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BETA
Poksińska, Bozena, Biträdande professorORCID iD iconorcid.org/0000-0003-4040-8302
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Publications (10 of 47) Show all publications
Rotter, T., Plishka, C., Lawal, A., Harrison, L., Sari, N., Goodridge, D., . . . Kinsman, L. (2019). What Is Lean Management in Health Care?: Development of an Operational Definition for a Cochrane Systematic Review. Evaluation & the Health Professions, 42(3), 366-390
Open this publication in new window or tab >>What Is Lean Management in Health Care?: Development of an Operational Definition for a Cochrane Systematic Review
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2019 (English)In: Evaluation & the Health Professions, ISSN 0163-2787, E-ISSN 1552-3918, Vol. 42, no 3, p. 366-390Article in journal (Refereed) Published
Abstract [en]

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization?s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Lean management, Toyota Production System (TPS), Lean production, operational definition, systematic review
National Category
Reliability and Maintenance
Identifiers
urn:nbn:se:liu:diva-154052 (URN)10.1177/0163278718756992 (DOI)000477030000005 ()29635950 (PubMedID)
Note

Funding agencies:  Saskatchewan Health Quality Council [C7036]; College of Pharmacy and Nutrition at the University of Saskatchewan, Canada

Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-08-12Bibliographically approved
Poksinska, B. & Swartling, D. (2018). From Successful to Sustainable Lean Production: The Case of a Lean Prize Award Winner. Total Quality Management and Business Excellence, 29(9-10), 996-1011
Open this publication in new window or tab >>From Successful to Sustainable Lean Production: The Case of a Lean Prize Award Winner
2018 (English)In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 29, no 9-10, p. 996-1011Article in journal (Refereed) Published
Abstract [en]

Many improvement programmes often fail to sustain over an extended period of time. Previous research suggests that a similar set of factors influence the success and sustainability of an improvement programme. The purpose of this paper is to make a distinction between the success and sustainability of improvement programmes, and to identify mechanisms that specifically contribute to the sustainability. In this paper, we study a sustainable improvement programme from the perspective of complexity theories that stress the importance of studying change as a dynamic process of interacting elements and events unfolding in time. We conducted a longitudinal, in-depth case study of a Swedish Lean Prize Award Winner where a Lean improvement programme was studied over 9 years. An improvement programme is successful if goals are achieved and the targeted problems are resolved. Furthermore, the first-order sustainability means the ability to sustain results and the second-order sustainability means the ability to keep an improvement programme alive. The lessons identified from complexity theories, such as destabilising the organisation, ensuring novelty and constant flow of change or self-organisation at the team level, are examples of mechanisms important to achieve the sustainability of the improvement programme.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Lean production, Improvement program, sustainability
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-100163 (URN)10.1080/14783363.2018.1486539 (DOI)000442759900003 ()
Funder
VINNOVA, 2008-01958
Note

The previous status of this publication was Manuscript.

Available from: 2013-10-30 Created: 2013-10-30 Last updated: 2018-09-13Bibliographically approved
Smeds, M. & Poksinska, B. B. (2018). The effects of cancer care pathways on waiting times. International Journal of Quality and Service Sciences
Open this publication in new window or tab >>The effects of cancer care pathways on waiting times
2018 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose

The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.

Design/methodology/approach

A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.

Findings

Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.

Originality/value

“Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2018
Keywords
Health care, Standardisation, Patient care, Quality management, Health care management, Quality of health care
National Category
Reliability and Maintenance Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-154049 (URN)10.1108/IJQSS-04-2018-0041 (DOI)2-s2.0-85058658565 (Scopus ID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-14Bibliographically approved
Smeds, M. & Poksińska, B. (2018). The implementation and improvement science perspective on interventions in health care. In: : . Paper presented at 3rd Nordic implementation conference, Copenhagen Denmark, 28-31 May 2018.
Open this publication in new window or tab >>The implementation and improvement science perspective on interventions in health care
2018 (English)Conference paper, Poster (with or without abstract) (Other academic)
Keywords
implementation science, improvement science, health care
National Category
Reliability and Maintenance
Identifiers
urn:nbn:se:liu:diva-155095 (URN)
Conference
3rd Nordic implementation conference, Copenhagen Denmark, 28-31 May 2018
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-03-22Bibliographically approved
Poksinska, B. B., Fialkowska-Filipek, M. & Engström, J. (2017). Does Lean healthcare improve patient satisfaction?: A mixed-method investigation into primary care. BMJ Quality and Safety, 26(2), 95-103
Open this publication in new window or tab >>Does Lean healthcare improve patient satisfaction?: A mixed-method investigation into primary care
2017 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 2, p. 95-103Article in journal (Refereed) Published
Abstract [en]

Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.

Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.

Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.

Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
Keywords
Lean healthcare, patient satisfaction, primary care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126610 (URN)10.1136/bmjqs-2015-004290 (DOI)000393198900005 ()26864659 (PubMedID)2-s2.0-85011547135 (Scopus ID)
Note

Funding agencies: The Swedish Institute

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2017-11-30Bibliographically approved
Kurilova-Palisaitiene, J., Sundin, E. & Poksińska, B. (2017). Lean improvements in remanufacturing: solving information flow challenges. In: QMOD proceedings: . Paper presented at 20th QMOD conference, Copenhagen/Elsinore, Denmark and Helsingborg, Sweden, 5-7 August, 2017.
Open this publication in new window or tab >>Lean improvements in remanufacturing: solving information flow challenges
2017 (English)In: QMOD proceedings, 2017Conference paper, Published paper (Refereed)
Abstract [en]

Purpose - One efficient way to prolong the functional life of used products is remanufacturing. Compared to manufacturing, remanufacturing is a complex industrial process due to among other things high product variability, low production volumes and uncertain quality of returned used products. Remanufacturers are dependent on product information from Original Equipment Manufacturers (OEM), but that information is often not shared. Remanufacturers struggle to access or develop lacking product information and need a strategy to address information flow challenges. Lean could be a suitable strategy to improve the information flow. Therefore, the purpose of the paper is to identify and suggest Lean improvements to address remanufacturer’s information flow challenges.

Methodology/Approach - Based on a case study of a filling machine remanufacturer, this paper discusses the information flow challenges and Lean-based solutions. The data was collected through a three-hour focus group interview combined with a Value Stream Mapping (VSM) method with the participation of seven company employees representing sales, logistics, quality, maintenance and production departments.

Findings - Two key information flow challenges were identified at the company: a lack of available product data and miscommunication with the OEM, and poor internal information sharing. The analysis of the identified challenges and improvement ideas created a platform for developing Lean-based solutions:1) developing standard operations through instruction checklists and kitting areas;2) boosting supplier and customer relations through six best partnering practices; and3) developing people and teams through teamwork and training.

Originality/Value of paper – All industries have their own specific challenges and development needs. This paper focuses on information flow challenges in remanufacturing. Original product information is often not shared, even when the remanufacturer has a contract with the OEM. Only few remanufacturers work with Lean today, but Lean could be a strategy to address the information flow challenges. This paper contributes to the knowledge on how Lean could be applied in the remanufacturing context.

Keywords
Lean remanufacturing, Information flow, Challenges, Improvements
National Category
Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:liu:diva-142344 (URN)
Conference
20th QMOD conference, Copenhagen/Elsinore, Denmark and Helsingborg, Sweden, 5-7 August, 2017
Available from: 2017-10-27 Created: 2017-10-27 Last updated: 2018-05-17Bibliographically approved
Smeds, M. & Poksińska, B. (2017). Push out, inclusion or exclusion? What are actually the effects of implementing cancer patient pathways in Sweden?. In: : . Paper presented at 20th QMOD, Helsingör Denmark, 4-7 August, 2017.
Open this publication in new window or tab >>Push out, inclusion or exclusion? What are actually the effects of implementing cancer patient pathways in Sweden?
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Keywords
Quality management, health care, standardisation, patient pathways, cancer care, waiting times, prioritisation
National Category
Other Mechanical Engineering
Identifiers
urn:nbn:se:liu:diva-155093 (URN)
Conference
20th QMOD, Helsingör Denmark, 4-7 August, 2017
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-03-22Bibliographically approved
Poksinska, B. B. (2015). Lean healthcare: what is the contribution to quality of care?. In: Anders Örtenblad, Carina Abrahamson Löfström, Rod Sheaff (Ed.), Management innovations for health care organizations: adopt, abandon or adapt? (pp. 209-226). New York: Routledge
Open this publication in new window or tab >>Lean healthcare: what is the contribution to quality of care?
2015 (English)In: Management innovations for health care organizations: adopt, abandon or adapt? / [ed] Anders Örtenblad, Carina Abrahamson Löfström, Rod Sheaff, New York: Routledge, 2015, p. 209-226Chapter in book (Refereed)
Abstract [en]

This chapter aims to present how Lean has been adopted by healthcare provider organizations in hospital and primary care settings, and to discuss the implications for quality of care. Could Lean be the management innovation that helps healthcare organizations tackle their current challenges? How is Lean adopted in healthcare? What are the opportunities and limitations of adopting a production-based system to an advanced service system such as healthcare? The findings and conclusions presented in this chapter are based on six years of research on the practices and outcomes of adopting Lean in hospital units and primary care centers in Sweden.

Place, publisher, year, edition, pages
New York: Routledge, 2015
Series
Routledge Studies in the Management of Voluntary and Non-Profit Organizations
Keywords
Lean production, healthcare
National Category
Economics and Business
Identifiers
urn:nbn:se:liu:diva-126615 (URN)9781138825697 (ISBN)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2016-11-23Bibliographically approved
Langstrand, J., Cronemyr, P. & Poksinska, B. (2015). Practise what you preach: quality of education in education on quality. Total Quality Management and Business Excellence, 26(11-12), 1202-1212
Open this publication in new window or tab >>Practise what you preach: quality of education in education on quality
2015 (English)In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 26, no 11-12, p. 1202-1212Article in journal (Refereed) Published
Abstract [en]

The quality of teaching should be the central theme in the education on quality management (QM). Delivering bad courses about QM would reduce the legitimacy of the subject, since we do not practise what we preach. The purpose of this paper is to discuss how the quality of education can be enhanced through effective course design based on quality thinking and higher education theory. The study covers three university courses in the field of QM; an introductory course in QM, and courses in Six Sigma and Lean Production, respectively. Each course has been analysed and described in terms of factors affecting student learning and the perceived quality of the courses. The impact of course design on examination results and student evaluation has been studied and compared to historical data. The study demonstrates that course design can have a profound impact on student learning as well as course evaluation. Analysis of the three examples provided in this paper indicates that the QM principles can effectively be used in course design processes. Attention to the principles presented in this paper facilitates the design of courses that enhance learning and ensure higher student satisfaction. The application of QM principles in higher education has a long theoretical tradition. This paper provides three strong examples of how this can be done in practise.

Place, publisher, year, edition, pages
Routledge, 2015
Keywords
quality, education, course design, kvalitet, utbildning, undervisning, kursdesign, kursutveckling
National Category
Other Engineering and Technologies not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-109049 (URN)10.1080/14783363.2014.925290 (DOI)000364562700007 ()
Available from: 2014-08-04 Created: 2014-08-04 Last updated: 2017-12-05
Engström, J., Elg, M., Poksinska, B., Witell, L. & Snyder, H. (2015). The role of customers in the development of public organizations. In: Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar (Ed.), Sustainable development in organizations: studies on innovative practices (pp. 93-108). Cheltenham: Edward Elgar Publishing
Open this publication in new window or tab >>The role of customers in the development of public organizations
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2015 (English)In: Sustainable development in organizations: studies on innovative practices / [ed] Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar, Cheltenham: Edward Elgar Publishing, 2015, p. 93-108Chapter in book (Refereed)
Place, publisher, year, edition, pages
Cheltenham: Edward Elgar Publishing, 2015
National Category
Economics and Business
Identifiers
urn:nbn:se:liu:diva-125519 (URN)000374407200007 ()978-17-8471-688-2 (ISBN)
Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2016-05-19Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4040-8302

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