Organization of change agents during care process redesign in Swedish health care

Abstract

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.

A Case Study of Three Swedish Hospitals’ Strategies for Implementing Lean Production

“…The hospital-wide strategies might impact perceptions about LP differently among different units and different professional groups. In-depth analyses of the results of the strategies are given in other papers Holden et al 2015;Williamsson et al 2016). The intended main contribution of this article was to give more general descriptions of the studied hospitals' implementation strategies.…”

“Nurses’ use of visual management in hospitals—A longitudinal, quantitative study on its implications on systems performance and working conditions”

“…The development of questions concerning VM tool use and provided support by VM tools (see Cognitive measures below) were inspired by Ståhl et al. () and developed out of preliminary results from previous qualitative studies of the same hospitals (Eriksson et al., ; Williamsson et al., ). The measures were further validated during two focus group interviews about the use of VM tools and terminology about VM tools held with registered and assistant nurses ( N = 6) at T1.…”

“…While some research shows that VM is generally underestimated and that industry lacks knowledge of its potential benefits, some examples of known benefits are increased employee commitment and participation, establishing a basis for continuous improvement, improved employee knowledge and skills, and sensitivity to customer needs (Bititci, Cocca, & Ates, ; Jaca et al., ). Care process redesign can be seen as an iterative planning process where different leadership approaches and management tools have various success in engaging healthcare staff (Dellve, Andreasson, Eriksson, Strömgren, & Williamsson, ; Eriksson, Holden, Williamsson, & Dellve, ; Williamsson, Eriksson, & Dellve, ). Staff engagement and participation are crucial for successful change (Kotter, ; Todnem By, ) and the association between VM tool use and employee engagement in improvement work (e.g., continuous improvement) is seen in both industry and healthcare (Dellve, Williamsson, Strömgren, Holden, & Eriksson, ; Holden & Hackbart, ; Jaca et al., ).…”

Strategies to Implement the Baldrige Criteria for Performance Excellence

“…Organizational transformational activities at times create misalignments between work expectations and individual definitions of self as related to work (Williamsson et al, 2016). When alignment does not exist within interactions with differing areas of an organization regarding a change, resistance to the change occurs (Latta, 2015).…”

“…Business leaders within both organizations faced initial trouble with the acceptance and buy-in from staff to take on the efforts needed to implement the criteria. Organizational transformational activities at times create misalignments between work expectations and individual definitions of self as related to work (Williamsson, Eriksson, & Dellve, 2016) [63]. When alignment does not exist within interactions with differing areas of an organization regarding a change, resistance to the change occurs (Latta, 2015) [37].…”