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Ahmadi E, Lundqvist D, Bergström G, Macassa G. Managers in the context of small business growth: a qualitative study of working conditions and wellbeing. BMC Public Health 2024; 24:2075. [PMID: 39085841 PMCID: PMC11292885 DOI: 10.1186/s12889-024-19578-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE In view of the importance of managers' wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers' wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers' wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth. METHODS The study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied. RESULTS The findings indicate that a manager's working environment evolves from its initial stages and through the company's growth, leading to variations over time in the manager's experiences of wellbeing and work-life balance as well as changes in job demands and resources. Managers' working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work-life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers' increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers' wellbeing. CONCLUSIONS This study shows that, in the context of small business, managers' working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers' working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.
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Affiliation(s)
- Elena Ahmadi
- Department of Occupational Health, Psychology and Sports Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, 80176, Sweden.
- Department of Business and Economic Studies, Faculty of Education and Business Studies, University of Gävle, Gävle, Sweden.
| | - Daniel Lundqvist
- Department of Behavioural Sciences and Learning, Division of Education and Sociology, Linköping University, Linköping, Sweden
| | - Gunnar Bergström
- Department of Occupational Health, Psychology and Sports Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, 80176, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institute, Box 210, Stockholm, 171 77, Sweden
| | - Gloria Macassa
- Department of Social Work, Criminology and Public Health Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- EPIUnit-Instituto de Saude Publica, Universidade do Porto, Porto, Portugal
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Sariraei SA, Shkoler O, Giamos D, Chênevert D, Vandenberghe C, Tziner A, Vasiliu C. From burnout to behavior: the dark side of emotional intelligence on optimal functioning across three managerial levels. Front Psychol 2024; 15:1338691. [PMID: 38708021 PMCID: PMC11069314 DOI: 10.3389/fpsyg.2024.1338691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Burnout has been typically addressed as an outcome and indicator of employee malfunctioning due to its profound effects on the organization, its members, and its profitability. Our study assesses its potential as a predictor, delving into how different sources of motivation-autonomous and controlled-act as mediational mechanisms in the association between burnout and behavioral dimensions of functioning (namely, organizational citizenship behaviors and work misbehaviors). Furthermore, the buffering effects of emotional intelligence across three different managerial levels were also examined. Methods To this end, a total non-targeted sample of 840 Romanian managers (513 first-, 220 mid-, and 107 top-level managers) was obtained. Results Burnout predicted motivation, which predicted work behaviors in a moderated-mediation framework. Contrary to our initial prediction, emotional intelligence augmented the negative association between burnout and motivation, exhibiting a dark side to this intelligence type. These findings are nuanced by the three managerial positions and shed light on the subtle differences across supervisory levels. Discussion The current article suggests a relationship between multiple dimensions of optimal (mal)functioning and discusses valuable theoretical and practical insights, supporting future researchers and practitioners in designing burnout, motivation, and emotional intelligence interventions.
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Affiliation(s)
- Samira A. Sariraei
- Department of Human Resources Management, HEC Montreal, Montreal, QC, Canada
| | - Or Shkoler
- Department of Psychology, Ariel University, Ariel, Israel
| | - Dimitris Giamos
- Department of Human Resources Management, HEC Montreal, Montreal, QC, Canada
| | - Denis Chênevert
- Department of Human Resources Management, HEC Montreal, Montreal, QC, Canada
| | | | - Aharon Tziner
- Tel-Hai Academic College, Kiryat Shmona, Israel
- Peres Academic Center, Rehovot, Israel
- Netanya Academic College, Netanya, Israel
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Gilbert MH, Dextras-Gauthier J, Boulet M, Auclair I, Dima J, Boucher F. Leading well and staying psychologically healthy: the role of resources and constraints for managers in the healthcare sector. J Health Organ Manag 2023; ahead-of-print. [PMID: 38001565 DOI: 10.1108/jhom-12-2021-0442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
PURPOSE Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them. DESIGN/METHODOLOGY/APPROACH A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO). FINDINGS Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers. PRACTICAL IMPLICATIONS The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results. ORIGINALITY/VALUE In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.
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Affiliation(s)
| | | | - Maude Boulet
- École nationale d'administration publique, Montreal, Canada
| | | | - Justine Dima
- School of Management and Engineering Vaud, Yverdon-les-Bains, Switzerland
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Andersone N, Nardelli G, Ipsen C, Edwards K. Exploring Managerial Job Demands and Resources in Transition to Distance Management: A Qualitative Danish Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:69. [PMID: 36612399 PMCID: PMC9819480 DOI: 10.3390/ijerph20010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Organizations worldwide have shifted to working from home, requiring managers to engage in distance management using information and communication technologies (ICT). Studies show that managers experience high job demands and inadequate guidance during COVID-19; therefore, the transition to distance management raises questions about the increase in managerial job demands and the impact on managers' well-being. This study aims to explore first-line managers' perceptions of job demands and available resources during the first year of the pandemic and understand the implications for first-line managers' well-being. First-line managers face complex and conflicting demands, making them more challenged in their management task than other management levels. We used the job demands-resources model in this qualitative, longitudinal empirical study. The study draws on 49 semi-structured interviews with seven first-line managers from a large pharmaceutical company in Denmark, whom we followed throughout the first year of the COVID-19 pandemic, from May 2020 to May 2021. Our findings suggest that the first-line managers perceived increased emotional and practical demands. While the managers appreciated the initial guidance provided by the organization, they perceived the organizational support as outdated and superficial. As a result, to cope with the uncertainty caused by the pandemic and the shift to distance management, the managers relied on work engagement enablers such as social support. Even though the COVID-19 pandemic portrays unique circumstances in transitioning to distance management that require further exploration outside the COVID-19 context, the insights from this study can assist organizations in developing awareness about transitions to better support first-line management to embrace changes in the future.
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Affiliation(s)
- Nelda Andersone
- DTU Management Department, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | | | - Christine Ipsen
- DTU Management Department, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Kasper Edwards
- DTU Management Department, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
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Lundqvist D. Psychosocial work environment and health when entering or leaving a managerial position. Work 2022; 73:505-515. [DOI: 10.3233/wor-210469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Recruiting and retaining managers has become increasingly difficult in recent years, primarily because of a pressured work situation. A better understanding of managers’ work situation is required, and of the support they need. OBJECTIVE: The purpose of the study is to increase the understanding of managers’ psychosocial work environment and health by investigating individuals as they enter or leave a managerial position. METHODS: Longitudinal questionnaire data from 1971 individuals distributed across four groups were used: individuals who 1) entered or 2) left a managerial position between measuring points, and those who remained employed as 3) managers or 4) non-managers at both measuring points. RESULTS: Demands increased between the measuring points for those who entered a managerial position. Their resources and health were, however, rated higher than non-managers already before the transition. Demands decreased for those who left a managerial position, while their resources remained higher than non-managers. Health did not change by changing position. CONCLUSION: This study contributes to knowledge of what happens when someone enters or leaves a managerial position and increases the understanding of differences between managers and non-managers. Organizations should develop supportive strategies through talent management programs to help build resources in employees and future managers. Support should also aim to reduce the increased level of demands in newly hired managers.
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Affiliation(s)
- Daniel Lundqvist
- Unit of Education and Sociology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden. E-mail:
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Dharani B, Guntern S, April K. Perception Differences in Burnout: A Study of Swiss-German Managers and Subordinates. J Occup Environ Med 2022; 64:320-330. [PMID: 34775394 DOI: 10.1097/jom.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burnout differences between management and subordinates can affect preventative interventions chosen by management. Our study investigated if these differences in experiences of burnout (1) are dimension specific (2) correspond to differences in perceptions of the effectiveness of burnout prevention methods. METHODS Two hundred thirty nine managers and 217 subordinates completed an online survey that categorized their self-reported experiences into the three dimensions of burnout and investigated their perceptions of the effectiveness of burnout prevention techniques. RESULTS Contrary to the literature, Swiss-German managers experienced greater exhaustion than subordinates. Despite this experiential difference, their perceived effectiveness of burnout prevention methods did not differ. CONCLUSIONS Contextual differences explain dimension-specific differences in self-reported experiences of burnout at different hierarchal levels; however, these did not contribute to leader distance or perception gap either due to foundational or context-specific factors.
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Affiliation(s)
- Babar Dharani
- Graduate School of Business, University of Cape Town, Private Bag X3, Rondebosch, South Africa
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Hamouche S, Marchand A. Occupational identity, work, and burnout among managers: Do high performance human resource management practices play a moderator role? JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2021. [DOI: 10.1080/15555240.2021.1877553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Salima Hamouche
- Faculty of Management, Canadian University Dubai, Dubai, UAE
| | - Alain Marchand
- School of Industrial Relations, University of Montreal, Montreal, Canada
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Hamouche S, Marchand A. Linking work, occupational identity and burnout: the case of managers. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2020. [DOI: 10.1108/ijwhm-01-2020-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PurposeBased on identity theory, identity represents a set of meanings individuals hold for themselves based on their role in the society. Hence, they often engage in the process of verifying their role, seeking for the compatibility between these meanings and those perceived in a specific lived situation. If this compatibility is not perceived, this is likely to generate negative emotions. that could compromise their mental health. This paper examines the contribution of a weak verification of role identity in the explanation of managers ‘burnout. It aims at integrating identity theory into occupational stress research by analysing the proposition that a low level of verification of a salient role-identity will be associated with a high level of burnout. Hence, we consider identity salience as a moderating variable.Design/methodology/approachCross-sectional data of 314 Canadian managers employed in 56 Quebec firms. Multilevel regression analyses were performed to analyse the data.FindingsLow levels of verification of some standards of managers' role identity, mainly work demands and recognition which encompasses (monetary and non-monetary recognition, career prospects and job security) are significantly associated with managers' burnout. Furthermore, as predicted, results show that identity salience plays a moderating role on the relation between a weak verification of some standards of managers' role identity and burnout, mainly work demands, superior support and recognition.Originality/valueThis study proposes a relatively unexplored approach for the study of managers' burnout. It broadens the scope of research on workplace mental health issues, by the integration of the identity theory.
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Peter KA, Schols JMGA, Halfens RJG, Hahn S. Investigating work-related stress among health professionals at different hierarchical levels: A cross-sectional study. Nurs Open 2020; 7:969-979. [PMID: 32587715 PMCID: PMC7308679 DOI: 10.1002/nop2.469] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/16/2020] [Indexed: 12/02/2022] Open
Abstract
Aim To determine the extent of stress at work among health professionals working in upper-, middle- and lower-management positions and those not working in management positions. Design Cross-sectional design and randomly selected hospitals, nursing homes and home care organizations. Methods The study sample included nursing staff and midwives, physicians, medical-technical and medical-therapeutic professionals at all hierarchical levels (N = 8,112). Data were collected using self-report questionnaires and analysed using multiple regression models. Results Health professionals in upper- and middle-management positions reported higher quantitative demands, severe work-private life conflicts (p < .05) as well as less role clarity in middle-management positions (B = -1.58, p < .05). In lower-management positions, health professionals reported higher physical (B = 3.80, p < .001) and emotional demands (B = 1.79, p < .01), stress symptoms (B = 1.81, p < .05) and job dissatisfaction (B = -1.17, p < .05). Health professionals without management responsibilities reported the poorest working conditions in relation to various stressors, job satisfaction (B = -5.20, p < .001) and health-related outcomes (e.g. burnout symptoms: B = 1.89, p < .01).
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Affiliation(s)
- Karin A. Peter
- Division of Applied Research & Development in NursingBern University of Applied SciencesBernSwitzerland
| | - Jos M. G. A. Schols
- Department of Health Services ResearchFocusing on Value‐based Care and AgeingMaastricht UniversityMaastrichtThe Netherlands
- Department of Family MedicineCAPHRI ‐ Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Ruud J. G. Halfens
- Department of Health Services ResearchCAPHRI ‐ Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - Sabine Hahn
- Division of Applied Research & Development in NursingBern University of Applied SciencesBernSwitzerland
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Fagerlind Ståhl AC, Ståhl C, Smith P. Longitudinal association between psychological demands and burnout for employees experiencing a high versus a low degree of job resources. BMC Public Health 2018; 18:915. [PMID: 30045705 PMCID: PMC6060513 DOI: 10.1186/s12889-018-5778-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Exhaustion and burnout are common causes for sickness absence. This study examines the relationship between psychological demands and burnout over time, and if environmental support modifies the longitudinal relationship between psychological demands and burnout at baseline, with burnout measured 2 years subsequently. Methods A questionnaire was sent to employees in seven Swedish organizations in 2010–2012 with follow-up after 2 years, n = 1722 responded (64%). Linear regressions were used to examine the associations between burnout and psychological demands at baseline and burnout at follow-up. Stratified regression models examined if relationships between burnout and psychological demands at baseline on burnout at follow-up differed for employees in supportive versus unsupportive work environments. Results Burnout and psychological demands at baseline were associated with burnout at follow-up, after adjustment for study covariates. No significant differences were observed between estimates for psychological demands and burnout among respondents in supportive work environments versus those in unsupportive work environments. Conclusions This study shows that high demands are associated with greater risk of burnout, regardless of level of other work supports. This has implications for prevention of sick leave due to burnout and for rehabilitation, where demands such as work pace, workload and conflicting demands at work may need to be reduced.
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Affiliation(s)
- Anna-Carin Fagerlind Ståhl
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Christian Ståhl
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,HELIX Competence Centre, Linköping University, Linköping, Sweden.
| | - Peter Smith
- Institute for Work & Health, 481 University Ave, Suite 800, Toronto, ON, M5G 2E9, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Lundqvist D, Fogelberg Eriksson A, Ekberg K. Managers’ social support: Facilitators and hindrances for seeking support at work. Work 2018; 59:351-365. [DOI: 10.3233/wor-182690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniel Lundqvist
- HELIX VINN Excellence Centre, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Unit of Education and Sociology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping University, Linköping, Sweden
| | - Anna Fogelberg Eriksson
- HELIX VINN Excellence Centre, Linköping University, Linköping, Sweden
- Department of Behavioural Sciences and Learning, Unit of Education and Sociology, Linköping University, Linköping, Sweden
| | - Kerstin Ekberg
- HELIX VINN Excellence Centre, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping University, Linköping, Sweden
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Bruschini M, Carli A, Burla F. Burnout and work-related stress in Italian rehabilitation professionals: A comparison of physiotherapists, speech therapists and occupational therapists. Work 2018; 59:121-129. [DOI: 10.3233/wor-172657] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marco Bruschini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonella Carli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Franco Burla
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Ayala Calvo JC, García GM. Hardiness as moderator of the relationship between structural and psychological empowerment on burnout in middle managers. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2017. [DOI: 10.1111/joop.12194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fagerlind Ståhl AC, Gustavsson M, Karlsson N, Johansson G, Ekberg K. Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis. APPLIED ERGONOMICS 2015; 47:285-291. [PMID: 25479999 DOI: 10.1016/j.apergo.2014.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 06/04/2023]
Abstract
The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations.
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Affiliation(s)
- Anna-Carin Fagerlind Ståhl
- Helix VINN Excellence Centre, Linköping University, SE-581 83 Linköping, Sweden; National Centre for Work and Rehabilitation, Dept. of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
| | - Maria Gustavsson
- Helix VINN Excellence Centre, Linköping University, SE-581 83 Linköping, Sweden; Unit of Education and Sociology, Dept. of Behavior Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Nadine Karlsson
- National Centre for Work and Rehabilitation, Dept. of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
| | - Gun Johansson
- Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| | - Kerstin Ekberg
- Helix VINN Excellence Centre, Linköping University, SE-581 83 Linköping, Sweden; National Centre for Work and Rehabilitation, Dept. of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
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