Susanne Löfgren, Johan Hansson, John Øvretveit and Mats Brommels
The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors…
Abstract
Purpose
The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.
Design/methodology/approach
The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.
Findings
Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.
Research implications/limitations
A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.
Originality/value
This case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.
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Florian Johannsen and Susanne Leist
The purpose of this paper is to develop a proposed Six Sigma approach for integrated solutions of goods and services.
Abstract
Purpose
The purpose of this paper is to develop a proposed Six Sigma approach for integrated solutions of goods and services.
Design/methodology/approach
This conceptual paper follows the principles of design research in developing a Six Sigma approach for integrated solutions. The approach is tested in practice in the context of a financial services company in the automotive industry.
Findings
The study demonstrates that the differential characteristics of service processes and manufacturing processes must be taken into account when developing a Six Sigma approach for integrated solutions. Evaluation of the proposed approach in cooperation with a financial services company reveals considerable benefits.
Research limitations/implications
The detailed description of the approach is limited to the “Define” phase of the Six Sigma program. Moreover, the proposed approach is tested in only one setting; its application in other settings should be an objective for future research.
Practical implications
The paper provides practitioners with a structured Six Sigma approach for integrated solutions.
Originality/value
The paper is the first to propose a Six Sigma approach for integrated solutions of goods and services.
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Susanne Gustavsson, Ida Gremyr and Elisabeth Kenne Sarenmalm
The purpose of this paper is to study how an account of multiple patient roles when using the Kano model in healthcare improvements can support identification of a wide range of…
Abstract
Purpose
The purpose of this paper is to study how an account of multiple patient roles when using the Kano model in healthcare improvements can support identification of a wide range of patients’ needs.
Design/methodology/approach
The study presented in this paper was part of a longitudinal action research study. The empirical material was collected by various methods (interviews, a focus group, participative observations, and a survey) over a two-month period within the Children’s and Women’s Healthcare department in a Swedish hospital. The respondents included the management team, healthcare professionals, patients, and the patients’ partners.
Findings
The study shows that incorporating a view of multiple patient roles into application of the Kano model, and using input on customer needs obtained from patients, relatives, and healthcare professionals, helps to identify a wide range of patients’ needs.
Originality/value
The view on patients within healthcare is being transformed from one based on servility to that of patients as customers. This paper elaborates on a hands-on way of applying the Kano model based on a view of multiple patient roles as a means to support this new patient view. The application builds on input from various groups (such as patients and healthcare professionals), and, by using input from various stakeholders. This approach appears to overcome a gap, identified in earlier research, of either relying solely on patients, or solely on healthcare professionals, when identifying patients’ need. Rather input from several groups – patients, relatives, and professionals – are suggested to be used in combination.