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Hospital management from a high reliability organizational change perspective: A Swedish case on Lean and Six Sigma

机译:从高度可靠的组织变革角度看医院管理:瑞典关于精益和六个西格玛的案例

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Purpose - The purpose of this paper is to describe and analyze nurses' perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO). Design/methodology/approach - Nurses' roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n = 17) nurses at two Swedish hospitals. Findings - The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses' well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional's logic collides with management's logic. Expert knowledge (top-down approach) without nurses' local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement. Practical implications - Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian rnethod structures that limit the healthcare professionals' autonomy should be softened or abandoned. Originality/value - The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.
机译:目的-本文的目的是描述和分析在引入精益和六西格码之后护士对卫生保健工作的看法和评估,以及护士如何渴望维持高可靠性组织(HRO)。设计/方法/方法-护士的角色以及他们对新效率和高质量工作方法的反应方式至关重要。根据对两家瑞典医院(n = 17)护士进行的深入,半结构化访谈,分析了基本主题。调查结果-护士认为精益比六西格码更好,因为它采用了自下而上的方法,并且与护士众所周知的工作素质相似。护士协调患者护理,团队协作并担任领导角色。为了保持高可靠性并成为高质量的开发人员,护士需要稳定的资源。但是,专业人员的逻辑与管理层的逻辑相冲突。没有护士本地知识的专业知识(自上而下的方法)(自下而上的方法)会导致问题。医疗保健质量方法是标准化的,但必须灵活使用。但是,HRO不仅来自方法质量,还来自工作态度,承诺和持续的工作改进。实际意义-管理层可以通过以下方式支持人员进行发展工作:持续教育,培训,团队合作,知识共享与合作。限制医护人员自主权的专制体制应该被软化或放弃。原创性/价值-该研究使用了HRO的理论概念,这些概念是为意外事件开发的,以解释在医疗保健领域实施精益和六西格码的后果。

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