership in a structured way, The measured factors, assessing quality culture and co-worker health showed rather high mean values.

Practical implications – The communicative leadership developing program seams to help leaders to communicate in a structured way.

Purpose: The purpose of this paper is to explore existing and desired methodologies for systematic quality work to promote quality in preschools from the principal’s perspective. Design/methodology/approach: A collaborative approach was used in this research project, and principals were asked to complete portfolio assignments. Their answers to those portfolio assignments were analysed by the research team and subsequently compared to total quality management values. Findings: Existing and desired methodologies for systematic quality work are presented and sorted into 13 and 17 groups, respectively. The principals desire four times more methodologies than they are presently using to promote systematic quality work, and the results show that they must extend their methodologies to support TQM values. Research limitations/implications: This research is based on answers collected from 18 principals in one municipality in Sweden. Practical implications: The use of the cornerstone model provides a framework to illustrate the application of TQM in preschools. Originality/value: Principals struggle to find time for systemic quality work. The presented results can be used to work systematically with quality in preschools and other organizations. 

In 2015, a project was initiated to explore how quality can be enhanced in Swedish businesses by developing an internal coaching process to support value-based leadership development. The three–year project, financed by The Knowledge Foundation, is a research and development partnership consisting of three Swedish manufacturing companies and Mid Sweden University. Results presented in the poster address both the process and outcomes from this project.

Purpose

To present the results in changes in a company's value-base two years into a project with the purpose to explore how quality can be enhanced when a value-based leadership is integrated with sustainable practices.

Method:

A number of activities were completed in the company. A survey was designed to measure SQD values as an indicator for value based leadership. The survey were administered both at the start of the project and then again one year later to measure changes in leadership and values. The results from the survey were first analyzed using SPSS (Cronbach Alpha and T-test) and then in relation to completed activities. This was done by the research team together with management team in the company.

Results:

The results will be the presentation of completed activities within the company as well as results from the two measurements shows that the mean of the measured values are higher in the second measurement when it comes to the whole factory. When it comes to the managers it is the opposite regarding how they look at their role when it comes to the values: Leadership commitment and Participation of everybody.

Conclusions so far:

• Measuring soft aspects helps to focus on culture and values.
• The wording of the statements can affect culture.
• Talking about leadership in connection to an organizations unique context initiates new dialog forms, topics, and gives the leaders a “leadership language”.
• Focusing on positive aspects of leadership creates energy and a solution focused climate.
• Statistically significant results can be shown after such a short period as one year.
• Increased pride in the team and the work-place!
• Further investigate correlations between factors. 

Abstract

One of the most critical aspects for building quality and innovation in organizations is the role of values. Performance suffers when organizations fail to prioritize values. A challenge for many leaders is to understand deep-rooted values together with what they are and how they are developed. These deep-rooted values are reflected in the behaviors, language and signs occurring in the organization and can be seen as the organizations culture. When a culture is shaped, leadership is central and the managers in the organization are vital. Managers in an organization affect the predominating culture through their behaviors and approach to their co-workers. This make it interesting to try to find out underlying values held by managers striving for good leadership and performance. Underlying values can be unconscious and taken for granted, and thereby hard to ask about.  By using an interview guide inspired by Appreciative Inquiry (AI) (an approach based on generativity and positivity), underlying values and the leadership used by top managers can be discovered.

Purpose - The purpose of this paper is to present and discuss the results from the Appreciative Inquiry (AI) inspired interviews to explore the underlying values held by top manager and to identify soft aspects of leadership.

Methodology/approach – Top managers were interviewed as a part of a research project with the aim to support the development of value-based leadership that integrates company values, organizational culture, customer needs and sustainable development. A structured interview guide, inspired by AI, was developed and used to pinpoint their motivation and vision of a good organization in order to understand the values the leaders had and to identify soft aspects of leadership.  The interviews were analyzed in workshops with the whole research group and structured and visualized through affinity chart.

Findings – The results show underlying values held by top managers and identified soft aspects of leadership.

Practical implications – The presented interview guide can be used to identify the top managers underlying values and the presented results from the interviews can be used to inspire other leaders to develop their leadership in their striving of good leadership and effective organizations.

Purpose – The purpose of this paper is to present and discuss the results from the appreciative inquiry (AI)-inspired interviews to explore the underlying values held by top managers and to identify soft aspects ofleadership.Design/methodology/approach – Top managers were interviewed as a part of a research project withthe aim to support the development of value-based leadership that integrates company values, organizationalculture, customer needs and sustainable development. A structured interview guide, inspired by AI, wasdeveloped and used to pinpoint their motivation and vision of a good organization to understand the valuesthat the managers had and to identify soft aspects of leadership. The interviews were analyzed in workshopswith the whole research teamand structured and visualized through affinity diagrams.Findings – The results showed the underlying values held by top managers and identified soft aspects ofleadership.Practical implications – The presented interview guide can be used to identify the top managers’underlying values, and the presented results from the interviews can be used to inspire other managers andleaders to develop their leadership in their striving of good leadership and effective organizations.Originality/value – The paper explains how to apply an AI-inspired interview guide in finding out valuebasedleadership and soft aspects of leadership for enhancing organizational culture.

For leaders to successfully meet the complexity of businesses today, many argue the need to design a performance measurement system that integrates hard data outcomes with soft measures found in organizational culture including values, norms, and behaviors. The purpose of this paper is to present an approach to collecting baseline data that captures the soft dimensions of organizational culture with system thinking as a guiding theory. The results present an approach for measuring the soft dimensions of organizational culture with description of methods, the type of data and what level of organizational culture they measure.

Purpose – The purpose of this study is to develop a model describing different factors that affect quality andefficiency in transitional care.

Design/methodology/approach – A meta-synthesis focusing on the transitions between wards wasconducted within a research project. The results from eight studies within that research project have beencombined and analysed from a holistic view.

Findings – The findings are a model with a description of seven different categories consisting of the identifiedfactors affecting quality and efficiency in transitional care. Those categories are (1) learning organisation,(2) standardising and structuring, (3) applying a holistic view, (4) understanding organisational culture in ahealth care context, (5) management and leadership, (6) for whom value is created and (7) working together. The results from the study have been verified in previous research.

Research limitations/implications – The result of the completed meta-synthesis is based on studiesconducted at two medium-sized hospitals in Sweden. The developed model can be used in a similar context toimprove quality and efficiency in patient transfers by management and employees working based on thevarious factors.

Originality/value – This model describes factors (success factors, prerequisites, conditions and lack thereof) affecting the ability to achieve quality and efficiency in transitional care that can be used in future research aswell as for practical improvements.

There are challenges faced by many countries around the world related to an increasing number of elderly people and a shortage of health care personnel. The purpose of this paper was to explore the extent to which the magnet model and core values of TQM offer complementary perspectives with the intention of providing a good working environment for health care professionals and better quality of care for elderly people. The magnetic forces were analysed versus the core values/cornerstones of TQM. The results show similarities that reinforce the quality of care and a good working environment for health care professionals.

The purpose of this paper is to describe the core leadership behavior in Change Oriented Leadership, the KaosPilots and Deming´s 14 points. Furthermore we aim to compare similarities and differences in these leadership behaviors, in order to propose new leadership behaviors within Quality Management to fit tomorrow´s more creativity based organizations. Methodology The research has been conducted through describing and comparing core leadership behaviors, in Change Oriented Leadership, KaosPilots and Deming´s 14-points. Findings Our comparison indicates that there are behaviors in the Change Oriented Leadership that are missing in Quality Management and probably would benefit organizations if they were adopted. The leadership that the KaosPilots addresses is different from the leadership in Quality Management in many ways but probably necessary to learn from to meet new demands from the customers and the co-workers. Originality/value Leadership within Quality Management developed with innovation and entrepreneurship from Change Oriented Leadership complimented with playfulness and chaos from the KaosPilots would most likely generate a more creative environment and thereby create more competitive organizations.

The purpose of this paper is to compare leadership behaviours from two different approaches with the leadership behaviours within Quality Management in order to find possible areas for developing leadership within Quality Management. A case study has been carried out at a Swedish award-winning organisation in order to study leadership behaviours. In-depth interviews have been carried out with the intention to explore how the manager has worked to become one of Sweden’s best workplaces. Leadership behaviours from three different approaches are summarised in ‘The Core Leadership Behaviours’. The analysis of the leadership methodologies and behaviours used by the leaders and the ‘Core Leadership Behaviours’ from the three different approaches has been summarized for each approach. The comparison indicates that there are interesting leadership behaviours in Change Oriented Leadership as well as in KaosPilots that are not established within Quality Management. The leadership behaviours could complement Quality Management to meet new and challenging demands from customers and co-workers

Abstract

Purpose –

The purpose of this paper is to emphasize the importance of measuring the starting

point of improvement work focusing on soft values and to present one way of measuring the

starting point of a Lean implementation. The purpose is also to describe the Lean

implementation planned within a municipal division and also to present their measured

starting conditions.

Methodology/approach –

A literature study, with Lean implementation, measuring starting

points for improvement work, soft values and the effects of the improvement work in focus

has been carried out. Documents from the planned Lean implementation within a municipal

division have been studied. To measure the conditions for the implementation a previously

conducted measurement approach that measured health-related Quality Management was used.

Findings –

The paper contains an argument for the importance of measuring the effect of a

Lean implementation with a focus on soft values and measuring starting points. A description

of one planned Lean implementation within a municipal division and their starting conditions

are presented.

Practical implications –

To measure the conditions at the starting point of a Lean

implementation gives managers information to help them focus on important improvement

areas. A description of a Lean implementation can help other organizations to plan their

implementation.

Customer value is of importance to all businesses in the search for competitive advantage. To learn about what customers truly appreciate, measuring can be a vital source of information towards an understanding of what creates customer value. Commercial experiences are claimed to be an offering of their own, separate from goods and services. The existing tools and models for measuring customer value do not focus on the elements pointed out as vital for commercial experiences. A case study was performed on customers participating in a high-impact commercial experience to understand what is valuable to the customer. The results were used todevelop an approach to measuring customer value specifically for commercial experiences. In the study, questionnaires were designed to find out about custom erexpectations before the experience compared with customer satisfaction after theexperience in search for important factors of customer value. The study achieved a high score indicating a high level of received customer value, reinforcing the selected measurement variables. The approach proposes the development of a measuring tool consisting of 22 elements along with the WOW-impact specificallyadapted for measuring customer value in commercial experiences. This is one way of expressing the created experiential quality.

Purpose – The purpose of this paper is to identify, present and analyze the strengths and weaknesses mentioned by leaders when describing how their organization works with creating customer value in commercial experiences. Furthermore, the overall research purpose is to explore the creation of customer value in commercial experiences.

Design/methodology/approach – An interview study with eight managers focused on how their organization creates customer value when offering commercial experiences. Results were analyzed with regard to creating customer value, customer involvement and development of new experiences.

Findings – A literature study confirms an increasing interest in commercial experiences both financially and because of customer demand. The conducted interview study found several areas of improvement where the greatest potential was in the building of a strong organizational culture based on values to ensure co-creation of customer value between the organization and the customer. Also found to be important were working with customer involvement when co-producing the experience,discovering customer expectations and measuring the results of the delivered customer value.

Originality/value – When it comes to commercial experiences, one of the keys to creating customer value is the element of surprise and delivering the unexpected. This advocates studying the theory of attractive quality, discovering the unspoken needs of the customer.

The need to achieve a strong corporate culture is one of the key questions within Total Quality Management (TQM). TQM is generally considered to be based on a number of core values; such as customer focus, decisions based on facts, process orientation, continuous improvement, everybody’s commitment and leadership, (Hellsten & Klefsjö, 2000). The core values should ideally be conformed to by all employees within a TQM organization, (ibid). Achieving these core values seems to be rewarding. Many companies that have succeeded in adapting their core values have received quality awards, e.g. Malcolm Baldridge National Quality Award and EFQM Excellence Model. These quality awards are based on values that are widely considered to be the building blocks of effective TQM implementation (Hendricks & Singhal, 1999). There are a lot of descriptions in literature about the importance of working with the ideas of TQM such as putting focus on the customer, establishing processes and also about educating the employees in using tools of improvement, but very little focus on discussing how shared values really are achieved.   A common set of values within an organization is often referred to as the company or corporate culture. A strong culture implies that there is uniformity among the employees regarding, for example values (Pinder 1998). In our literature studies we came across two interesting strategies that combined together provide a tactic for working with shared values to attain a strong corporate culture. According to Chatman (1989) the best way is an integration of the strategies of selection and socialization. That implies both considering values at the selection when the organization chooses its members, by recruiting an individual with the right values and later on by maintaining or reinforcing values by socialization which can be done by training, orientation and other methods. As regards working with achieving TQM values we mostly encountered the use of socialization and feel that there is a need for broader thinking by putting greater emphasis on the selection process when recruiting new members into the organization.   The purpose of this paper is to raise the discussion about how to achieve homogeneity of values, such as TQM values in order to be a successful organization. The presented theories are accompanied by an observation from the renowned Walt Disney World in Florida, providing an example of how they are working with the selection strategy.

To adapt organisations to the increased pace of societal change owing to climate andfinancial crises and the post-pandemic situation, planning operations with anorganisational culture that can adapt and transform is needed. Research has demonstratedthe importance of an organisation’s culture with respect to employee performance and thevalue delivered to stakeholders. To develop an organisation’s culture, knowledge of thebehaviours that support and those that hinder organisational values is equally important.This study aims to develop and evaluate measures of organisational culture adapted to anorganisation’s values.

Evaluation is often connected to the use of quantitative data. However, in some contexts, quantitative data is not entirely comprehensive. Municipalities offer government services to citizens but have difficulty evaluating the value citizens experience from the services. Therefore, this paper presents the results of a project involving Mid-Sweden University and the Sundsvall municipality in central Sweden by presenting a model for citizen value collection. The value collection targets municipal workers (service providers) and citizens (service receivers). The model is constructed using design science and builds upon the recursive quality management methodology of Plan-Do-Study-Act. The results provide a valuable model for practice (municipalities), allowing citizen and worker values to be collected from municipal services and comparing them to evaluate whether any value gaps must be addressed.

This paper investigates continuous improvement of leadership with the aid of coaching and specifically peer-coaching as a model for leadership improvement. The paper is based on the idea of experimental learning both as a tool to motivate, educate and inspire leaders in two studied organizations. Learning-by-doing along with reflection has formed the basis for leadership improvement and leadership awareness in this study. The concept of Developing- by-doing have been used to help leaders design the foundation of an organizational specific coaching model. 

Since the bestselling book “Toyota Kata” was first published in 2009 the practices of the Toyota Kata has spread quickly among practitioners and consultants all over the world. However, the number of academic papers and studies concerning Toyota Kata occurs as remarkably sparse. Based on the apparent gap, this paper identifies and proposes a future research agenda on Toyota Kata based on a survey with Swedish Toyota Kata experts. As a result, 20 areas are highlighted and identified as the currently most desirable to understand and study more closely. Based on the areas, six themes are also identified and formulated. 

Purpose - The purpose of this paper is to present the state of the art when it comes to QM and nursing science, focusing on patient transfers from Intensive Care Unit (ICU)  to general wards, using the TQM values:  ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ as an analytical framework.

Methodology/approach Literature from the research fields of QM and nursing sciences was reviewed and analyzed with the TQM values as a framework.

Findings – No articles were found concerning QM within the specific area of patient transfer from ICU to general wards but the results are a summary of QM research and nursing science sorted under the TQM values. A result is that interdisciplinary care can improve a culture of safety and it can decrease mortality rates, staff turnover and increase quality of care and patient satisfaction. This means that there is a need for working with the QM culture in the patient transfer from ICU to general wards.

Practical implications – This review identified a large need for empirical research in the field of health care where CI methods needs to be described, for example what tool or method that was applied and how it was applied and how the implementation were conducted.

Purpose: The purpose of this paper was to present success factors for increasing quality and safety of intensive care unit (ICU) transitional care as described by co-workers at the sharp end using the core values of total quality management (TQM) as a theoretical lens.

Methodology/Approach: The study had a qualitative design, with data from nine interdisciplinary focus group discussions, including co-workers from the intensive care and general wards. Data were sorted into TQM core values and analysed using qualitative content analysis.

Findings: Quality and safety in transfer processes requires a holistic view, avoiding silos, shared arenas for collaboration, and evidence-based methodologies and tools for safe transfers.

Research Limitation/Implication: A limitation of this study is that it only portrays the challenges encountered by two hospitals during the process of transitional care in the ICU.

Originality/Value of paper: By using TQM core values as a theoretical lens, we could present a usable, holistic picture of success factors and how to improve the transfer process.

Background - Many errors and threats to patient safety are caused by deficiencies in the organization, such as inadequate procedures, inadequate planning and lack of information or communication. A specific danger to patient safety is the various gaps in the continuity of care. An example of the gap is the transfer of patients from the high-tech intensive care environment to the less frequent personnel ward environment, a process called ICU transitional care. ICU-nurses, ward-nurses, physicians, and other healthcare professionals, may provide this care. The effects of a poorly coordinated discharge can lead to readmission to the ICU and avoidable deaths.This study is a part of a research project financed by The Kamprad Family Foundation, with a purpose to gain new knowledge about how efficiency and quality in patient transfers within healthcare care can be improved. The purpose will be achieved through cooperation between the two research subjects Quality Management and Nursing science.Purpose - The purpose of this paper was to gain knowledge about how to improve patient transfers from intensive care to the general ward, by describing the intensive care co-workers generated suggestions.Methodology/approach – Six interdisciplinary focus groups interviews were conducted with co-workers at two hospitals in Sweden. The interviews were taped, verbatim transcribed and analysed with a mixed method. The QM values: ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ were used as an analytic framework.Findings - The co-workers suggested that the process should be defined and structured. The analyses showed a total of 94 suggestions that mainly were focused at following areas; planning, information, and communication, interest in the transfer process, enough resources, standardize and create routines, learning, follow up and evaluate.Practical implications - ICU transitional care is multifaceted and needs a holistic, system thinking solution. The findings indicate that the process could be safer, and more efficient by implementing the co-worker generated suggestions. The suggestions can be used to improve patients’ transfers in many contexts in healthcare, not only ICU transitional care.

When applied successfully, the QM initiatives TQM and Lean enhance an organization´s ability to meet and exceed the expectations of the customers as well as co-workers and other stakeholders. There are however also QM initiatives that fail and one reason for this is the organization’s inability to create a supportive culture, a culture that rests on a number of values which aim at improving the quality and thereby customer satisfaction. Even though this is known by both practitioners and researchers, little has been written on how to achieve a QM culture in practice and there are not many methodologies and tools designed directly with purpose of creating this culture. In addition, the measurements used for monitoring organizational success focus mainly on ‘hard’ process or financial measures such as lead-time reduction and operating income.  

The purpose of this thesis has been to ‘examine how a strong organizational culture can be created and to contribute with knowledge about how to create and measure a QM culture’. To fulfill this purpose, a number of case studies have been carried out and a questionnaire has been developed in order to measure the presence and importance of a number of QM values.

The research presented in this thesis reinforces the fact that culture is an important factor to take into account when applying QM initiatives. A structured way of working with culture and the development of a strategy on how the culture in the organization will be changed is needed. This in combination with methodologies and tools aiming directly at enhancing a QM culture. The research also shows that the relationship between organizational culture, values and behaviors needs to be considered when working to create a strong QM culture. Most of the methodologies and tools found in the case studies aim directly at reinforcing the ‘right’ behaviors in the organization, hence enhancing the underlying values. For instance, the way an organization works with selection, e.g. recruitment and promotion, based on behaviors rather than documented merits is one methodology found in the research. The leadership was found to be important when it came to building or strengthening the culture. Managers are considered key players and need to act as role models, displaying the desired behaviors themselves. The managers need to be present among their co-workers and aware of how their own actions affect the possibility to build a strong QM culture.

Another conclusion drawn is the need to measure the ‘softer’ side of QM. One starting point when applying a QM initiative should be the assessment of the existing culture in the organization as a complement to the ‘harder’ measures. The research presented in this thesis suggests that the questionnaire that has been developed could be an appropriate tool for this purpose. If the existing culture in an organization does not support the values within QM, the behaviors of managers and co-workers that are needed to improve quality and thereby customer satisfaction could be hard to achieve.

A new kind of commercial offer is on the rise, that of a commercial experience. It is said to be the next progression of value after a service and that it is distinct from a service in several ways, two important being a) the provider having to create something new or memorable to the customer, i.e. creating attractive quality, and b) the offer being a co-creation between the customer and the provider.

Little has been written though about how creating a commercial experience can affect the way organizations should work. One of the areas that ought to be affected is the way organizations work to shape and coordinate co-workers and leaders behaviors by having a common set of values, or in other words a strong organizational culture.  A number of studies show that the leaders in an organization have a strong influence on its culture while others show that working with Total Quality Management (TQM) can enhance the corporate values and lead to profitable organizations.

The purpose of this thesis was to explore and contribute knowledge about how to create a commercial experience. The more specific purpose was to explore this area in relation to leadership, values, organizational culture and TQM.

To fulfill these purposes two case studies were carried out with the intention of finding ways of working. The first focused on how a renowned organization that offers commercial experiences works and the second on organizations offering commercial experiences in the region of Jämtland.

One conclusion drawn from the research is that methodologies and tools that aim directly to enhance the organization´s values and hence its culture might be of even more importance in organizations offering a commercial experience. It seems to be important to be aware that values need to be translated into behaviors to make them understandable in the organization. Storytelling is one tool that can be used as an enhancer of organizational culture, a tool that might be a fairly unrecognized for this purpose. It is also evident that the leadership practiced within the organization is crucial if a strong organizational culture is to be achieved.

Further, strategies for selecting the right values appear to be important when trying to create a strong organizational culture - a strategy not so evident within TQM. This could be one area where TQM needs to be developed in order to support the creation of a commercial experience but also to implement TQM more effectively.

Purpose - The purpose of this paper is to present and discuss results from a survey designed to measure baseline data in a project with the aim to support the development of value-based leadership that integrates company values, organizational culture, customer needs and sustainable development.

Methodology/approach – As part of a research project’s base line data collection, a survey designed to measure Leadership commitment, Participation of everybody, Lean values and Perceived co-worker health was developed and tested. The results were analyzed in order to meet each company’s specific need for developing their leadership and culture.

Findings – The results show a difference between the two examined companies, both when it comes to mean values and correlations between the measured factors. The results also indicate the importance of analyzing the results from surveys more in depth and together with other ways of examining culture in order to gain a better understanding of the company’s unique culture and leadership.

Practical implications – The presented survey and way of analyzing the results can help organizations in understanding their own unique needs when working to create a Lean culture as well as healthy co-workers in order to attain sustainable development.

Purpose – The purpose of this paper is to investigate the effects a lean initiative has on the health-related quality management (QM) values, “Leadership Commitment” and “Participation of Everybody,” as well as on perceived co-worker health in the public sector.

Design/methodology/approach – A case study was carried out at a municipal division that had been working with lean for approximately 18 months. A questionnaire was used to measure the effect on health-related QM values both before and after the initial 18 month period. Documents from the intended lean implementation were studied at the starting point and after 18 months; this was followed up by examining new documents. The results from the questionnaires were analyzed using SPSS and the documents were analyzed by means of document comparisons and consensus discussion in the research group.

Findings – The effects on the health-related QM values; “Leadership Commitment” and “Participation of everybody” in this study showed that the values still permeated the organization to a relatively high extent after 18 months but that no statistical differences can be shown between the two measurement points. When measuring what effects a lean initiative has on values, a period of 18 months might be too short, if significance changes are expected. None the less, the results can be a way of monitoring the development of these softer values. Something that is equally important is to see if there have been any major changes, as a way of keeping the work with building a new culture alive and in focus. The results strengthen the assumption that a long-term mindset is needed when QM initiatives such as lean are applied within an organization especially when changes to values and workplaces are expected.

Originality/value – This study has further explored the QM in relation to lean in the respect of how the QM values “Leadership commitment” and “Participation of Everybody” are effected by a lean initiative.

Purpose: The purpose of this paper is to present the results from a questionnaire assessing the quality culture used recurrently in order to better understand strengths and challenges in regards to developing a sustainable Quality Management (QM) culture. 

Methodology: A previously developed questionnaire aiming at assessing the quality culture in an organization was handed out to all preschool principals in a Swedish municipality on four occasions during a research project aiming at developing the principals’ ability to work with QM. The results was analysed statistically using SPSS to compare the results from the first and the fourth measurement point. 

Main Findings: The results shows a general higher level of agreement to the statements and that 13 of the 42 statements had statistically significant differences between the first and the last measurement point, representing seven of the 14 factors in the questionnaire. The factors regarding information and the internal system view seems to be most affected during the project period. The results also indicates a movement from a more person (principal) centred focus towards a more systemic view.

Practical implications: Using the questionnaire regularly can help an organization to monitor and create a deeper understanding and knowledge regarding how leaders and co-workers assess the quality culture. This can in turn be a foundation for future strategic efforts towards an organisations vision and goals.

Originality/value: The longitudinal use of the survey in one organization. 

Type of paper: Research paper

The purpose of this paper is to describe a way to assess the quality culture in an organization using a strength based qualitative approach. The purpose is also to present the result from using the approach in a preschool setting and then analysed in relation to values needed to create a sustainable QM culture. 

An interview guide inspired by Appreciative Inquiry (AI) was used in order to identify success factors as perceived by the principals. The success factors were then analysed in relation to sustainable quality values.

The results show that when the principals themselves describes success factors needed to deliver with quality in a preschools setting they focus on leadership, co-workers and conditions for continuous improvements. The values regarding having a holistic view and a customer focus are not so much in focus giving an insight into what needs to be emphasised on when working with the quality culture. In conclusion there seems to be a need to move from an internal to a more external, long-term holistic perspective on quality in order to meet the demands for developing the future generation of children. 

Purpose –The purpose is to describe and evaluate a Lean leadership-training program within the healthcare sector, developed through a co-creative process with the intent of enhancing the possibilities for a context-specific adaption of Lean.

Methodology/approach – A co-created leadership-training program, executed over a period of one year, is described both as a model development process and as the final training program. The program was evaluated through reflective discussions and feedback as well as a written final evaluation of the program from participants in the program.  

Findings – Even though the process was not followed to the end the evaluation shows that the objectives of the training program was met, at least amongst the participators attended the whole program. Using a co-creative process when developing and realizing a leadership-training program enhances the possibilities for an organizational adaption of Lean to its own context. One condition for this approach to be successful is that the expectation on both the organization and the University needs to be in focus through the whole process. In addition the executive team needs to be continuously engaged and create conditions for the organization to realize the potential winnings from the training program.

Purpose: The purpose of this paper is to describe and evaluate a Lean leadership-training program within the health-care sector. A training program developed through a cocreative process with the intent of enhancing the possibilities for a context-specific adaption of Lean. Design/methodology/approach: A cocreated leadership-training program, executed over a period of one year, is described both as a model development process and as the final training program. The program was evaluated through reflective discussions and feedback as well as a written final evaluation of the program from participants in the program. Findings: The evaluation shows that the objectives of the training program were met, at least among the participants who attended the whole program. Using a cocreative process when developing and realizing a leadership-training program enhances the possibilities for an organization to adapt Lean to its own context. One condition for this approach to be successful is that the expectations of both the organization and the university need to be in focus through the whole process. In addition, the executive team needs to be continuously engaged and create conditions for the organization to realize the potential benefits of the training program. Originality/value: This paper highlights the challenge when applying Lean in a health-care organization but also describes a way to address Lean training and learning in this context. 

Purpose – The purpose of this study is to present a comprehensive approach to studying organizational culture using “soft measures” to facilitate sustainable quality development in organizations. The purpose is also to present, discuss and compare the results from a survey designed to measure a company’s value base.

Design/methodology/approach – A number of different methods were used to collect soft data to study and measure organizational culture and at the same time influence the culture and the leadership within three organizations. One method, the survey, was used on two different occasions to obtain an overview of the culture within an organization and to investigate if the activities had influenced the culture and the leadership.

Findings – The application of soft measures used by leaders to study and develop organizational culture resulted in statistically significant positive changes in organizational work culture, according to a pre-post survey after a short period of one year.

Practical implications – The approach can be used by leaders in different types of organizations as the challenge of changing the organizational culture through the leadership seems to be a common challenge regardless of line of business.

Originality/value – The study shows the benefits of using a comprehensive approach to assess an organization’s culture based on qualitative measures and analysis.

There is a strong relationship between employee satisfaction and organizational results and using an employee surveys effectively could support quality improvements and organizational culture. The purpose of this paper is to present an employee satisfaction survey designed to change organizational culture and co-worker behaviors. Included in the analysis are results from that survey focusing on culture and leadership. The results show that asking a different kind of questions in an employee satisfaction survey and analyzing the results in more detail could give an organization a management tool to be used both to monitor and to build organizational culture.