Operationalising lean in healthcare: the impact of professionalism

Abstract

Lean is endorsed as policy in practice in the UK but the challenges and complexities affecting Lean in healthcare are still to be adequately assessed. Through a qualitative single case study of an NHS organisation implementing Lean, 43 interviews with multi-disciplinary team members involved in Lean were conducted. The progress of Lean is found to be inhibited as medical professionals have failed to engage or provide clinical leadership in supporting the trajectory of Lean. This resulted in limited outcomes, sustainability implications, and failed projects. Lean is challenged by complexity and this is evident in conflicts between professional identity, corresponding status and clinical/managerial relationships. Medical professionals as a group have received a limited focus in papers assessing the progress of Lean in Healthcare from an operational perspective. Going forward, strategies for mitigating the negative impact of this can be developed to support operational managers in the healthcare domain.     

Measuring impact of Lean implementation on construction safety performance: a structural equation model

Abstract

The construction industry is a risky endeavour. Therefore, it is essential to develop significant safety measures for lowering risks and ensuring safety during projects. However, current safety applications are yet to be developed given the increasing number of workplace accidents. Among these, Lean applications have the potential to improve safety standards and enhance safety performance. Within this context, this study develops components for Lean implementation and construction safety performance, and it presents a conceptual framework to study the relationship between them. A questionnaire was designed and given to Lean practitioners to quantify the impact of the components. Structural Equation Modelling was used to analyse the framework and validate the relationship between Lean implementation and safety performance. The results of the study indicate that there is a significant relationship between Lean implementation and safety performance. The findings also imply that firms that perform well in implementing Lean practices achieve better safety performance. The primary contribution of this research is to prove that Lean practices are closely related to safety performance, with the aim of encouraging construction practitioners to work in a safer environment by using well-established Lean practices. Moreover, the study aims to expand the use of Lean practices to achieve better safety performance by revealing the strong ties between safety and Lean. Finally, this study can guide construction practitioners to adopt Lean techniques and apply them in their projects to enhance safety performance.     

Top Management's Transformational Leader Behaviors and Innovation Orientation: A Cross-Cultural Perspective in Eight Countries

This study builds upon the established relationship between top management's transformational leadership and firm-level innovation. It extends current research by determining how specific transformational-leader behaviors influence the firm's innovation orientation and how national culture moderates this relationship. The study examines these behaviors empirically in 954 firms from eight countries. Findings reveal that six transformational-leader behaviors positively influence innovation orientation but with differing levels of intensity. Only two of these relationships, “providing an appropriate model” and “accepting group goals,” are culturally independent, while the other behaviors' effects tend to be culturally dependent. For example, “providing intellectual stimulation” has a stronger effect in collectivist cultures, cultures with high power distance, and low uncertainty-avoidance cultures than in other cultures. Similar culture-dependent findings emerge for other leader behaviors.     

The S‐Curve Effect of Lean Implementation

There is currently no theory that explains the pattern of change in a plant's performance as it implements a lean program. Does it improve at a declining, increasing, or constant rate, or in some other pattern? We use empirical data from the implementation of the Volvo Group's lean program worldwide to develop a grounded theory to explain this pattern. We find that the pattern roughly follows an S‐curve shape: as a plant progresses in its implementation of lean production, its operational performance improves slowly first, then grows rapidly, and finally tapers off. The initial stage can be characterized by “exploration”, during which the plant is essentially discovering and experimenting with lean principles, and the later stages by “exploitation”, during which the plant is realizing their benefits. We derive the grounded theory from quantitative internal company data and find additional qualitative support for it from our visits to 45 Volvo plants on 5 continents and 210 interviews with employees in these plants and Volvo headquarters. The S‐shape pattern has important implications. Practitioners must assess a plant's maturity in lean implementation and adjust their targets, action plans, and expectations accordingly. Scholars must take the position of the plant on the S‐curve into consideration when they analyze the impact of lean programs.     

Values and behavior orientation in leadership studies: reflections based on findings in three German-speaking countries

The article focuses on two sets of concepts commonly used in the explanation of leadership behavior, including values in one area and behavioral intentions in the other. Most leadership researches concentrate exclusively on one or the other area and there are few integrative approaches. The literature also shows that there are often implicit assumptions of a direct and linear relationship between the two sets of concepts. We introduce a model reflecting this research dichotomy by differentiating between “far-from-action” concepts like values or leadership ideals and “close-to-action” concepts like intended behavior. In a next step, we question the assumption of a direct and linear link between the two sets of concepts and discuss two studies in order to find out whether there is empirical support for our argument. We compare empirical findings on leadership ideals (GLOBE study) and intended leadership behavior (Vroom/Yetton study) collected from managers in the German-speaking countries Austria, Germany, and Switzerland. The results show inconsistencies that suggest quite complex intrapersonal processes influenced by cultural factors. We conclude that the link between “far-from-action” and “close-to-action” concepts is worth pursuing further and expands the initial model, thus paving the way for a more holistic understanding of the intrapersonal processes on which leadership behavior is based. Finally, we discuss the consequences of these processes for the stability of leadership behavior.     

Lean in Swedish agriculture: strategic and operational perspectives

The purpose of this article is to present and test a framework for lean implementation in the agricultural sector, addressing challenges from an operational and strategical perspective. The article builds on the previous literature on the use of Lean and reports empirical data from a lean implementation project in the south-western Sweden, including interviews, observations, diaries and questionnaires. A framework is developed to examine strategic and operational perspectives on Lean Thinking. Using this framework, a number of challenges encountered in Lean implementation are presented. This article is limited to the study of Lean among a group of Swedish farms although its findings may have implications for the wider agricultural sectors. Many societal challenges are linked with agricultural sustainability, stressing the need for productive, resource-efficient, resilient and less wasteful food production. This article is the first to develop and test a Lean implementation framework in the agriculture sector.     

On becoming a leader in Asia and America: Empirical evidence from women managers

In concordance with recent calls for cross-cultural leadership research as well as research on women leaders, this study investigated how women in Asia and the U.S. become leaders and how they enact their leadership. In-depth interviews with 76 mid- to upper-level female managers in Asia (China, India, Singapore) and the U.S. were conducted. Analyses revealed that a simple dichotomy of “Asian” versus “Western” leadership did not appropriately describe the data. Rather, factors such as achievement orientation, learning orientation, and role models emerged as crucial success factors for advancement to leadership positions across continents. However, the particular meaning differed between countries. Furthermore, with regard to women's leadership style differences between Asian countries were more salient than between Asia and the U.S. Implications for leadership theory and practice are discussed.     

Hong Kong managers' perceptions of American business values

This report describes empirical research conducted to study the research question, “To what extent do foreign managers' own cultural values influence their perceptions of the corporate values of companies in other cultures?” Using the authors' “Business Values Questionnaire,” business managers from Hong Kong gave their perceptions of publicly stated corporate values of very large U.S. service companies. A similar United States sample was used as a comparison group. Results gave partial support to the authors' hypotheses that an individual's own cultural values influence perceived values of another culture.     

Effects of repeated multi-source feedback on the influence behavior and effectiveness of managers: A field experiment

Despite the widespread use of multi-source behavioral feedback as a method of leadership development, little research has been conducted to identify facilitating conditions that can make the feedback more effective. This article reports results from a longitudinal field experiment on the effects of providing feedback about influence behavior to middle managers in the corporate office of a supermarket chain. Managers who only attended a single feedback workshop were compared to managers who attended a second feedback workshop several months after the initial one. A significant increase in the use of “core” influence tactics with subordinates and peers was found only for the managers who received repeated feedback, and they were also rated higher in overall effectiveness by their bosses. Practical implications for leadership development and suggestions for future research are discussed.     

Best practices in business process redesign: an overview and qualitative evaluation of successful redesign heuristics

To implement business process redesign several best practices can be distinguished. This paper gives an overview of heuristic rules that can support practitioners to develop a business process design that is a radical improvement of a current design. The emphasis is on the mechanics of the process, rather than on behavioral or change management aspects. The various best practices are derived from a wide literature survey and supplemented with experiences of the authors. To evaluate the impact of each best practice along the dimensions of cost, flexibility, time and quality, a conceptual framework is presented that synthesizes views from areas such as information systems development, enterprise modeling and workflow management. The best practices are thought to have a wide applicability across various industries and business processes. They can be used as a “check list” for process redesign under the umbrella of diverse management approaches such as Total Cycle Time compression, the Lean Enterprise and Constraints Management.     

Economic perspectives on leadership: Concepts,causality, and context in leadership research

The fields of leadership and economics have interacted very little until now. The aim of this special issue on “economics and leadership” is to demonstrate the potential benefits of paying attention to and incorporating economic perspectives and methods into leadership research. Specifically, we argue that the field of economics can advance leadership research on three main topics: concepts, causality and context. For each topic, we summarize the state-of-the-art literature and showcase important insights, tools and findings. We also discuss possible critiques of the economic perspective on leadership. The timeliness of this issue is evident from recent discussions on the three C's within the field of leadership research, not least within The Leadership Quarterly itself. Our paper as well as the other six papers in this issue demonstrates that narrowing the gap between economics and leadership is not only beneficial and feasible, but also crucial for the progress of leadership research.     

Lean thinking in the highways construction sector: motivation,implementation and barriers

The interest in lean thinking in the UK’s civil construction industry is on the rise. The research presented in the paper evaluates the adoption of lean thinking in the highways construction sector by investigating 7 motivation factors, 20 lean techniques and 16 barriers through in-depth interviews with 20 sector managers and a questionnaire survey of 110 responses. The findings show the existence of strong external motivational factors for lean thinking such as clients’ push and companies’ expectation of winning more contracts alongside lean’s operational benefits. Limited adoptions of the lean techniques, mostly in the stepwise process improvement cycle, the Last Planner System and Visual Management, were determined. This raises concerns about ‘pseudo-lean’ practices in the sector. Lack of standardisation, insufficient benefit capturing, insufficient know-how, insufficient control of the entire value stream and limited view to the techniques were found as the top barriers.     

The queen bee: A myth? The effect of top-level female leadership on subordinate females

We investigate the effect of female leadership on gender differences in public and private organizations. Female leadership impact was constructed using a quasi-experiment involving mayoral elections, and our research used a sample of 8.3 million organizations distributed over 5600 Brazilian municipalities. Our main results show that when municipalities in which a woman was elected leader (treatment group) are compared with municipalities in which a male was elected leader (control group) there was an increase in the number of top and middle female managers in public organizations. Two aspects contribute to the results: time and command/role model. The time effect is important because our results are obtained with reelected women – in their second term – and the command/role model (the queen bee phenomenon is either small, or non-existent) is important because of the institutional characteristics of public organizations: female leaders (mayor) have much asymmetrical power and decision-making discretion, i.e., she chooses the top managers. These top managers then choose middle managers influenced by female leadership (a role model). We obtained no significant results for private organizations. Our work contributes to the literature on leadership by addressing some specific issues: an empirical investigation with a causal effect between the variables (regression-discontinuity design – a non-parametric estimation), the importance of role models, and how the observed effects are time-dependent. Insofar as public organizations are concerned, the evidence from our large-scale study suggests that the queen bee phenomenon may be a myth; instead, of keeping subordinate women at bay, our results show that women leaders who are afforded much managerial discretion behave in a benevolent manner toward subordinate women. The term “Regal Leader” instead of “Queen Bee” is thus a more appropriate characterization of women in top positions of power.     

Does shared and differentiated transformational leadership predict followers' working conditions and well-being?

Transformational leadership has been widely researched and is associated with followers' performance, attitudes, and subjective well-being at the individual level. Less research has focused on transformational leadership as a group phenomenon. In a survey study (425 followers and 56 leaders), we examined how group-level and differentiated transformational leadership shape followers' perceptions of their working conditions and individual subjective well-being. There was stronger evidence that differentiated transformational leadership's relationships with indicators of well-being was mediated by perceptions of working conditions, in that 10 out of 20 tests for mediation using differentiated transformational leadership were significant, compared to just three out of 20 for group-level transformational leadership. The results suggest that transformational leadership needs to be studied as a group phenomenon considering how group-level perceptions may impact on followers' well-being and that leaders need to realize that there is an “I” in groups and addition to a “we” in groups.     

The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals

Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care—clinical or technical medical care that emphasizes “what” the patient receives and process performance that emphasizes “how” health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.     

A conceptual replication of ambidextrous leadership theory: An experimental approach

Ambidextrous leadership theory proposes that a leader's interplay between opening behaviors and closing behaviors enhances followers' exploration and exploitation behaviors, which ultimately increases innovative outcomes. Unfortunately, previous research suffers from problems with causal interpretation and endogeneity concerns threatening the validity of the theory. Our aim was to constructively replicate previous research with an experimental design, more rigorous measures, and state-of-the-art data analytical approaches (2SLS). In two randomized experiments (Study 1: N = 395, Study 2: N = 229), we manipulated four leadership styles (opening, closing, ambidextrous, and transformational leadership) and tested their effects on participants' exploration/exploitation behaviors as well as objective innovation outcomes. We only found partial support for the hypotheses from ambidextrous leadership theory. We discuss implications in terms of refining central concepts of the theory and offering more accurate assumptions about timing. We also elaborate on more general insights from our constructive replication studies for the leadership field.     

The relative importance of participative versus decisive behavior in predicting stakeholders' perceptions of leader effectiveness

Today's leaders are often faced with resolving paradoxes stemming from interrelated, yet contradictory demands. One example is the tension between participation and decision speed because, despite its advantages, stakeholder involvement often slows the decision-making process. Theory and research suggest that a “both-and” approach in which leaders simultaneously harmonize competing demands is associated with effectiveness. Consistent with this reasoning, we hypothesized that leaders rated higher in both participative and decisive behavior are perceived as most effective. Additionally, however, we hypothesized that stakeholders place different importance on these behaviors, with direct reports emphasizing participation and supervisors emphasizing decisiveness. Using a large 360-degree feedback dataset, several analyses conducted both within and between stakeholder groups supported these predictions. These results add needed nuance to the leadership literature, suggesting that a “both-and” approach may paradoxically result in some behaviors that are less predictive of effectiveness for certain stakeholders.     

Leadership in organisations: Meta,macro and micro

The study of leadership suffers from too many definitions, not too few. Much of this confusion springs from the fact that there are two fundamentally different perspectives on leadership. From these arise three common usages of the word. This article suggests that we recognise this diversity and abandon the search for a unique definition.The first perspective views leadership as “influence on individuals” without using power or authority. This “meta” leadership relates individuals to their environment through “visioning” — a complex interaction of perception, articulation, conviction and empathy (PACE).The second perspective views leadership as the “shaking and moving” of an organisation to face the future, cope with change and achieve results. It includes both the creation of a successful organisation, through “macro” leadership, and the accomplishment of specific jobs or tasks, through “micro” leadership.These three types of leadership — meta, macro and micro — are examined from the two perspectives. It is suggested that all three should be exercised by managers at all levels - no matter how junior.     

Trojan Horses or Local Allies: Host-country National Managers in Developing Market Subsidiaries

We investigate a multinational corporation's (MNC) decision to appoint host-country national (HCN) managers to foreign subsidiaries based on the institutional context of and familiarity with the host country. HCN managers are commonly associated with specialized knowledge, superior responsiveness, and higher legitimacy. Yet, we argue that local familiarity of HCNs can also be perceived as risky or harmful by MNC parents. We analyze how formal and informal institutions affect the trade-off between positive effects and potential costs associated with HCN managers (“Local allies” vs. “Trojan horses”). We find that legal institutions protect foreign MNCs from potential costs, encourage the use of HCNs and reinforce their benefits. Corruption and corruption distance, however, increase perceived costs associated with HCN managers up to a point at which they outweigh their perceived benefits.