Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care

Associations between lean maturity in primary care and musculoskeletal complaints among staff: a longitudinal study

OBJECTIVE

This study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later.

DESIGN

Descriptive, correlational and longitudinal design.

SETTING

Primary care units in mid-Sweden.

PARTICIPANTS

In 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016.

OUTCOME MEASURES

Associations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving.

RESULTS

The shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year β: -0.002, 95% CI -0.03 to 0.02), neck (β: 0.006, 95% CI -0.01 to 0.03), low back (β: 0.004, 95% CI -0.02 to 0.03) and upper back (β: 0.002, 95% CI -0.02 to 0.02).

CONCLUSION

The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.

Does organizational readiness matter in lean thinking practices? An agency perspective

Purpose

Extant research documents the importance of lean thinking for organizations, however, as prior research has largely focused on hard lean practices, but little is known about the effects or the significance of soft lean practices. This research attempts to address this issue by examining how soft lean practices enhance organizational lean readiness, and in turn increase the success of lean implementation.

Design/methodology/approach

This research adopts a single case study design in a small-medium enterprise livestock feed manufacturing organization, and investigates the period from late 2011 through the end of 2019 covering two attempts at lean implementation – an initial failed attempt followed by a successful introduction of lean within the case organization. The research analyzes interviews with 29 managers and employees from all organizational levels and departments within the case organization. Secondary data including organizational documents and performance measures and metrics were also incorporated into the research design.

Findings

Drawing on agency theory, the authors advance a principal-agent interaction perspective to conceptualize organizational lean readiness – specifically, the authors consider the “state or condition” of four agency factors (goal conflict, information asymmetry, risk aversion and length of relationship), and explore if these four agency factors can be utilized as proxies for organizational readiness for lean implementation. The authors identify the formation of a shared vision and identity within the organization as an effective mechanism through which soft lean practices enhance organizational lean readiness. Finally, the analysis offers an understanding of how the long-term success of lean implementation is improved by the introduction of soft lean practices as a prerequisite to create organizational readiness for the implementation of hard lean practices.

Originality/value

The study is unique in the sense that it empirically links agency theory and the role of soft lean practices in developing organizational lean readiness in a small-medium enterprise context by defining the ideal state of four agency factors as proxies for organizational readiness.

How do family supportive supervisors affect nurses' thriving: A research before and during COVID-19 pandemic

Nurses need psychological resources (supervisor support), as well as formal support from their organizations, which help them combat the demands from work and home and be more thrive at work. Family supportive supervisor behaviors have been demonstrated above and beyond general levels of supervisor support in reducing work-family conflict and improving well-being. In line with this, first aim is to examine the effects of Covid-19 pandemic on nurses' perceived family supportive supervisor behaviors, work-to-family conflict, psychological well-being, and thriving. Second aim is to test the effects of nurses' perceived family supportive supervisor behaviors on their thriving through work-to-family conflict and psychological well-being. This study was designed as cross-sectional and analytical. A total of 511 nurses from Nigeria and Turkey participated in the study. Parametric tests and Structural Equation Analysis were employed to analyze the data. During Covid-19 pandemic, the scores of nurses' perceived family supportive supervisor behaviors and thriving decreased while the scores of their work-to-family conflict increased significantly. Results confirmed the negative effects of Covid-19 pandemic on nurses. Furthermore, results showed that family supportive supervisor behaviors had positive effect on thriving by decreasing work-to-family conflict and increasing psychological well-being. This study is one of the very first study examining the effects of family supportive supervisor behaviors on nurses' work-to-family conflict, psychological well-being and thriving. Results of this study indicate that nurses need family supportive supervisors to be more thrive at work. Therefore, formal family friendly policies and implications improving family supportive supervisor behaviors are recommended in organizations.

What relationships can be found between nurses' working life and turnover? A mixed-methods approach

AIM

This study aimed to describe why registered nurses decide to leave their work and to investigate relationships between registered nurses' working life and turnover (leaving the unit vs. leaving the profession).

BACKGROUND

Much research has explored nurses' intention to leave, whereas less research has looked at turnover and especially leaving the profession.

METHODS

Data were collected using questionnaires and interviews.

RESULTS

The three most common reasons for both groups (leaving the profession, n = 40; leaving unit but not profession, n = 256) were high workload, low salary and applied for and got a new job. Multivariate logistic regression analysis revealed statistically significant relationships between turnover and empowering structures, such as access to resources and informal power as well as the factor learning in thriving.

CONCLUSIONS

Structural empowerment, such as good access to resources and informal power, is important to keeping nurses in the profession, whereas learning seems to increase the risk of leaving the profession when variables such as vitality, resources, informal power and age are held constant.

IMPLICATIONS FOR NURSING MANAGEMENT

To counteract nurses leaving the profession, managers must provide nurses with good access to resources and informal power, such as networks within and outside the organisation, and focus on nurses' vitality.

Standardization vs Customization: Finding the Right Balance

There is an inherent tension between standardization and customization of care delivery processes. The challenge for health care systems is to achieve the right balance. At its best, standardized work can create efficiencies that generate the additional time needed for personalized care. Similarly, at its best, customization allows the people within a system to accommodate the needs, preferences, and circumstances of the unique individuals and local communities they serve. We provide examples and offer principles to decide when standardization offers the most successful path and when customization may be preferred. We believe that, in sum, the balance has shifted too far toward standardization and that a rebalancing toward customization will benefit patients, clinicians, and the health care system.

Implementing Lean Quality Improvement in Primary Care: Impact on Efficiency in Performing Common Clinical Tasks

BACKGROUND

Many primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency.

OBJECTIVE

To examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks.

DESIGN

Non-randomized stepped wedge with segmented regression and interrupted time series analysis (January 2011-December 2016).

PARTICIPANTS

A total of 317 physician-led teams in 46 primary care departments in a large ambulatory care delivery system.

INTERVENTION

Lean redesign was initiated in one pilot site followed by system-wide spread across all primary care departments. Redesigns included standardization of exam room equipment and supplies, streamlining of call management processes, care team co-location, and team management of the electronic inbox.

MEASURES

Time-stamped EHR tracking of physicians' completion time for 4 common tasks: (1) office visit documentation and closure of patient charts; (2) telephone call resolution; (3) prescription refill renewal; and (4) response to electronic patient messages.

RESULTS

After Lean implementation, we found decreases in the amount of time to complete: office visit documentation (- 29.2% [95% CI: - 44.2, - 10.1]), telephone resolution (- 22.2% [95% CI: - 38.1, - 2.27]), and renewal of prescription refills (- 2.96% per month [95% CI: - 4.21, - 1.78]). These decreases were sustained over several years. Response time to electronic patient messages did not change significantly.

CONCLUSIONS

Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks. Our findings support the use of Lean techniques to engage teams in routine aspects of patient care. More research is warranted to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.

Psychosocial factors in nursing work and occupational risks: a systematic review

OBJECTIVE

to identify, in international scientific production, the main psychosocial factors in nursing work, found through the Copenhagen Psychosocial Questionnaire (COPSOQ) application.

METHODS

a systematic review study of psychosocial factors at work among nursing professionals, who used COPSOQ in the assessment of work environments.

RESULTS

fifteen articles were identified, which highlighted as main psychosocial dimensions of nursing work demands, work organization, social relationships and leadership, work-home interface, workplace health and well-being and offensive behaviors.

CONCLUSION

the high demands for cognitive, emotional work and work pace were identified in the nursing routine. Management support had a positive impact. Physical and psychological violence and shift work interfere in family life, aggravating the fatigue of these professionals. Interventions for reducing work stress presuppose the identification of psychosocial factors involved in nursing work.

Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications

Purpose

Waste identification plays a vital role in lean healthcare applications. While the value stream map (VSM) is among the most commonly used tools for waste identification, it may be limited to visualize the behaviour of dynamic and complex healthcare systems. To address this limitation, system modelling techniques (SMTs) can be used to provide a comprehensive picture of various system-wide wastes. However, there is a lack of evidence in the current literature about the potential contribution of SMTs for waste identification in healthcare processes.

Methods

This study evaluates the usability and utility of six types of SMTs along with the VSM. For the evaluation, interview-based questionnaires were conducted with twelve stakeholders from the outpatient clinic at the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi.

Results

VSM was found to be the most useful diagram in waste identification in general. However, some SMTs that represent the system behaviour outperformed the VSM in identifying particular waste types, e.g., communication diagram in identifying over-processing waste and flow diagram in identifying transportation waste.

Conclusion

As behavioural SMTs and VSM have unique strengths in identifying particular waste types, the use of multiple diagrams is recommended for a comprehensive waste identification in lean. However, limited resources and time, as well as limited experience of stakeholders with SMTs, may still present obstacles for their potential contribution in lean healthcare applications.

Teachers' Personal and Collective Work-Identity Predicts Exhaustion and Work Motivation: Mediating Roles of Psychological Job Demands and Resources

The aim of this study was to investigate the mediating roles of teachers' psychological job demands and resources regarding personal and collective work-identity, respectively, and exhaustion and self-determined work motivation, respectively. A total of 2,905 members of a Swedish teacher's trade union received an online questionnaire by e-mail; 768 individuals answered the questionnaire and so participated in this study. The data were obtained by self-reported measures (e.g., emotional and cognitive components of work-identity, psychological job demands and resources, exhaustion and work motivation) and analyzed by mediation regression analyses. The results showed that teachers' psychological job demands (prosocial extra-role performance) mediated relationships between cognitive personal work-identity and emotional collective work-identity, respectively, and exhaustion. Teachers' psychological job resources (educational inspiration) mediated relationships between emotional personal work-identity and cognitive collective work-identity, respectively, and self-determined work motivation. Thus, teachers might be disadvantaged by stronger personal work-related thinking and collective work-related feeling when related to exhaustion, to some extent accounted for by psychological job demands, and they might find advantage in stronger personal work-related feeling and collective work-related thinking when related to work motivation, to some extent accounted for by psychological job resources.

Validation of the Copenhagen Psychosocial Questionnaire Version III and Establishment of Benchmarks for Psychosocial Risk Management in Sweden

This study presents the Swedish standard version of the Copenhagen Psychosocial Questionnaire, COPSOQ III, and investigates its reliability and validity at individual and workplace levels with the aim of establishing benchmarks for the psychosocial work environment. Cross-sectional data from (1) a random sample of employees in Sweden aged 25–65 years (N = 2847) and (2) a convenience sample of non-managerial employees at 51 workplaces (N = 1818) were analysed. Internal consistency reliability was evaluated as well as the effects of sex, work sector and blue/white-collar work. Population benchmarks and mean scores for major occupational groups were computed based on weighted data. ICC(1) and ICC(2) estimates were computed to evaluate aggregation to the workplace level and Pearson inter-correlations to evaluate construct validity at individual and aggregated levels. The reliability and scale characteristics were satisfactory, with few exceptions, at both individual and workplace levels. The strength and direction of correlations supported the construct validity of the dimensions and the amount of variance explained by workplace justified aggregation to the workplace level. The present study thus supports the use of COPSOQ III for measurement at the workplace level and presents benchmarks for risk management as well as for research purposes.