ELEC2017 3.4 o. roemeling - the role of leadership in continuous improvement efforts in a hea

faculty of economicsand business

innovation management & strategy

Continuous improvement in HC: towards a mature approach

ELEC 2017, 8-9 Nov

Session: Learning Lean / Lean Learning in Healthcare

dr. O.P. (Oskar) Roemeling

University of Groningen

[email protected]

Authors: Bianca van Elp, Oskar Roemeling & Nick Ziengs

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An opportunity for improvement…

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Some background….

Msc. thesis project focused on Leadership and CI.

Successful project at a case organization with several years of

experience with Lean.

The limited attention to soft-aspects made us decide to build a paper.

We plan to submit our final-paper to Production Planning and Control.

Today: highlights and main insights.

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Study background

Lean aims to improve process flow through the reduction of waste and

variation and is one of the most popular approaches in HC. (D’Andreamatteoa, Iannia, Legab, & Sargiacomoa, 2015; Roemeling, Land, Ahaus, Slomp, & Bijllaardt, 2017; Shah & Ward,

2007)

Main pillar of Lean is continuous process improvement or CI, and CI can be

seen as a dynamic capacity to achieve a sustained competitive advantage.(Teece, Pisano, & Shuen, 1997)

CI initiatives in healthcare environments rarely get past the initial stages of

maturity. (Roemeling, Land, & Ahaus, 2017)

Soft aspects, such as leadership, of CI receive little attention, yet these are

becoming more and more relevant in the discussion of Lean. (Radnor, 2010; Poksinska, 2010; Matthias and Brown, 2016; Losonci, Kása, Demeter, Heidrich, and Jenei, 2017)

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Study background

Our research underlines the importance of soft aspects when working

according to Lean principles.

We focus on the role of leadership style and explore the relationship between

leadership and maturity of the Lean approach.

Central RQ:

How do transactional and transformational leadership styles

facilitate the development of continuous improvement activities?

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Some theory…We think of continuous improvement as:

An organization its attempts to continuously analyze work

processes, and introduce both incremental and large scale

improvements.

We can distinguish between five stages of CI development

(maturity). (Bessant et al. 1992 )

1. Pre-interest --- 5. embedded in organizational routines.

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Some theory…Transformational: characterized by a focus on- and care about

followers and their personal needs and development.

Transactional: relationship focused on extrinsic rewards, give

and take.

Maturity CI Behavior Goals Focus Suggested

Leadership Style

1 Pre-CI interest “Natural” or background

improvement

Short-term General Transactional

2 Structured CI Formal attempts to create

and sustain CI

Short-term General Transactional

3 Goal-oriented CI CI is directed at company

goals and objectives

Long-term Specific Transformational

4 Proactive CI CI is largely self-driven by

individuals and groups


5 Full CI capability CI is the dominant way

of life


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Approach

To investigate the role of Leadership styles in CI maturity we conducted an

embedded single case study.

EldCare: healthcare provider in the Netherlands, employs over 6.000

people. In 2010 EldCare adopted Lean as their preferred CI approach.

EldCare won the first national Lean award in 2014.

The organization focuses primarily on providing nursing care, either at

home or at one of the eight EldCare facilities.

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Approach

Data collection:

• Interviews: 17 in total with team leaders and members.

• Site visits: during orientation and research phase.

• Observations: during team meetings.

• Documents: e.g. internal reports.

Analysis:

• Coding of transcripts using inductive and deductive codes.

First within teams, then across teams.

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FindingsBased on interviews and observations we determine leadership style.

Manager Leadership Style Explanation

MAN01 Transactional Direct, open, confronting, say what you see, asks many

questions, customer-oriented, impose conditions,

contingent reward, action-oriented, overseeing

MAN02 Transactional

(transformational)

Direct, action-oriented, asks many questions, taking

decisions, apodictic, involvement, contingent reward,

overseeing, connector

MAN03 Transactional

(transformational)

Action-oriented, listens, asks questions, contingent

reward, passive management-by-exception, being

proud, self-confidence

MAN04 Transformational

(transactional)

Focus on feeling good, asks an open attitude, listens,

learn from mistakes, facilitates, cooperation at the work

floor, action-oriented, contingent reward

MAN05 Transformational Use of metaphors, involvement, enthusiastic, future-

oriented, good atmosphere, being a role model,

personal attention, customer and care-oriented

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TeamLean

since ...

LevelMaturity

1 2 3 4 5

TM01

2012 3 Goal-oriented CI

Explanation: Pilot location, structure of “Improve” is not fully implemented,

label “Improve” is unknown but the tools are known, structural problem-solving

Quotes

MAN04: “We have an open culture at this location”

MEM06: “The manager is very involved, he listens to me and tries to

understand me”

TM02

2012 2 Structured CI

Explanation: Pilot location, different managers in short time frame, barely

familiar with every tool, not everyone at the location is informed, structural

problem-solving

QuotesMAN03: “I hope that the Lean consultants stay at our organization”

MEM05: “He always has his door open, he is really approachable”

TM03 2012 4 Proactive CI

Explanation: Pilot location, CI is integrated, familiarity with “Improve” and

every tool, progressiveness, structural problem-solving

Quotes

MAN02: “I see at other locations that the Lean consultant is more on the

foreground, but I do everything by myself at this location”

MEM09: “I think it is a pity that the manager is barely apparent at the work

floor”

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Discussion

Based on previous studies (e.g. Bessant et al., 1992; Crosby, 1979; Cupello, 1994), we

expected that the longer team members work with continuous

improvement principles, the more mature the approach becomes.

Our studied case did not support this assumption.

We identify differences in maturity in teams, this difference does

not appear to be linearly related to the time of introduction of the

continuous improvement principles.

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Discussion

In order to move to a more mature approach a mix of both

transactional and transformational styles is more effective than a

single style.

This is in contradiction with most established ideas where the

transformational style is the preferred style. Especially when

thinking of Lean applications.

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Proposition 1: Adopting a single leadership style will limit CI

maturity and prevent the achievement of full CI maturity.

Proposition 2: A transactional leadership style should be

emphasized at lower levels of CI maturity, whereas a

transformational leadership style should be emphasized at

higher levels of maturity.

Proposition 3: A mix of leadership styles is more effective in

reaching higher levels of CI maturity than applying a single

leadership style.

Discussion

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Contact?

[email protected]