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  • 1.
    Hellman, Stefan
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Förändringsprogram i hälso- och sjukvården: Nätverkskonstruktioner som möjliggör och försvårar införandet av lean2016Doctoral thesis, monograph (Other academic)
    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. 

  • 2.
    Hellman, Stefan
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Kastberg, Gustaf
    Siverbo, Sven
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Explaining process orientation failure and success in health care - three case studies2015In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 6, p. 638-653Article in journal (Refereed)
    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.

  • 3.
    Siverbo, Sven
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Hellman, Stefan
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Lean i hälso- och sjukvården: Att översätta filosofi, principer och verktyg2013In: 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)
  • 4.
    Siverbo, Sven
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Hellman, Stefan
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School.
    Kastberg, Gustaf
    Lunds universitet.
    Explaining process orientation failure and success in health care: Three case studies2013Conference paper (Refereed)
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