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  • 1.
    Dellve, Lotta
    et al.
    KTH Royal Institute of Technology, Sweden.
    Andreasson, Jörgen
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    KTH Royal Institute of Technology, Sweden.
    Strömgren, Marcus
    KTH Royal Institute of Technology, Sweden.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Nyorientering av svensk sjukvård: Verksamhetstjänande implementeringslogiker bygger mer hållbart engagemang och utveckling - i praktiken2016Report (Other academic)
  • 2.
    Dellve, Lotta
    et al.
    University of Borås, Sweden.
    Eriksson, Andrea
    KTH Royal Institute of Technology, Sweden.
    Williamsson, Anna
    RISE Research Institutes of Sweden. KTH Royal Institute of Technology, Sweden.
    Strömgren, Marcus
    KTH Royal Institute of Technology, Sweden.
    Andreasson, Jörgen
    University of Borås, Sweden.
    Holden, Richard
    Vanderbuilt University, Sweden.
    Lean implementation approaches at different levels in Swedish hospitals: the importance for working conditions, worker engagement, health and performance2014Conference paper (Refereed)
    Abstract [en]

    Background Swedish healthcare organizations are investing heavily in internal reforms. Lean has been frequently used as an overall concept to improve care processes and decrease costs. Some evidence shows positive results, especially if work environment issues are considered in parallel with other desired outcomes. However, there are considerable difficulties in evaluating lean as a concept since its application and interpretation seem to vary widely. Further, like for other management concepts, lean outcomes crucially depend on the implementation process. Aim This program investigates implementations of lean and lean-like developments of processes of care, and how these affect the working conditions, health, and performance of healthcare employees. We also investigated organizational factors and conditions that mediated specific outcomes. Method Mixed method design: questionnaire to employees (n=880) and managers (n=320), qualitative interviews (n=55) and observations with follow up during three years. Five hospitals were selected, and within them five units that were connected by their flow of acute care patients, i.e. the emergency unit, the medical and surgical emergency ward (or ICU at small hospital) as well as one medical and one surgical ward. Initially we used qualitative-driven analyses and thereafter quantitative-driven mixed method analysis. Results The implementation strategies varied between the hospitals and between the strategic and operative levels. Strategic managers also used different approaches to overcome the gap between strategic and operative levels. Operative managers shared similarities in their stepwise and coaching approaches encouraging participation among employees, but differences regarding how assignments were delegated. Social capital and attitudes among health care profession were of importance for employees’ work engagement and active engagement in development work.

  • 3.
    Dellve, Lotta
    et al.
    KTH Royal Institute of Technology, Sweden; University of Gothenburg, Sweden.
    Strömgren, Marcus
    KTH Royal Institute of Technology, Sweden.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Holden, Richard J.
    Indiana University, USA.
    Eriksson, Andrea
    KTH Royal Institute of Technology, Sweden.
    Health care clinicians’ engagement in organizational redesign of care processes: Health care clinicians’ engagement in organizational redesign of care processes2018In: Applied Ergonomics, Vol. 68, p. 249-257Article in journal (Refereed)
    Abstract [en]

    The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.

  • 4.
    Dellve, Lotta
    et al.
    University of Gothenburg, Sweden.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology. KTH Royal Institute of Technology, Sweden.
    Development Work in Swedish Eldercare: Resources for Trustworthy, Integrated Managerial Work During the COVID-19 Pandemic2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 864272Article in journal (Refereed)
    Abstract [en]

    The extensive needs for developments of eldercare addressing working conditions, care quality, influence, and safety was highlighted during the pandemic. This mixed-method study contribute with knowledge about capability-strengthening development work and its importance for trustworthy managerial work, before and during the COVID-19 pandemic. Questionnaire data and narratives from first-line managers immediately before (n = 284) and 16 months into the pandemic (n = 189), structured interviews with development leaders (n = 25), and documents were analyzed. The results identify different focuses of development work. Strategic-level development leaders focused the strengthening of old adults' capabilities. While operational-level leaders approached strengthening employees' capability. First-line managers' rating of their trustworthy managerial work decreased during the pandemic and was associated with their workload, development support and capability-strengthening projects focusing employees' resources. The study demonstrates the gap between strategic and the operational levels regarding understanding of capability set and needed resources for strengthening capabilities and trustworthy, integrated managerial work regarding safety, influence, and quality conditions for old adults and employees. Copyright © 2022 Dellve and Williamsson.

  • 5. Dellve, Lotta
    et al.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    Health care professionals’ motivation, engagement and collaboration in organizational developments of processes of care2012Conference paper (Refereed)
  • 6.
    Dellve, Lotta
    et al.
    KTH Royal Institute of Technology, Sweden; University of Borås, Sweden.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Strömgren, Marcus
    KTH Royal Institute of Technology, Sweden.
    Holden, Richard
    Vanderbuilt University, USA.
    Eriksson, Andrea
    KTH Royal Institute of Technology, Sweden.
    Lean implementation at different levels in Swedish hospitals: the importance for working conditions and stress2015In: International Journal of Human Factors and Ergonomics, Vol. 3, no 3-4, p. 235-253Article in journal (Refereed)
    Abstract [en]

    Healthcare organisations in Sweden are reorienting toward horizontal organisation around care processes. This paper’s aim was to investigate how implementation approaches for improvements of care processes in line with lean production (LP), at hospital strategic and operative levels, are associated with working conditions and stress-related health among the employees. Five hospitals working with improvements to care processes were studied using questionnaires to employees (n = 1,303) and interviews at strategic and operative levels at baseline and follow-up. The process redesign implementation strategies varied between the strategic and operative levels. There were associations between a higher degree of LP at operative level and increased work resources and decreased work demands. Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There was evidence of more beneficial or improved working conditions in relation to higher degree of LP at operative levels.

  • 7.
    Dellve, Lotta
    et al.
    KTH Royal Institute of Technology, Sweden.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Strömgren, Marcus
    KTH Royal Institute of Technology, Sweden.
    Holden, Richard
    University of Indiana, USA.
    Åhlström, Linda
    Andreasson, Jörgen
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    KTH Royal Institute of Technology, Sweden.
    The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up2015Conference paper (Other academic)
    Abstract [en]

    Introduction The public sector has during the last decades been struggling with the challenge of how to increase the efficiency, the quality of performance, as well as with problems related to work environment and recruitments. Hospitals have struggled with increased focuses on costumer orientation, rationalizations and care processes redesign, and have often used Lean production (LP) as management model. Aim to assess the long-term importance of implementing LP in hospitals for the psychosocial work conditions.  Based on earlier research (e.g. Westgaard & Winkel, 2011), the following hypothesis were tested (1) Strategic large scale  implementation of LP is associated with negative impact on mental health; (2) Implementation of LP is associated with weak negative impact on psychosocial work conditions; (3) The association between implementation of LP and psychosocial conditions is moderated by profession and participatory approaches. Method  Five hospitals working with improvements of care processes were studied 2012-2014 using questionnaires to employees (T1 n=1303) and interviews at strategic and operative levels. Analyzes with mixed models repeated measurements were performed. The explaining variables for the models were implementation of lean at strategic resp operative level, and time (T1, T2, T3). The outcome variables were work-related health (SRH, work ability, stress-symptoms) and psychosocial work conditions. Results  Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There were no overall differences in self rated health and work ability with regard to implementation of LP. A higher degree of LP at operative level was associated with decreased work demands. There was, especially initially, more beneficial or improved working conditions in relation to higher degree of LP at operative levels. The long-term follow-up showed that quantitative demands increased and predictability as well as leadership decreased in the non-lean hospitals. There were different patterns with regard to profession and participatory approaches that will be presented.

  • 8. Eklund, Jörgen
    et al.
    Brännmark, Mikael
    Dellve, Lotta
    Elg, M
    Eriksson, A
    Halling, Bengt
    Halvarsson, A
    Kock, H
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Andersson, K
    Håkansson, Malin
    Langstrand, J
    Poksinska, Bozena
    Renström, Jonas
    Svensson, L
    Vänje, Annika
    Lean and working conditions: a current position2013In: HELIX Conference, 2013Conference paper (Refereed)
  • 9.
    Eriksson, Andrea
    et al.
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    University of Gothenburg, Sweden.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Skagert, Katrin
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    How Conditions and Resources Connected to Digital Management Systems and Remote Work Are Associated with Sustainable Work2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 23, article id 15731Article in journal (Refereed)
    Abstract [en]

    The current state of work–life transformation will see more white-collar work being performed remotely using digital management systems. There is, however, a lack of research on factors and resources contributing to sustainable work when working remotely using digital management systems. The aim of this study was to study the conditions and resources connected to digital management systems and remote work, and their associations with sustainable work, in terms of process quality, trust, and sense of coherence, when working remotely during the COVID-19 pandemic. An analytical cross-sectional study was performed. Questionnaire data from white-collar employees (n = 484) in two private companies were analyzed with regression models, focusing on the importance of the conditions and resources connected to digital management systems and remote work, stratified by working from home or at the office. The results showed digital conditions and resources being associated with indicators of sustainable work. Furthermore, the results showed that social work relations were additional important explanatory factors for sustainable remote work. This study contributes to the development of a new post-pandemic work–life balance by concluding that sustainable remote work needs to be ensured by functional digital management systems and adequate leadership supporting the development of a positive team and learning climate. © 2022 by the authors.

  • 10.
    Eriksson, Andrea
    et al.
    KTH Royal Institute of Technology, Sweden.
    Holden, Richard J.
    Indiana University, USA.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    KTH Royal Institute of Technology, Sweden; University of Borås, Sweden.
    A Case Study of Three Swedish Hospitals’ Strategies for Implementing Lean Production2016In: Nordic Journal of Working Life Studies, Vol. 6, no 1, p. 105-131Article in journal (Refereed)
    Abstract [en]

    Many hospitals have recently implemented the management concept lean production. The aim of this study was to learn how and why three Swedish hospitals selected and developed their hospital-wide lean production strategies. Although previous research shows that the concept is implemented in various ways, there is limited research on how and why different hospitals choose different implementation strategies and if the chosen strategies contribute to sustainable participation in organizational development. A case study of three different Swedish hospitals implementing lean production was thus performed. We studied the content of the hospitals’ selected implementation strategies, conditions and rationales behind their strategy selection, and how different organizational actors participated in the implementation. Qualitative interviews with 54 key actors at the studied hospitals were performed. In addition, a self-administered survey questionnaire to employees was answered at T1 (2012, n = 557), T2 (2013, n = 554), and T3 (2014, n = 366). The three studied hospitals chose different strategies for implementing lean production due to different contextual conditions and for different reasons. The hospital-wide implementation strategies were related to employees’ interest and participation in lean production. The results show that many different actors at different organizational levels need to participate in lean production in order to sustain and diffuse change processes. Furthermore, broad motives including quality of care seem to be needed for engaging different professional groups.

  • 11. Eriksson, Andrea
    et al.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Implementation of the organizational concept lean production: Case studies of two Swedish hospitals2012In: NOVO Symposium: Hållbar hälso- och sjukvård, 2012, p. 25-25Conference paper (Refereed)
  • 12. Eriksson, Andrea
    et al.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Motivations and strategies for why and how to implement the organizational concept lean – a case study of a Swedish hospital2012Conference paper (Refereed)
    Abstract [en]

    The aim of this study was to analyze motivations and strategies of a Swedish hospital for why and how to implement lean. A case study, including interviews with key actors, observations and document analysis, was performed. Lean was in the studied hospital viewed as tools to deal with suggestions from employees on how to improve the delivery of care. Process leaders employed for a limited time were responsible for implementing lean in the different units. The hospitals future choices of implementation strategies, including training of managers, can be seen ascritical for motivating unit-level managers to sustain lean over time.

  • 13. Eriksson, Andrea
    et al.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Three Swedish hospitals’ lean strategies and their contribution to organizational development2014In: ODAM/NES, 2014, p. 657-658Conference paper (Refereed)
  • 14.
    Harlin, Ulrika
    et al.
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Berglund, Marina
    Eklund, Jörgen
    Metodstöd för en hållbar arbetsmiljö – Reflektioner kring en pågående industristudie2022In: Book of abstracts FALF 2022 Framtidens arbete – arbetets framtid, 2022Conference paper (Refereed)
  • 15.
    Harlin, Ulrika
    et al.
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Eklund, Jörgen
    KTH Royal Institute of Technology, Sweden.
    Berglund, Martina
    Linköping university, Sweden.
    Dialogverktyget Work Balance i praktiken: En lärande utvärdering för hållbart arbete2022Report (Other academic)
    Abstract [en]

    För att svara upp mot utmaningarna inom det organisatoriska och sociala arbetsmiljöområdet och främja ett hållbart arbetsliv har Scania utvecklat dialogverktyget Work Balance. Det är forskningsbaserat och avser ge stöd och struktur åt chefer att föra djupare och regelbunden dialog med medarbetare kring upplevelser av arbetssituationer. Dialogen är strukturerad inom de fyra ämnesområdena Hanterbarhet, Begriplighet, Meningsfullhet och Återhämtning, och avses användas på frivillig basis i grupp eller individuellt. HELIX har i samarbete med Scania genomfört en lärande utvärdering av Work Balance. Syftet med denna utvärdering var att identifiera möjliggörare och hinder för användningen av Work Balance samt att ta fram förbättringsförslag som underlag för Scanias vidareutveckling av dialogverktyget. HELIX-forskare intervjuade 44 medarbetare, första och andra linjens chefer ur produktions- och kontorsmiljö, från sex produktionsenheter i fyra länder. Dessa använde eller hade valt att inte använda dialogverktyget. Resultaten visar en över lag positiv syn på Work Balance, på frivilligheten i användningen, relevansen, anpassningsbarheten, flexibiliteten och det varierade användningssättet. Men vid en produktionsenhet där verktyget inte fungerat som önskat har användningen avbrutits. Implementeringen varierade avseende tydlighet i information och träning i verktyget. Användningsförutsättningarna varierade kraftigt beroende på tidigare erfarenheter, kultur och mognad hos team och chefer att vara öppna och sätta ord på känslor. Användningen varierade även mellan produktionsenheter. Vid regelbunden användning var man mycket nöjd, men andra som inte sett nyttan hade slutat använda Work Balance. I produktion var teamen större, tiden mer begränsad, språk och frågor kändes mer abstrakta och användningen upplevdes svårare än i kontor. Högre chefers efterfrågan av användning tenderade ge en mer uthållig användning. Upplevda effekter var; öppnare klimat, bättre kommunikation, ökat samförstånd och tidigare identifiering av problem. Många trodde på en indirekt positiv koppling mellan Work Balance och nyckeltal. En enklare version av Work Balance efterfrågades, men också bättre hantering av identifierade problem, där mer stöd och utbildning till chefer och team behövs. En väl utvecklad förbättringskultur torde vara en bra grund för en utvecklad dialog där Work Balance kopplas till andra verktyg eller metoder som används i teamets kärnprocesser.

  • 16.
    Harlin, Ulrika
    et al.
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society.
    Eklund, Jörgen
    KTH Royal Institute of Technololgy, Sweden.
    Berglund, Martina
    Linköping University, Sweden.
    The dialogue tool Work Balance in practice : A learning evaluation for sustainable work2022Report (Other academic)
    Abstract [en]

    In order to respond to the challenges in the organisational and social work environment area and to promote a sustainable working life, Scania has developed the dialogue tool called Work Balance (WB) It is research-based and intended to provide support and structure for managers to maintain an in-depth and regular dialogue with employees about their experiences of work situations. The dialogue is structured using four elements – Manageability, Comprehensibility, Meaningfulness and Recovery – and is intended to be used on a voluntary basis in groups or individually. In cooperation with Scania, HELIX has conducted a learning evaluation for Work Balance. The purpose of this learning evaluation was to identify enablers and obstacles to the use of Work Balance and to produce improvement proposals as a basis for Scania’s further development of the dialogue tool. HELIX researchers interviewed 44 employees, first- and second-line managers from production and office environments, from six production units in four countries. These employees used or had chosen not to use the dialogue tool. The results show an overall positive view of Work Balance, of the voluntary use, relevance, adaptability, flexibility and the varied mode of application. However, its use has been discontinued at one production unit where the tool did not work as desired. The implementation varied in terms of clarity of information and training in the tool. The conditions of use varied greatly depending on previous experience, culture and maturity of teams and managers in terms of being open and putting feelings into words. Use also varied between production units. Those who used it regularly were very satisfied, while others who did not see the benefit stopped using Work Balance. In production, the teams were larger, time was more limited, language and questions felt more abstract, and use was perceived as more difficult than in an office environment. Senior managers requesting that it be used tended to result in more sustained use. Perceived effects were: a more open atmosphere, better communication, increased consensus and earlier identification of problems. Many believed in an indirect positive link between Work Balance and key performance indicators. A simpler version of Work Balance was requested, but also better handling of identified problems, where more support and training for managers and teams are needed. A well-developed culture of improvement should be a good basis for a developed dialogue where Work Balance is linked to other tools or methods used in the team’s core processes.

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  • 17. Holden, Richard J
    et al.
    Eriksson, Andrea
    Andreasson, Jörgen
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Healthcare workers’ perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals2015In: Applied Ergonomics, Vol. 46, p. 181-192Article in journal (Refereed)
    Abstract [en]

    As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers’ perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital’s employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.

  • 18.
    Mattsson, Janet
    et al.
    Karolinska Institute, Sweden.
    Östlund, Britt
    Björling, Gunilla
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    Interprofessional Learning for Enhanced Patient Safety: Biomedical Engineering Students and Nursing Students in Joint Learning Activities.2019In: Journal of Research in Interprofessional Practice and Education, Vol. 9, no 1Article in journal (Refereed)
    Abstract [en]

    Background: In the last decade, research has highlighted the importance of interprofessional approaches to education and practice. Collaboration between medical practice and engineering has been identified as particularly relevant to developing accountable models for sustainable healthcare and overcoming increased specialization leading to professional barriers. This study aims to analyze insights and understanding expressed by nursing students and biomedical engineering students following a joint learning activity regarding a medical device used in the hospital setting. Method: A qualitative approach deriving from a phenomenological view examined an interprofessional learning activity where the focus was on active integration and knowledge exchange. Conclusion: The activity was expressed as a positive opportunity for getting insights into perspectives from other professional groups as well as insights into the importance of a system perspective in patient safety. The learning and insights listed in the evaluations included ideas about how the two professional groups could collaborate in the future.

  • 19.
    Wallo, Andreas
    et al.
    Linköping university, Sweden.
    Martin, Jason
    Linköping university, Sweden.
    Elg, Mattias
    Linköping university, Sweden.
    Harlin, Ulrika
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology. Linköping university, Sweden.
    Bozic, Nina
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society.
    Skagert, Katrin
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society.
    Williamsson, Anna
    RISE Research Institutes of Sweden, Materials and Production, Product Realisation Methodology.
    Gremyr, Ida
    Chalmers University of Technology, Sweden.
    Mapping the challenges of a socially sustainable, competitive, and green industry in the age of rapid change: A Delphi study2023Report (Other academic)
    Abstract [en]

    This report presents the findings of a Delphi study coordinated by Linköping University (LiU) in collaboration with RISE Research Institutes of Sweden and the Chalmers University of Technology. The study was carried out in 2022 as part of a Vinnova-funded planning project aimed at establishing an interdisciplinary research environment to prepare an application for a new competence centre focused on building a long-term, sustainable Swedish industry. The Delphi study aimed to identify key challenges related to the ambition to develop a socially sustainable, competitive, and green industry subjected to an accelerating pace of change. The Delphi study was based on an interactive research approach to facilitate the cocreation of knowledge for the dual purpose of advancing long-term theory development and innovation processes. The consortium and its reference groups consist of industrial companies (such as AstraZeneca, Ericsson IndustryLab, Rimaster, Saab Aeronautics, Scania, Volvo GTO and Volvo Cars), intermediaries and educational actors (such as Skill, IUC Sverige and Linköping Science Park), labour market organisations (including IF Metall, Industriarbetsgivarna, Unionen, and Teknikföretagen), governmental agencies (the Office for Sustainable Working life), and researchers from LiU, Chalmers, and RISE. There are key industrial targets forming the starting point for the Delphi study that also guide policies and investments in strategic agendas for the industrial stakeholders. For the Swedish industry to be resilient and sustainable, new competence and organisational abilities are required to decrease the dependency on fossil energy in production. Transformation towards electrification, circular economy, and digitalisation are key enablers, and these transitions are ongoing and accelerating at a fast pace. Furthermore, new and constantly emerging targets require organisational resilience, like managing new requirements and targets within energy consumption and supply of competence. The findings of this report include a total of 14 identified challenges. To organise and create conditions for flexible work for all To successfully manage crises and drastic external events To successfully drive and contribute to the green industrial transformation To facilitate employee-driven innovation and organisational learning To attract, develop and retain employees with the right skills To take advantage of and exploit the opportunities of digitalisation To create inclusive workplaces and utilise diversity To organise competence development To collaborate with external parties to ensure the availability of competence To design for socially sustainable work considering efficiency and good health in a dynamic environment To organise the creation of added value for and together with customers and suppliers To systematically drive continuous improvement work in parallel with long-term development work To develop leadership that creates better opportunities both for a climate-neutral footprint and a competitive industry with good working conditions To transform research- and policy-based knowledge into practice The 14 challenges were further analysed according to perceived importance and ability and presented in a priority matrix. According to the priority matrix, the 14 challenges were then synthesised into six main research themes: A. Innovative competence supply practice, B. Resilient organisations & production systems, C. Analytics for improvement & learning, D. Socially sustainable work, E. Green transformation practices, and an open and undefined research theme labelled as Future challenges. The research themes are also presented together with six main analytical and theoretical perspectives in a matrix that can be used to intersect and interweave the research themes to guide the research agenda in a potential future research program.

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    fulltext
  • 20.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Change agents and use of visual management tools in care process redesign: Implications on working conditions for operative managers and healthcare professionals2018Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Swedish healthcare has been subject to change efforts to increase efficiency in care processes. In the 2000-2010’s lean production has influenced healthcare with change approaches such as visual management tools to increase patient flows and efficiency. Most previous research on lean healthcare has focused single hospitals or departments as case studies focusing lean production as successful for efficiency, or “mean” production affecting the work environment. Focus in this thesis though is instead on what strategies and approaches hospitals use in their care process redesign and their associations with working conditions and systems performance. This thesis’ overall aim was to assess change strategies and change approaches at strategic and operative levels during care process redesign at hospitals, focusing organization of change agents and use of visual management tools, and its implica-tions for alignment, working conditions and systems performance. Four studies were conducted at five Swedish hospitals, whereof three had lean-inspired change strategies. One qualitative cross-sectional study, one quantitative longitudinal study and two mixed method longitudinal studies are included in the thesis. Data was collected over three years with semi-structured interviews, structured interviews, staff questionnaires, manager questionnaires and photo document-ation. Qualitative data were analyzed by content analysis. Quantitative data were analyzed with Wilcoxon tests, mixed models of repeated measurements, ANOVA, and linear regression models. Results showed strategies involve operative manag-ers as change drivers, supported by change agent functions. Change agents’ contribution to change depends on e.g. closeness to operative managers due to the change agents place in the healthcare hierarchy, and also clarity regarding roles and responsibilities in change. Change agents with a close collaboration with operative managers, have better preconditions to contribute to alignment between change strategies and change approaches. Hospital care units in the 2010’s tend to use lean-inspired operative change approaches also without working with change strategies based on lean. Operative lean approaches show associations with positive working conditions for healthcare professionals. Visual management tools as change strategy has potential to support collaboration and communication within and between organizational levels and is considered to contribute to systems performance and alignment. Visual management tools as a cognitive job resource for operative managers show associations with e.g. lower burnout and more functioning collaboration as well as daily use among nurses show associations with cognitive, social and emotional benefits, perceived systems performance and buffering mental stress. Change agents and use of visual management tools are considered as contributors for operative managers’ and healthcare professionals’ sustainable work during care process redesign.

  • 21.
    Williamsson, Anna
    KTH Royal Institute of Technology, Sweden.
    Operative managers’ job-demands-resources when redesigning care processesManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose The aim was to describe hospitals’ approaches to use change agents and visualmanagement tools, and examine change agents and visual management tools as job resourcesfor operative managers, during care process redesign. Design A longitudinal three year (T0, T1, T2) mixed method design was used. Qualitativedata from semi-structured interviews was collected at five hospitals (T0, T2). Quantitativedata from questionnaires (T1, T2) was collected to examine the use and support from changeagents and visual management tools among operative managers at the hospitals. Operativemanagers’ support and associations with their working conditions were further examined inrelation to the Job Demands and Resources model. Analyses of differences between groups ofoperative managers were performed with Wilcoxon tests. Findings Change agents as emotional job resources supported operative managers whenintroducing care process redesign. Higher change agent support was associated to positiveresults regarding burnout and organizational outcomes. Visual management tools as cognitivejob resources supported operative managers when used daily, and were associated to positiveresults regarding burnout, and organizational outcomes. Combined support from both changeagents and visual management tools was associated to beneficial organizational outcomes(collaboration between operative managers as well as between operative managers andhealthcare professionals during care process redesign, and possibilities to fulfill managerialduties) and thus were considered as important job resources for operative managers to drivechange.

  • 22.
    Williamsson, Anna
    et al.
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society. KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    University of Gothenburg, Sweden.
    Developing Eldercare in Ageing Societies: A Qualitative Study on Misaligned Visions and Caged Change Agents2023In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, article id 2798463Article in journal (Refereed)
    Abstract [en]

    Eldercare is facing current demands to develop due to changing demographics with increasing populations of elderly over the ageof 85 combined with smaller populations of young people able to provide care and contribute to care via their taxes. The need for development of quality and safety was highlighted during the COVID-19 pandemic. Swedish government subsidies aimed at developing municipalities responsible for publicly managed eldercare have only been evaluated to a limited extent and the realisation of visions of future eldercare is shrouded in mystery. The study aims to explore the development work and strategies in Swedish municipal eldercare organisations, specifically in terms of alignment between democratic visions at political and strategic levels and operationalisation at operational levels. 28 interviews with development leaders were conducted in 14 Swedish municipality organisations between March and October 2021. The interviews focused on supporting roles and functions, responsibilities and collaborations, visions and operationalisations, and the follow-up and evaluation of eldercare development. A thematic analysis resulted in the main theme “top-down handling of unmanageable alignment” and the subthemes “shaping a highroad for change;” “sticking to visions, hopes, and respect for practice;” and “self-serving focus on politics.” The quality of alignment strategies and putting the strategic vision into practice were related to organisation size and resources. A gap between strategic and operational levels was accentuated in terms of inconsistent responsibilities in following through with development projects and development being characterised by top-down initiatives and resources at the strategic level but strained implementation abilities at operational levels. Peripherally located change agents with legitimacy at multiple organisational levels are suggested to ease top-down as well as bottom-up drive, which could increase a vertical alignment of visions and practice.

  • 23.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Karltun, Anette
    Nurses’ use of visual management in hospitals - a longitudinal, quantitative study on its implications on systems performance and working conditions2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 4, p. 760-771Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to examine potential benefits provided by dailyvisual management tool use and explore its association with systems performanceand working conditions among hospital nurses.Background: Visual management tools used in everyday work and improvementwork in health care theoretically contribute to shared understanding of complexwork systems and provide certain user benefits. Cognitive load, miscommunicationwithin and between professional groups, and pressure to engage in care processredesign add to nurses’ strained working conditions.Design: Quantitative longitudinal.Methods: Questionnaires were distributed at T0, (N = 948, 66% response rate), T1(N = 900, 70% response rate), and T2 (N = 621, 72% response rate) to nurses atfive hospitals. Three groups of users (daily users, start users, and non‐daily users)were compared by means T1–T2 (significance tested with Wilcoxon signed ranktest) and by mixed model repeated measures T0, T1, T2.Results: Daily use associated to better overview of work, collaboration, social capital,and clinical engagement. Job resources were rated higher by daily users. Mentalstress increased and development opportunities decreased over time among nondailyusers. There were associations between use and perceptions of systems performance,though the differences between groups were small.Conclusion: This study specifically explores visual management tool use in the hospitalsetting, which contributes to research by broadening the understanding of cognitive,social, and emotional benefits provided by visual management tool use. Dailyuse was associated to positive working conditions, small but positive differences insystems performance, and indicated a buffering effect on nurses’ mental stress.

  • 24.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Dellve, Lotta
    Karltun, Anette
    Visualizing improvements of care processes- supporting engagement and perceived systems performance in improvement work2014Conference paper (Refereed)
  • 25.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    Dellve, Lotta
    Organization of change agents during care process redesign in Swedish health care2016In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 5, no 3, p. 20-32Article in journal (Refereed)
    Abstract [en]

    Background: Swedish health care organizations (HCOs) are changing using management concepts such as Lean, in attempts of improving efficiency, quality of care and work environment. Since there are pre-conditional challenges for operative managers to engage in change, HCOs tend to assign supportive functions such as change agents (CAs) to facilitate change. Research on the use of CAs in HCOs is sparse, thus the aim of this study explores role assignments and conditions of formally appointed CAs contributing to care process redesign. Methods: A purposive sample of three Swedish hospitals initiating Lean-inspired care process redesign during 2010–2011 was done. In-depth interviews were held with fifty-one key functions during change. Focus group interviews were conducted with thirty-eight health care professionals. Data were analysed by content analysis. Results: Top managers’ goal was to have operative management responsible for change during care process redesign, with support from assigned CAs. Organizing of CAs varied concerning, e.g. their hierarchical positions, job descriptions and practices, and conditions to act as driving forces towards change. Being granted formal power, having earned legitimacy and credibility, clarity regarding roles and responsibilities in change; a good sense of timing and ability to build relationships and trust, were identified as beneficial for CAs to support change. Conclusions: Role assignment and organizing of CAs varies. A position closer to the operative levels, formalized and clarified responsibilities, earned legitimacy and timing support adaptation and alignment of planned change, such as Lean-inspired care process redesign.

  • 26.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    Dellve, Lotta
    The organization and work practice of change agents in health care organizations; effects on health care professionals’ engagement and participation in improvement work2014Conference paper (Other academic)
  • 27.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Eriksson, Andrea
    Dellve, Lotta
    Who are the change agents when hospitals are implementing Lean?2013Conference paper (Other academic)
  • 28.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Karltun, Anette
    Dellve, Lotta
    Visual management; condition or consequence to social capital and clinical engagement among nurses?2017Conference paper (Other academic)
  • 29.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Karltun, Anette
    Dellve, Lotta
    Visual management in hospitals during organizational developments - benefits and contributions for working conditions and efficacy2015Conference paper (Other academic)
    Abstract [en]

    Introduction Many hospitals choose to use certain tools related to lean, such as visual management (VM) during organizational development (OD) and daily processes. By using VM in the strategic planning process and depending on what is visualized in what stage of the planning process, different cognitive, social and emotional benefits may be gained. Research on VM in healthcare has so far concerned case studies of VM in surgical departments or during OD, and there is a lack of studies with rich empirical data. The aim of this paper was to explore VM use at hospital units undergoing OD; the main VM focus, and the benefits and perceived VM contributions concerning working conditions and efficacy. Material and Methods Photos of VM (120) at 16 units were taken during 2013-2015 and categorized by content analysis into VM focus and main content. A questionnaire concerning use of and perceived VM contributions in daily work (regarding; a) overview work, b) focus important information, c) detection of improvement opportunities) as well as working conditions, efficacy and quality of care was distributed to registered nurses and assistant nurses at five hospitals (21 units) at two occasions, 2013 (N=926) and 2014 (N=632). Comparative analysis’ within and between higher and lower use units were conducted. Results Content analysis of the photos showed three main VM foci; results, flow and improvements.  Five of the 21 units were considered to have higher VM and 16 units had lower. In comparative analysis, higher VM was associated with higher predictability and influence as well as with cognitive and social benefits of importance when participating in OD. Higher VM was also associated with higher degree of goal monitoring and evaluation, patient flow and efficacy in health care service. Conclusions Daily use of VM in hospitals undergoing OD had importance for employees’ working conditions as well as  perception of OD; overview of work, focus on results,  detection of improvement opportunities and outcomes in terms of patient flow and efficacy.

  • 30.
    Williamsson, Anna
    et al.
    KTH Royal Institute of Technology, Sweden.
    Karltun, Annette
    Dellve, Lotta
    Visualizing improvements of care processes- a contribution to shared understanding and engagement, or cognitive strain?2014Conference paper (Other academic)
  • 31.
    Williamsson, Anna
    et al.
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society.
    Skagert, Katrin
    RISE Research Institutes of Sweden, Digital Systems, Prototyping Society.
    Trygghet i professionen: En vetenskaplig omvärldsanalys av socialsekreterares arbetssituation2023Report (Other academic)
    Abstract [sv]

    Syftet med litteraturgranskningen var att kartlägga; kunskapsläget kring socialsekreterares arbetsmiljö i allmänhet, samt identifiera interventioner och aktiviteter för att stärka socialsekreterares möjlighet att i trygghet utöva sitt uppdrag korrekt utan påverkan i synnerhet. Via de svenska databaserna Swepub och GU supersök identifierades 15 publikationer, varav 5 inkluderades i analysen. För engelskspråkiga publikationer gjordes sökningar i Scopus, där 69 lästes i sin fulltext. Efter genomläsning inkluderas 44 stycken. Av de inkluderade publikationerna dominerade kvantitativa studier baserade på enkätdata. Förhållandevis få studier redogjorde för någon form av insats för att stärka tryggheten. Teoretiska referensramar som användes bland publikationerna var teorin om Exit- Voice och krav- och resursmodellen relaterat till olika hälsoutfall där samband mellan arbetsförhållanden och tankar på att sluta, arbetstillfredsställelse, utmattning samt upplevelsen av förändring av ens egna medkänsla med klienter kunde fastslås. De vetenskapliga artiklarna beskriver problem och faktorer som påverkar tryggheten i professionen på olika systemnivåer. Dels finns resultat på individuell medarbetarnivå, på arbetsgrupp- och yrkesprofessionsnivå, i relation till andra myndigheter samt på övergripande samhällsnivå som relaterar både till påverkan, hantering och konsekvenser för tryggheten i yrkesprofessionen. De krav som uppstår kan påverka i en nedåtgående spiral men det finns också stöd och resurser som kan stärka tryggheten för att balansera krav och grundläggande förutsättningar i yrket. Det traditionella arbetsmiljöarbetet kan behöva kompletteras med proaktivt arbete för att stärka förmågan att hantera oförutsedda händelser. Här tycks öppenhet i organisationen och professionsstärkande åtgärder vara viktigt både för individens, professionsteamets och organisationens hållbarhet.

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