Interactions between lean management and the psychosocial work environment in a hospital setting – a multi-method study

BMC Health Services Research

Hugo Westerlund³  Johan Thor⁴  Ulrica von Thiele Schwarz¹  Waqar Ulhassan² 

[1] Department of Psychology, Stockholm University, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Plan 5, Tomtebodavägen 18A, SE-17165 Stockholm, Sweden;Stress Research Institute, Stockholm University, Stockholm, Sweden;Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden

关键词: Sweden;    Nurses;    Employee involvement;    Stress;    COPSOQ;   

Others  :  1118339
DOI  :  10.1186/1472-6963-14-480

 received in 2014-03-19, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration.

Methods

The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis.

Results

Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I.

Conclusions

The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention’s harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.

【 授权许可】

   
2014 Ulhassan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Womack JP, Jones DT: Lean thinking : banish waste and create wealth in your corporation, 1st Free Press edn. New York: Free Press; 2003.
• [2]Casey JT, Brinton TS, Gonzalez CM: Utilization of lean management principles in the ambulatory clinic setting. Nat Clin Pract Urol 2009, 6(3):146-153.
• [3]Holden RJ: Lean thinking in emergency departments: a critical review. Ann Emerg Med 2011, 57(3):265-278.
• [4]Poksinska B: The current state of Lean implementation in health care: literature review. Qual Manag Health Care 2010, 19(4):319-329.
• [5]Conti R, Angelis J, Cooper C, Faragher B, Gill C: The effects of lean production on worker job stress. Int J Oper Prod Manag 2006, 26(9):1013-1038.
• [6]Parker SK: Longitudinal effects of lean production on employee outcomes and the mediating role of work characteristics. J Appl Psychol 2003, 88(4):620-634.
• [7]Waring JJ, Bishop S: Lean healthcare: rhetoric, ritual and resistance. Soc Sci Med 2010, 71(7):1332-1340.
• [8]Hasle P, Bojesen A, Jensen PL, Bramming P: Lean and the working environment: a review of the literature. Int J Oper Prod Manag 2012, 32(7):829-849.
• [9]Lewchuk W, Stewart P, Yates C: Quality of working life in the automobile industry: a Canada-UK comparative study. New Tech Work Employ 2001, 16(2):72-87.
• [10]Seppala P, Klemola S: How do employees perceive their organization, and job when companies adopt principles of lean production? Hum Factor Ergon Man 2004, 14(2):157-180.
• [11]Landsbergis PA, Cahill J, Schnall P: The impact of lean production and related new systems of work organization on worker health. J Occup Health Psychol 1999, 4(2):108-130.
• [12]Llorens C, Alos R, Cano E, Font A, Jodar P, Lopez V, Navarro A, Sanchez A, Utzet M, Moncada S: Psychosocial risk exposures and labour management practices. an exploratory approach. Scand J Public Health 2010, 38:125-136.
• [13]Souza LB: Trends and approaches in lean healthcare. Leadersh Health Serv 2009, 22(2):121-139.
• [14]Rabe M, Giacomuzzi S, Nubling M: Psychosocial workload and stress in the workers’ representative. BMC Public Health 2012, 12:909. BioMed Central Full Text
• [15]Karasek R, Theorell T: Healthy work : stress, productivity, and the reconstruction of working life. New York: Basic Books; 1990.
• [16]Siegrist J: Effort-reward imbalance at work and cardiovascular diseases. Int J Occup Med Environ Health 2010, 23(3):279-285.
• [17]Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB: The job demands-resources model of burnout. J Appl Psychol 2001, 86(3):499-512.
• [18]Bakker AB, Demerouti E: The job demands-resources model: state of the art. J Manag Psychol 2007, 22(3):309-328.
• [19]Kristensen TS, Hannerz H, Hogh A, Borg V: The Copenhagen Psychosocial Questionnaire–a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health 2005, 31(6):438-449.
• [20]Pejtersen JH, Kristensen TS, Borg V, Bjorner JB: The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health 2010, 38(3 Suppl):8-24.
• [21]Thorsen SV, Bjorner JB: Reliability of the Copenhagen Psychosocial Questionnaire. Scand J Public Health 2010, 38(3 Suppl):25-32.
• [22]Ulhassan W, Thor J, Sandahl C, von Thiele Schwarz U: Does Lean implementation interact with team functioning? J Health Organ Managin press
• [23]Anderson-Connolly R, Grunberg L, Greenberg ES, Moore S: Is lean mean? workplace transformation and employee well-being. Work Employ Soc 2002, 16(3):389-413.
• [24]Hasle P: Lean production - an evaluation of the possibilities for an employee supportive lean practice. Human Factors and Ergonomics in Manufacturing & Service Industries 2012. n/a-n/a
• [25]Ipsen C, Jensen PL: Organizational options for preventing work-related stress in knowledge work. Int J Ind Ergonom 2012, 42(4):325-334.
• [26]Farris JA, Van Aken EM, Doolen TL, Worley J: Critical success factors for human resource outcomes in Kaizen events: an empirical study. Int J Prod Econ 2009, 117(1):42-65.
• [27]Pawson R, Tilley N: Realistic evaluation. London: SAGE; 1997.
• [28]Zapf D, Dormann C, Frese M: Longitudinal studies in organizational stress research: a review of the literature with reference to methodological issues. J Occup Health Psychol 1996, 1(2):145-169.
• [29]Theorell T, Hasselhorn HM: On cross-sectional questionnaire studies of relationships between psychosocial conditions at work and health–are they reliable? Int Arch Occup Environ Health 2005, 78(7):517-522.
• [30]Kompier M: Assessing the psychosocial work environment - “subjective” versus “objective” measurement. Scand J Work Env Hea 2005, 31(6):405-408.
• [31]Thompson AG: Questioning practices in health care research: the contribution of social surveys to the creation of knowledge. Int J Qual Health Care 2003, 15(3):187-188.
• [32]McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, Thomas R, Harvey E, Garratt A, Bond J: Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess 2001, 5(31):1-256.
• [33]Cull WL, O’Connor KG, Sharp S, Tang SF: Response rates and response bias for 50 surveys of pediatricians. Health Serv Res 2005, 40(1):213-226.