Continuous improvement: role of organisational learning mechanisms

The mediating role of incentives in association between leadership attention and self-perceived continuous improvement in infection prevention and control among medical staff: A cross-sectional survey

Objectives

Promoting improvement in Infection Prevention and Control (IPC) is an important part of improving the quality of care. The influence of leadership attention and incentives on the self-perceived continuous improvement in IPC has drawn a lot of attention, but relevant academic research is still lacking. The objective of this study is to explore the effect of leadership attention on self-perceived continuous improvement in IPC among medical staff and its underlying mechanisms.

Method

The 3,512 medical staff from 239 health facilities in Hubei, China, were surveyed online during September 2020. Data on leadership attention, incentives, and improvement in Infection Prevention and Control were collected using self-administered questionnaires. Correlation analysis was used to analyze the relationship between leadership attention, incentives, and improvement in Infection Prevention and Control. Amos 24.0 was used to analyze the mediating role.

Results

The scores of leadership attention, incentives and self-perceived continuous improvement in Infection Prevention and Control were all high. The score of leadership attention was the highest (4.67 ± 0.59), followed by self-perceived continuous improvement (4.62 ± 0.59) and incentives in Infection Prevention and Control (4.12 ± 0.83). Leadership attention positively affected self-perceived continuous improvement in Infection Prevention and Control (β = 0.85, 95% CI = [0.83, 0.87]). Moreover, incentives partially mediated the effect of leadership attention on self-perceived continuous improvement in Infection Prevention and Control among medical staff (β = 0.13, 95% CI = [0.12, 0.15]).

Conclusion

Leadership attention positively affects self-perceived continuous improvement in Infection Prevention and Control among medical staff, and incentives mediates this relationship. The present study has valuable implications for self-perceived continuous improvement in Infection Prevention and Control from the perspective of leadership attention and incentives.

Success factors for lean six sigma projects in healthcare

Identifying critical success factors (CSFs) of continuous improvement projects is crucial for management control and operations management domains. Despite the availability of manufacturing-related literature, studies on CSFs in more dynamic and complex healthcare-related operations are scarce. This study, based at a large public tertiary healthcare organization, identifies CSFs in implementing Lean Six Sigma (LSS). 62 LSS projects completed by Green Belts in consultation with Black Belts were analyzed for project success by a review team of practitioners (Black Belters) and academics. Using a grounded theory approach, numerous success factors were initially identified. A series of brainstorming sessions and workshops helped to narrow down and revise all the CSFs present in each of the 62 LSS projects to eight CSFs. The success of the 62 completed projects was assessed against each of the eight CSFs on a five-point Likert scale. Success was measured against whether the project met its stated aim and achieved the Key Performance Indicators that had initially been identified. Finally, the correlations of each factor rating against project success were analyzed to validate the relationship between each success factor and project success. The findings confirm that all eight CSFs identified are significantly correlated to project success. This study contributes to the management control, operations management, and healthcare literature by identifying CSFs of continuous improvement projects and introducing a relatively unique, rigorous, and practically proven evaluation method applied via an industry and academic partnership. Specified CSFs and the method used to identify these will benefit managers of continuous improvement projects.

Continuous improvement: challenges for the project-based organization

Purpose

There are limited studies of continuous improvement (CI) from the perspective of a project-based organization (PBO). Hence, the purpose of this paper is to explore challenges that PBOs may encounter when applying CI.

Design/methodology/approach

An exploratory and qualitative approach has been used, involving six management teams in six different PBOs, using focus groups interviews as data collecting method.

Findings

A high degree of autonomy among project managers seems to limit a collective approach to project management in PBOs. As a consequence the overall PBO performance becomes subordinate to the individual project performance—an approach opposite to that of CI. Further, the management teams themselves seem to uphold a project focus, also complicating improvement initiatives from a PBO-perspective.

Research limitations/implications

The management teams have been the unit of analysis, where the PBOs mainly conduct projects in an engineering and construction context, and are located in the same country and region. This approach enables the thorough study of a phenomenon, while preconditions for generalization are limited. However, the findings could be used by researchers as a basis for more in-depth studies of specific challenges, and for making surveys to obtain generalization of results.

Practical implications

The results can induce awareness and understanding of different challenges if applying CI in a PBO, hence a starting point for finding ways to overcome these challenges.

Originality/value

The article contributes to an increased understanding of challenges that PBOs may encounter when applying CI, confirming and presenting additional findings compared to previous studies.

How employees perceive organizational learning: construct validation of the 25-item short form of the strategic learning assessment map (SF-SLAM)

Purpose

This study aims at the employees’ view on organizational learning (OL). OL is originally assessed in the Strategic Learning Assessment Map (SLAM) at the level of the firm by addressing managers, who rated OL in the SLAM on five dimensions of individual, group, organizational, feed-forward and feedback learning. However, as employees are getting their jobs done discretely and are increasingly making their own decisions, their perspective on OL genuinely matters. Hence, the authors assessed OL at the level of the individual by addressing employees on all levels, who rated OL in a short form of the SLAM (SF-SLAM).

Design/methodology/approach

In this paper, the authors focused on the construct validity of this SF-SLAM by investigating its reliability, factorial validity and nomological network. First, they asked whether the SF-SLAM reliably measures OL on five dimensions of individual, group, organizational, feed-forward and feedback learning. Next, they asked whether the SF-SLAM was associated with its nomological network of engaging in innovation-related learning activities, behaving innovatively on the job and showing higher educational levels, intelligence and individual job performances. They used a diverse German employee sample of skilled and unskilled workers and managers (N = 434) and analyzed the data with structural equation modeling.

Findings

The SF-SLAM was reliable, but revealed both constrained factorial validity and validity on the basis of its nomological network. First, five dimensions found support in the employee sample, but their correlations were high or very high, except for individual learning. Second, the SF-SLAM showed only few differential relations with variables from its nomological network.

Originality/value

Taken together, the SF-SLAM is short, reliable and only valid for examining individual learning.

The role of employee empowerment in the implementation of continuous improvement

Purpose

The purpose of this paper is to understand the role of increasing employees’ level of continuous improvement (CI) empowerment, i.e. employees’ knowledge and understanding of CI, the possibility of open communication and support from the work environment regarding CI, in the implementation of CI over time.

Design/methodology/approach

Based on the theory of structural empowerment, the authors test the research question using evidence from a case study in a European financial services provider. Data are gathered with questionnaires on a team level and cover a period of 2.5 years including 780 participants.

Findings

The findings show that after conducting a CI programme in the case, there is a significant increase in employees’ CI empowerment over time, which has a positive but time-lagged relationship with the level of CI implementation.

Research limitations/implications

Implications are that CI empowerment can be created sustainably and is an important factor in establishing CI in a company, but that it takes time until empowerment leads to changes in behaviour. However, it has to be considered that these implications are solely derived from empirical results from a single company.

Practical implications

Financial service providers should invest in establishing CI empowerment and consider a delay in realising measurable benefits in terms of the level of CI implementation.

Originality/value

This paper is the first empirical study to examine the relationship between employee CI empowerment and the implementation of CI from a longitudinal perspective.

Quality improvement in large healthcare organizations

PURPOSE

The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development.

DESIGN/METHODOLOGY/APPROACH

A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years.

FINDINGS

The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found.

PRACTICAL IMPLICATIONS

A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization's measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks.

ORIGINALITY/VALUE

Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor's view on important factors to consider when building a coherent organizational M & F strategy.

Gotzamani K, L. Psomas E. The impact of employees’ attributes on the quality of food products

Purpose

– The purpose of this paper is to analyse the importance of specific, quality-related employees’ attributes to the enhancement of product quality in food companies. The main goal is to examine the synergistic relationships between specific employees’ attributes, which have been related in literature to ISO 9000 successful implementation, to continuous improvement, operational performance and product quality.

Design/methodology/approach

– The analysis includes an initial exploratory factor analysis, followed by confirmatory factor analysis and structural equation modelling, in order to investigate the relations between the constructs of the proposed model.

Findings

– The findings reveal that although the examined quality-related “employees’ attributes” do not directly contribute to “product quality”, they influence both “continuous improvement” and “operational performance” of food firms. The results also confirm the impact of both “continuous improvement” and “operational performance” on “product quality” and also that “continuous improvement” helps explain “operational performance”.

Research limitations/implications

– The domain in which the model has been validated, the restricted use of moderators in the model and lack of empirical validation of the model in non-food sector companies, based on various respondents from each company, are a number of limitations associated with this study which suggest future research proposals.

Practical implications

– The findings of this study can motivate managers of food companies to focus on certain quality-related employees’ attributes in order to boost continuous improvement of ISO 9001 systems and operational performance of their companies, leading to product quality enhancement.

Originality/value

– This study finds particular relevance in emphasizing that although specific quality-related employees’ attributes, as these are detected in literature, have a significant contribution towards continuous improvement and operational performance, they are not the only critical factor leading to product quality. More complex relationships need to be considered by integrating other constructs as major antecedents of food product quality.

Glascoff M. Process measures: a leadership tool for management

Purpose

– The purpose of this paper is to encourage the use of ongoing process-based measurement methods, specifically, control charts, as a process measurement tool to guide leadership improvement efforts. The work of Deming will be highlighted while providing a review of measurement methods.

Design/methodology/approach

– Organizational leadership requires inspiring people and creating an environment so everyone can contribute toward the success of the organization. To accomplish this, a leader needs appropriate, real-time information about how to adjust the current situation. Rather than waiting for something to go wrong and then attempting to fix the situation or tamper with the process, management should use process measures to guide improvement efforts.

Findings

– Real-time process measures guide improvement efforts by the workers and management because it enables them to pay attention to the process while simultaneously performing it. Traditional improvement methods often lead to worse results because they use retrospective data that encourages process manipulation.

Originality/value

– Process measures enable the workers and management to better understand the process, its capacity, and how the process can be improved.

The impact of knowledge conversion processes on implementing a learning organization strategy

Purpose

The purpose of this research is to explore the influence of the knowledge conversion processes (KCP) on the success of a learning organization (LO) strategy implementation.

Design/methodology/approach

Using a case study approach, the research model examines the impact of the KCP including socialization, externalization, combination and internalization on implementing a learning organization (LO) strategy in an Algerian international oil company. A sample of 500 managers was asked to respond to questionnaires from which only 416 were valid. Multiple regression analysis is employed to explore the influential processes on the LO strategy.

Findings

The findings revealed that socialization, internalization and combination have a significant impact on the success of a LO strategy. Socialization is the major influential factor, having the strongest impact on LO. However, externalization was found to have no statistical influence on LO.

Practical implications

This research provides evidence concerning the interdependence between knowledge management through KCP and LO.

Originality/value

The research is one of a few studies investigating the relationship between the knowledge conversion processes and learning organization, in contrast to the extensive research taking into consideration the well‐known knowledge process of creating, acquiring, capturing, sharing and using knowledge. This may be one of the first papers exploring the theme of the LO within Algerian business organizations.

Continuous improvement put into practice

Purpose

The purpose of this paper is to contribute to the existing body of knowledge about what distinguishes effective continuous improvement (CI) approaches and to explain some of the mechanisms which create a successful quality program.

Design/methodology/approach

The empirical data were collected from interviews with employees at several levels in seven companies. The companies were deliberately selected to represent different types of resource consumption and outcome from a quality program.

Findings

The implementation approaches of the studied companies were classified according to four different categories: parallel, integrated, coordinated and project approaches. Companies that adopt a project approach tend to fail to achieve anything more than minor improvements, while companies that take parallel and coordinated approaches realise significant improvements but use more resources than companies that utilise an integrated approach.

Practical implications

This paper illustrates and explains why the project approach ought to be avoided. The paper also highlights the benefits of an integrated approach that is focused on learning.

Originality/value

This paper contributes to theory and practice by providing an empirically‐based explanation for the outcome of alternative implementations of CI in practice.