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Reaching at Sustainable Development: Lean in the Public Sector
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.ORCID iD: 0000-0002-6167-4637
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The concept of sustainable development is commonly used worldwide. In the public sector, characterized by a rationalization focus, conclusions about the sustainability of lean production (lean), as a management concept for organizational change, are contradictory. This thesis aims to identify conditions promoting sustainable development in the public sector, in particular the healthcare sector, when implementing lean. Two qualitative and one quantitative case study were conducted using longitudinal data collection: focus group interviews, semi-structured interviews, analysis seminars, steering board meetings, and a questionnaire. The empirical data was collected from national lean programs in Sweden. The results describe that socio-technical principles may be used as indicators of sustainability as well as a guide in the implementation of lean in healthcare. Active ownership among stakeholders, a developmental view in the organization, stakeholder participation, organized joint innovative learning activities, role and goal clarity may be conditions influencing the sustainability of lean in the public sector. Furthermore, when supported by a favorable lean context, the results show that the lean tools value stream mapping, standardized work and 5S (housekeeping) may promote a sustainable implementation of lean in healthcare by the promotion of employees and managers’ working conditions and/or employee individual innovation. Visual follow-up boards may inhibit employees and managers’ job satisfaction, when not supported by job resources. Personnel stability, time for development, and information to be able to participate were in this context shown to be central job resources. In conclusion, conditions which may promote sustainable development in the public sector, when implementing lean are: stakeholder values of inclusive social well-being, an implementation process including stakeholder ownership and joint innovative learning, and a favorable lean context: balancing job resources and job demands. Lean tools may empower public healthcare employees to engage in development and counteract a poor implementation process and a poor lean context but only to a limited degree. The lean contexts studied were unfavorable, i.e., a weak implementation process and job resources not balancing the job demands. Hence, the lean implementations studied could not be considered sustainable.

Place, publisher, year, edition, pages
KTH Royal Institute of Technology, 2016. , 72 p.
Series
TRITA-STH : report, ISSN 1653-3836 ; 2016:7
Keyword [en]
Healthcare, participation, ownership, learning, clarity
National Category
Production Engineering, Human Work Science and Ergonomics
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-191550ISBN: 978-91-7729-090-2OAI: oai:DiVA.org:kth-191550DiVA: diva2:957330
Public defence
2016-09-23, T52, Hälsovägen 11C, Huddinge, 10:15 (English)
Opponent
Supervisors
Funder
AFA Insurance, 100013
Note

QC 20160901

Available from: 2016-09-01 Created: 2016-09-01 Last updated: 2016-09-02Bibliographically approved
List of papers
1. Sustainable Lean in psychiatry?: Assessment through socio-technical principles
Open this publication in new window or tab >>Sustainable Lean in psychiatry?: Assessment through socio-technical principles
2016 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 8, no 1, 53-71 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – This paper aims to identify conditions affecting sustainability of Lean implementations in Swedish psychiatric healthcare, from a socio-technical perspective. Design/methodology/approach – Longitudinal focus group interviews were conducted with 24 first-line managers within Swedish psychiatric healthcare. The analysis was made using Cherns’ ten socio-technical principles and a framework for sustainable development work in healthcare. Findings – The most critical socio-technical principles for a sustainable Lean implementation were boundary location; power and authority; and compatibility. At hospital level, socio-technical principles were inhibited by the weak ownership of the Lean implementation. However, strong ownership at division level meant the same principles were supported. Unclear goals made follow-ups difficult which had negative effects on the learning processes in the Lean implementation. The role and responsibility of first-line managers were unclear in that they perceived they lacked power and authority resulting in negative effects on the participation – an important sustainability concept. Originality/value – Empirically based papers assessing Lean implementations in psychiatry are rare. This study is a contribution to the research area of sustainable Lean implementations in healthcare. The practical implication of this study is that decision makers, senior managers, first-line managers and psychiatrists can be supported in reaching sustainable implementations of Lean.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2016
Keyword
First-line managers, Healthcare, Learning, Participation, Role clarity, Scandinavian
National Category
Health Sciences
Identifiers
urn:nbn:se:kth:diva-187218 (URN)10.1108/IJQSS-07-2015-0056 (DOI)2-s2.0-84962546084 (ScopusID)
Note

QC 20160518

Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2016-09-01Bibliographically approved
2. Conditions Enabling Development in National Lean Programmes
Open this publication in new window or tab >>Conditions Enabling Development in National Lean Programmes
Show others...
2016 (English)In: Leadership & Organization Development Journal, ISSN 0143-7739, E-ISSN 1472-5347Article in journal (Refereed) Submitted
Abstract [en]

Purpose – The purpose of this article is to identify work practices and activities at programme and local levels which constitute conditions that enable development in workplace development programmes (WPDPs). These are introduced by public agencies as change agents that provide the resources for local organizational change. Design/methodology/approach – The study constituted separate interactive research projects in three WPDPs conducted through a total of 256 interviews and documentation from meetings. The findings were compared in a qualitative content analysis. Findings – The outcomes of development processes in the programmes and local Lean implementation are enabled by the interplay of three conditions: a) organized learning activities with the stakeholders involved, b) key stakeholders’ active ownership and c) support for employee participation. The three conditions thus support programme management in leading the programme development processes. Research limitations/implications - The findings operationalize broad theoretical concepts. However, the research projects involved were not originally designed for this comparative study, which created some difficulties when performing the analysis. The longitudinal design and vast amount of data partly compensate for this. Practical implications – This knowledge will be helpful in the formation of new WPDPs that support local organizational development and for those who lead such processes. Originality/value – The novelty of the findings is the operationalization of broad theoretical concepts, such as the conditions that support development programmes. Moreover, this article shows a set of work practices and activities that management may be used in organizing WPDPs.

National Category
Production Engineering, Human Work Science and Ergonomics
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-191539 (URN)
External cooperation:
Note

QC 20160912

Available from: 2016-09-01 Created: 2016-09-01 Last updated: 2016-09-12Bibliographically approved
3. Lean implementation, work environment and sustainability
Open this publication in new window or tab >>Lean implementation, work environment and sustainability
2015 (English)In: Sustainable Development in Organizations: Studies on Innovative Practices / [ed] Elg, M., Ellström, P-E., Klofsten, M., and Tillmar, M, Edward Elgar Publishing, 2015, 29-41 p.Chapter in book (Refereed)
Abstract [en]

Lean is introduced in industry as well as in the public sector. Previous research has criticized Lean for creating bad working conditions. Also sustainability of organizational changes is claimed to be low. The aim of this chapter is to describe consequences for working conditions and sustainability as a result of implementations of Lean in manufacturing industry and in the public sector. A second aim is to give examples of the type of knowledge produced in an interactive research approach and to discuss the use of interactive research when implementing Lean. Two programs for implementing Lean were assessed through interactive research. The research showed that there is a huge variation between organizations regarding how Lean is interpreted, how it is implemented, and also regarding the outcomes. The majority of the employees in the manufacturing companies experienced that Lean meant improved working conditions, e.g. more participation, learning and development. However they also experienced more stress and repetitive work. For the public organizations, the employees experienced on average that the working conditions had deteriorated. Sustainability of the changes was also substantially lower than for the manufacturing companies. The interactive research approach enabled deep access to a broad sample of organizations and contributed to better relevance and validity of the research results.

Place, publisher, year, edition, pages
Edward Elgar Publishing, 2015
Keyword
business and management, management and sustainability, organisational innovation, organisation studies
National Category
Health Sciences
Identifiers
urn:nbn:se:kth:diva-179855 (URN)10.4337/9781784716899.00008 (DOI)000374407200003 ()9781784716882 (ISBN)
External cooperation:
Note

QC 20160201

Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2016-09-02Bibliographically approved
4. Lean in healthcare: Engagement in development, job satisfaction or exhaustion?
Open this publication in new window or tab >>Lean in healthcare: Engagement in development, job satisfaction or exhaustion?
2016 (English)In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 5, no 5, 91-105 p.Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Sciedu press, 2016
Keyword
Employees, Managers, Work environment, Job demands-resources model, Sustainability
National Category
Production Engineering, Human Work Science and Ergonomics
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-191546 (URN)10.5430/jha.v5n5p91 (DOI)
External cooperation:
Funder
AFA Insurance, 100013
Note

QC 20160902

Available from: 2016-09-01 Created: 2016-09-01 Last updated: 2016-09-02Bibliographically approved
5. Lean Tools Promoting Individual Innovation in Healthcare
Open this publication in new window or tab >>Lean Tools Promoting Individual Innovation in Healthcare
2016 (English)In: Creativity and Innovation Management, ISSN 0963-1690, E-ISSN 1467-8691Article in journal (Refereed) Submitted
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.

Keyword
Organisational development, Continuous improvement, 5S, Value stream mapping, Sustainability
National Category
Production Engineering, Human Work Science and Ergonomics
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-191548 (URN)
External cooperation:
Funder
AFA Insurance, 100013
Note

Qc 20160902

Available from: 2016-09-01 Created: 2016-09-01 Last updated: 2016-09-02Bibliographically approved

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