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Hellman, Stefan
Publications (4 of 4) Show all publications
Hellman, S. (2016). Förändringsprogram i hälso- och sjukvården: Nätverkskonstruktioner som möjliggör och försvårar införandet av lean. (Doctoral dissertation). Karlstad: Karlstads universitet
Open this publication in new window or tab >>Förändringsprogram i hälso- och sjukvården: Nätverkskonstruktioner som möjliggör och försvårar införandet av lean
2016 (Swedish)Doctoral thesis, monograph (Other academic)
Alternative title[en]
Change programmes in a healthcare organisation : Networks constructions that enable or impede the deployment of lean
Abstract [en]

Within the public sector great change efforts are currently made to meet future challenges. In the area of health care, change initiatives are implemented to enhance quality and efficiency. To this end, a lean change programme is being widely introduced in Sweden as well as internationally. The overriding aim of this study is to increase knowledge of what happens when change programmes, CP, such as lean are implemented in a healthcare organisation, HCO.

Previous research has shown that the main obstacle to implementing CP in HCO:s is their complexity. However, the complexity has often been reduced, as different factors such as management, professions, organisation and control have been studied separately. To fully capture the complexity of the HCO the Actor Network Theory, ANT, was used in this study. In line with ANT, introducing lean can be described in terms of a translation process in which human and non-human actors are woven into a network. This approach allows for the incorporation of various factors in the study of a change process in a complex organisation. Drawing on ANT, this thesis explores how network constructions enable or impede change programmes.

The approach is based on ethnographic monitoring of the implementation of lean in the Värmland county council public healthcare organisation. As a result of the holistic perspective, the study provides detailed descriptions of how complexity impacts on the implementation. It displays the relations enabling or impeding the implementation of CP and the methods actors use to establish and defend the relations.

The contribution of the study is threefold. Empirically, the study monitors a HCO aiming to implement full-scale lean as philosophy, principle and tool. Methodologically, the study evaluates ANT as a methodological theory to study CP in a HCO. Finally, the domain-specific contribution of the study is its identification of the relations and methods that impact on lean deployment. 

Abstract [sv]

Kan förändringsprogram från den japanska bilindustrin lösa framtidens utmaningar inom hälso- och sjukvården? Ja, tycks svaret på frågan vara. Allt fler hälso- och sjukvårdsorganisationer väljer nämligen att införa och tillämpa lean i hopp om att öka kvalitet och effektivitet. I denna bok följer Stefan Hellman införandet av lean i ett av Sveriges landsting.

 

Tidigare forskning visar att förändringsprogram som lean kan resultera i positiva effekter när det införs i hälso- och sjukvården. Införandet är emellertid förknippat med problem. Hellman visar att det både finns anhängare och motståndare till lean. Han intervjuar och observerar anhängarna och motståndarna och identifierar därigenom hur de går tillväga för att underlätta respektive försvåra införandet av lean. Därigenom ger Hellman en inblick i hälso- och sjukvårdens komplexitet och visar vilka konsekvenser den ger när förändringsprogram införs i praktiken.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2016. p. 194
Series
Karlstad University Studies, ISSN 1403-8099 ; 5
Keywords
Förändringsprogram, hälso- och sjukvård, lean, Actor Network Theory
National Category
Business Administration
Research subject
Business Administration
Identifiers
urn:nbn:se:kau:diva-39056 (URN)978-91-7063-682-0 (ISBN)
Public defence
2016-02-26, Agardhsalen 11D 257, Handelshögskolan, Karlstad, 10:27 (Swedish)
Opponent
Supervisors
Available from: 2016-02-05 Created: 2016-01-18 Last updated: 2016-05-23Bibliographically approved
Hellman, S., Kastberg, G. & Siverbo, S. (2015). Explaining process orientation failure and success in health care - three case studies. Journal of Health Organisation & Management, 29(6), 638-653
Open this publication in new window or tab >>Explaining process orientation failure and success in health care - three case studies
2015 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 6, p. 638-653Article in journal (Refereed) Published
Abstract [en]

Purpose – In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs.

Design/methodology/approach – The authors conducted three case studies and applied Actor-Network Theory as an analytic lens.

Findings – The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities.

Originality/value – Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Keywords
Health care, Actor Network Theory, Medical profession, Organization and control
National Category
Business Administration
Research subject
Business Administration
Identifiers
urn:nbn:se:kau:diva-31830 (URN)10.1108/JHOM-09-2013-0186 (DOI)000366627900001 ()26394249 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-0135
Available from: 2014-04-02 Created: 2014-04-02 Last updated: 2017-12-05Bibliographically approved
Siverbo, S., Hellman, S. & Kastberg, G. (2013). Explaining process orientation failure and success in health care: Three case studies. In: : . Paper presented at 22nd Nordic Academy of Management Conference, 21-23 August, Reykjavik, Iceland.
Open this publication in new window or tab >>Explaining process orientation failure and success in health care: Three case studies
2013 (English)Conference paper, Published paper (Refereed)
National Category
Business Administration
Identifiers
urn:nbn:se:kau:diva-29766 (URN)
Conference
22nd Nordic Academy of Management Conference, 21-23 August, Reykjavik, Iceland
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2013-10-18 Created: 2013-10-18 Last updated: 2017-12-06Bibliographically approved
Siverbo, S. & Hellman, S. (2013). Lean i hälso- och sjukvården: Att översätta filosofi, principer och verktyg. In: Eriksson, Nomie, Hogers, Kajsa-Mia och Müllern, Tomas (Ed.), Att utveckla vården!: Erfarenheter av kvalitet,verksamhetsutveckling och förbättringsarbete (pp. 99-120). Lund: Studentlitteratur
Open this publication in new window or tab >>Lean i hälso- och sjukvården: Att översätta filosofi, principer och verktyg
2013 (Swedish)In: Att utveckla vården!: Erfarenheter av kvalitet,verksamhetsutveckling och förbättringsarbete / [ed] Eriksson, Nomie, Hogers, Kajsa-Mia och Müllern, Tomas, Lund: Studentlitteratur, 2013, p. 99-120Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur, 2013
National Category
Economics and Business Business Administration
Research subject
Business Administration
Identifiers
urn:nbn:se:kau:diva-29757 (URN)9789144090771 (ISBN)
Available from: 2013-10-18 Created: 2013-10-18 Last updated: 2017-12-06Bibliographically approved
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