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A staff perspective on Lean maturity, well-being, and quality in primary care
University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.ORCID iD: 0000-0003-2211-620x
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract
Place, publisher, year, edition, pages
Uppsala: Uppsala University, 2020.
Series
Studies in the Research Profile Health-Promoting Working Life. Doctoral thesis ; 12
National Category
Other Medical Sciences
Research subject
Health-Promoting Work
Identifiers
URN: urn:nbn:se:hig:diva-31086ISBN: 9789188145406 (print)ISBN: 9789188145413 (electronic)OAI: oai:DiVA.org:hig-31086DiVA, id: diva2:1380497
Public defence
2020-02-27, Stora Jadwigasalen, Kungsbäcksvägen 47, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-02-04 Created: 2019-12-19 Last updated: 2020-02-04
List of papers
1. A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing
Open this publication in new window or tab >>A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing
2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 235Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector.

METHODS:

A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care.

RESULTS:

The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors.

CONCLUSIONS:

We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.

Keywords
service sector, health care sector, Lean maturity, instrument development, survey
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hig:diva-22027 (URN)10.1186/s12913-017-2163-x (DOI)000397166800002 ()28340573 (PubMedID)2-s2.0-85016132981 (Scopus ID)
Projects
Lean
Available from: 2016-06-30 Created: 2016-06-30 Last updated: 2019-12-19Bibliographically approved
2. Lean maturity and quality in primary care
Open this publication in new window or tab >>Lean maturity and quality in primary care
2019 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 2, p. 141-154Article in journal (Refereed) Published
Abstract [en]

Purpose - The purpose of this paper is to 1) describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations, and 2) determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines. High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Design/methodology/approach - Data were collected using a survey based on Liker’s four principles, divided into 16 items (n = 298 staff in 45 units). Complementary observations (n = 28 staff) were carried out at four units.

Findings - Lean maturity varied both between and within units. The highest Lean maturity was found for ‘adhering to routines’ and the lowest for ‘having a change agent at the unit’. Lean maturity was positively associated with satisfaction with care and with adherence to national guidelines to improve healthcare quality. 

Practical implications - Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

Originality/value - This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019
Keywords
healthcare, Lean principles, Liker, observations, qualitative
National Category
Other Health Sciences
Identifiers
urn:nbn:se:hig:diva-26374 (URN)10.1108/JHOM-04-2018-0118 (DOI)000463633800002 ()30950305 (PubMedID)2-s2.0-85060950444 (Scopus ID)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2020-01-29Bibliographically approved
3. Lean maturity and musculoskeletal complaints among primary care staff. A longitudinal study
Open this publication in new window or tab >>Lean maturity and musculoskeletal complaints among primary care staff. A longitudinal study
(English)Manuscript (preprint) (Other academic)
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hig:diva-31232 (URN)
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2019-12-19Bibliographically approved
4. Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care
Open this publication in new window or tab >>Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care
Show others...
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 652Article in journal (Other academic) Published
Abstract [en]

Background

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

Keywords
COPSOQ, JD-R theory, linear mixed model, LiHcQ Lean in healthcare questionnaire, quality of care, thriving, exhaustion
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hig:diva-29441 (URN)10.1186/s12913-019-4502-6 (DOI)000484951700004 ()31500624 (PubMedID)2-s2.0-85071970266 (Scopus ID)
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2020-01-29Bibliographically approved

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Kaltenbrunner, Monica

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