Emerald | Journal of Health Organization and Management | Table of Contents http://www.emeraldinsight.com/1477-7266.htm Table of contents from the most recently published issue of Journal of Health Organization and Management Journal en-gb Tue, 13 May 2014 00:00:00 +0100 2014 Emerald Group Publishing Limited editorial@emeraldinsight.com support@emeraldinsight.com 60 Emerald | Journal of Health Organization and Management | Table of Contents http://www.emeraldinsight.com/common_assets/img/covers_journal/jhomcover.gif http://www.emeraldinsight.com/1477-7266.htm 120 157 Guest Editorial: Lean in Healthcare: history and recent developments http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109026&show=abstract <strong>Abstract</strong><br /><br />Not available. Article literatinetwork@emeraldinsight.com (Terry Sloan, Anneke Fitzgerald, Kathryn J Hayes, Zoe Radnor, Suzanne Robinson, Amrik Sohal) Tue, 13 May 2014 00:00:00 +0100 Readiness Factors for Lean Implementation in Healthcare Settings – A Literature Review http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109023&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - This paper aims to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature.<B>Design/methodology/approach</B> - A comprehensive review of literature focusing on lean and lean healthcare was conducted. <B>Findings</B> - Leadership, organizational culture, communication, training, measurement and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. <B>Research limitations/implications</B> - The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. <B>Practical implications</B> - The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. <B>Originality/value</B> - To the best of our knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research. Article literatinetwork@emeraldinsight.com (Shahid Al-Balushi, Amrik Sohal, Prakash J Singh, Abdullah Al Hajri, Yahya Al Farsi, Rashid Al Abri) Tue, 13 May 2014 00:00:00 +0100 Exploring the nature and impact of leadership on the local implementation of The Productive Ward Releasing Time to CareTM http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109066&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - Purpose: To explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in healthcare organisations.<B>Design/methodology/approach</B> - Method: Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to CareTM in English hospitals, the paper explores leadership in relation to local implementation. Data was attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.<B>Findings</B> - Findings: Four overall themes were identified: Different leadership roles at multiple levels of the organisation, Experiences of ‘good and bad’ leadership styles, Frontline staff having a sense of permission to lead change, Leader’s actions to spread learning and sustain improvements.<B>Originality/value</B> - This paper offers useful perspectives in understanding informal, emergent, developmental or shared ‘new’ leadership because it emphasizes that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader’s boundary spanning activities to spread learning and sustain improvements. Article literatinetwork@emeraldinsight.com (Elizabeth Morrow, Glen Robert, Jill Maben) Tue, 13 May 2014 00:00:00 +0100 Lean in Healthcare from Employees’ Perspectives http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109002&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - This article aims to contribute towards a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.<B>Design/methodology/approach</B> - The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data was collected by methods including interviews, observations, and document studies.<B>Findings</B> - The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.<B>Practical implications</B> - Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations’ working environment, staff development, and organizational performance.<B>Originality/value</B> - In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this. Article literatinetwork@emeraldinsight.com (Erik Drotz, Bozena Poksinska) Tue, 13 May 2014 00:00:00 +0100 Does Lean Implementation interact with group functioning? http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109010&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, this study aims to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time. <B>Design/methodology/approach</B> - Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n=133) and 2011 (n=130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis. <B>Findings</B> - At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p=.02) and the Ward-II (p=.04), but not at Ward-I (p=.11). <B>Research limitations/implications</B> - Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.<B>Practical implications</B> - Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members’ relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging. <B>Originality/value</B> - This study focused specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean. Article literatinetwork@emeraldinsight.com (Waqar Ulhassan, Hugo Westerlund, Johan Thor, Christer Sandahl, Ulrica von Thiele Schwarz) Tue, 13 May 2014 00:00:00 +0100 Implementing lean methods in the Emergency Department: the role of professions and professional status http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109070&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - To examine the implementation of lean methods in an Emergency Department (ED) and the role of the professions in this process<B>Design/methodology/approach</B> - Qualitative, semi-structured interviews with ED staff in a UK NHS hospital<B>Findings</B> - Lean was met with more engagement and enthusiasm by the professionals than is usually reported in the literature. The main reasons for this were a combination of a national policy, the unique clinical environment and the status of the professional project for doctors in Emergency Medicine<B>Research limitations/implications</B> - single site, one-off study<B>Practical implications</B> - The status and development of professionals involved may play a big part in the acceptability of initiatives like lean methods in health care. The longer term sustainability of the organisational changes introduced remains open to question<B>Originality/value</B> - This paper analyses the success of lean methods in health care with reference to the professional status and stage of development of the professions involved, using the sociology of professions. This approach has not been used elsewhere Article literatinetwork@emeraldinsight.com (Stephen Timmons, Frank Coffey, Paraskevas Vezyridis) Tue, 13 May 2014 00:00:00 +0100 Applying Lean Flows in Pathology Laboratory Remodelling http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109055&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - This article examines the application and outcomes of applying all of the seven lean flows to pathology laboratory remodelling as part of a lean rapid improvement event.<B>Design/methodology/approach</B> - Longitudinal case study of a lean rapid improvement event linking emergency and pathology departments focussing on the systematic application of lean’s seven flows to the physical environment.<B>Findings</B> - Following the lean rapid improvement event, changes improving patient specimen, technician, supplies, and information flows avoided 187 km and eight days of unnecessary walking each year. <B>Research limitations/implications</B> - The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged.<B>Practical implications</B> - This research provides evidence that applying lean design concepts in a laboratory can make substantial improvements, particularly if the expertise of the people working in the laboratory is trusted to determine the most appropriate changes. Significant amounts of time and motion were saved by just one, easily quantifiable change.<B>Originality/value</B> - To the best of the authors’ knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations. Article literatinetwork@emeraldinsight.com (Kathryn J Hayes, Nick Reed, Anneke Fitzgerald, Vicki Watt) Tue, 13 May 2014 00:00:00 +0100 Squaring the circle of healthcare supplies http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109046&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - The aim of the study is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement.<B>Design/methodology/approach</B> - A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case.<B>Findings</B> - The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information.<B>Research limitations/implications</B> - The small number of cases limits the generalisability of the findings at this time. <B>Practical implications</B> - Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems.<B>Originality/value</B> - Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings. Article literatinetwork@emeraldinsight.com (Tillmann Boehme, Sharon Williams, Paul Childerhouse, Eric Deakins, Denis Towill) Tue, 13 May 2014 00:00:00 +0100 Complexity complicates lean: Lessons from seven emergency services http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=2&articleid=17109067&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - To explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data. <B>Design/methodology/approach</B> - A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data was collected from seven emergency services at a Swedish university hospital: Ear, Nose and Throat (ENT) (2), Pediatrics (2), Gynecology, Internal Medicine, and Surgery. Performance patterns were linked with qualitative data collected through realist interviews.<B>Findings</B> - The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and Gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For Medicine, Surgery, and Pediatrics, which exhibit greater care process complexity, sustainable or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.<B>Originality/value</B> - The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices. Article literatinetwork@emeraldinsight.com (Pamela Mazzocato, Johan Thor, Ulrika Bäckman, Mats Brommels, Jan Carlsson, Fredrik Jonsson, Magnus Hagmar, Carl Savage) Tue, 13 May 2014 00:00:00 +0100