From the introduction: This handbook is aimed primarily at front line managers (FLMs) in manufacturing industries. Frontline manager is defined here as the first management level with personnel responsibility. It is the most common managerial position and is found in all companies that have at least one management level. It is an extremely important role. Research also highlights the FLM as a key position in the creation of well-functioning and sustainable production.

You may be new to the role of being a manager, if so this book will help you to understand your tasks. If you are an experienced manager but new to the company, you will find some suggestions on how to succeed in your new job. Finally, we hope that we can offer some pearls of wisdom for those of you who are experienced managers in a company you have known for a long time.

The handbook is also for you who collaborate with FLMs. You may be working in the line or as a team leader, which is a leader without personnel responsibility. You may be a second line manager or have a production support role with responsibility for protection and safety, planning and scheduling, quality development, technical maintenance, technological development, product development, logistics, HR functions or something else. We hope that the handbook will provide you all with useful advice and information.

This handbook is intended to clarify the content of FLM’s work and how it can be developed. We do this by describing the role and work of the FLM but also the ever-present dynamics and problem-solving foundin the role. We also want to underscore opportunities for systematically developing the potential for and ability to work as a FLM. To enable you to work and thrive in the role in the long term or support someone else in this role. FLMs have a major impact on both work environment and efficiency within their area. As such, the manager’s work environment is also of great importance for success.

First-line managers (FLMs) have a vital role in developing stable output and organizational competitiveness through their ability to manage front-line operations in daily work. It is also well known that FLMs are strong determinants of good ergonomics and well-being for front-line staff. However, research focusing on how FLMs deal with their important role is lacking particularly regarding empirical studies. The focus here is how they deal with uncertainties and disruptive interruptions and develop more resilient performance in daily work – introduced in this article as resilient action strategies.

This research uses two conceptual frameworks on resilient engineering for analysis of FLM's actions in daily work in two manufacturing companies, to explore how resilient action strategies can be organizationally supported. The study combines analysis of front-line activities with multilevel organizational support based on 30 semi-structured in-depth interviews with FLMs and support functions, 21 workshops as well as policy documents of the two companies. The analysis exemplifies how resilience engineering was enabled in practice in the organizations.

The study contributes to the empirical understanding of how resilience can be organizationally supported in daily front-line work. Our results show that a developed and consistent infrastructure in companies promotes the emergence of resilient action strategies in front-line work. We propose an extended model for resilient front-line performance enhancement by including coordination as a linking aspect between the earlier suggested resilient potentials – anticipate, monitor, respond and learn. This highlights the importance of both organizational support and coordination between system levels to enable the development of resilient action strategies by FLMs.

BACKGROUND: Persons in need of services from different care providers in the health and welfare system often struggle when navigating between them. Connecting and coordinating different health and welfare providers is a common challenge for all involved. This study presents a long-term regional empirical example from Sweden-ESTHER, which has lasted for more than two decades-to show how some of those challenges could be met. The purpose of the study was to increase the understanding of how several care providers together could succeed in improving care by transforming a concept into daily practice, thus contributing with practical implications for other health and welfare contexts.

METHODS: The study is a retrospective longitudinal case study with a qualitative mixed-methods approach. Individual interviews and focus groups were performed with staff members and persons in need of care, and document analyses were conducted. The data covers experiences from 1995 to 2020, analyzed using an open inductive thematic analysis.

RESULTS: This study shows how co-production and person-centeredness could improve care for persons with multiple care needs involving more than one care provider through a well-established Quality Improvement strategy. Perseverance from a project to a mindset was shaped by promoting systems thinking in daily work and embracing the psychology of change during multidisciplinary, boundary-spanning improvement dialogues. Important areas were Incentives, Work in practice, and Integration, expressed through trust in frontline staff, simple rules, and continuous support from senior managers. A continuous learning approach including the development of local improvement coaches and co-production of care consolidated the integration in daily work.

CONCLUSIONS: The development was facilitated by a simple question: "What is best for Esther?" This question unified people, flattened the hierarchy, and reminded all care providers why they needed to improve together. Continuously focusing on and co-producing with the person in need of care strengthened the concept. Important was engaging the people who know the most-frontline staff and persons in need of care-in combination with permissive leadership and embracing quality improvement dimensions. Those insights can be useful in other health and welfare settings wanting to improve care involving several care providers.

Från inledningen: Den här handboken vänder sig framför allt till dig som är första linjens chef i tillverkande industri. Första linjens chef definieras här som den första chefsnivån som har personalansvar. Det är den vanligaste chefspositionen och finns i alla företag med minst en chefsnivå. Det är en oerhört viktig funktion! Även forskningen lyfter fram första linjens chef som en nyckelposition för att skapa en väl fungerande och hållbar produktion.

Du kanske är helt ny i rollen som chef och då är det här en hjälp till att förstå uppgiften. Eller så är du erfaren chef men ny i företaget, och kan behöva lite tips för att förstå och lyckas i ditt nya jobb. Slutligen hoppas vi erbjuda några guldkorn även för dig som är erfaren chef i ett företag som du känner sedan länge.

Handboken vänder sig också till dig som har en roll i samarbete med första linjens chefer. Du kanske jobbar i linjen eller är teamledare, dvs ledare utan personalansvar. Du kanske är andra linjens chef eller har en stödfunktion till produktionen med ansvar för skydd och säkerhet, planering, kvalitetsutveckling, tekniskt underhåll, teknikutveckling, produktutveckling, logistik eller HR-funktioner. Vi hoppas att ni alla kan hitta användbara råd och lärdomar i handboken.

I handboken vill vi tydliggöra arbetsinnehållet för första linjens chefer och hur det kan utvecklas. Vi gör det genom att beskriva rollen och arbetet som första linjens chef. Vi lägger också stor vikt vid att beskriva dynamiken och problemlösningen som hela tiden är närvarande. Dessutom vill vi peka på möjligheterna att systematiskt utveckla förutsättningarna för och förmågan att arbeta som chef i första linjen – så att du kan fungera och må bra i uppgiften på ett hållbart sätt eller stötta den personsom har denna roll. En första linjens chef har stor inverkan på både arbetsmiljön och effektiviteten inom sitt område. Även chefens arbetsmiljö är därför av stor vikt för att nå bra resultat inom dessa områden.

Human work activities are at the core of value adding processes creating system performance. The concept of human, technology and organization (HTO) is used in different cases as it offers a framework for understanding and developing work. The aim of this paper is to elucidate the character of work activities and their significance in using the HTO concept. The aspects elaborated on are: the relation between the objectives of the organization and the activity, the organizational context of the activity, the variability of the individual and the work process, the influence of history, the relation between the individual and the activity and finally how activity can be studied. Looking at three short examples from different industries, it can be concluded that the HTO concept is beneficial to use in order to better understand the studied activities in the examples. However, there must be clearly identifiable tasks to really benefit from the HTO concept.

Background: One important key to an organization’s long-term competitiveness is the ability of first line managers (FLMs) to handle their role as a leader in daily work. FLMs main task is to contribute to a high and stable production output according to customer demands from an input that is characterized by instability and variability. To do so, FLMs must develop resilient action strategies – ways of working and daily problem solving that systematically facilitate to cope with instability. In this study protocol we present a methodological approach developed to evaluate and improve these.

Methods/Design: The research approach is collaborative and developmental and performed together with two companies. The approach integrates and extends the theory and application of a model on interactive research and a framework on activity analysis. It will be applied using data collection techniques like interviews, diaries, observations, document analysis, and questionnaires. The analysis and development stages will be performed both separate and in collaboration in workshops and the result is planned to end up in the joint writing of a generic handbook on advantageous action strategies for FLMs’.

Discussion: This study contributes with a new integration of two methodological approaches which provides a novel way to understand and develop dynamic on-the-job behaviour in work settings.

För att kunna hantera dagens snabba förändringar är agilitet en färdighet svenska tillverkande företag behöver besitta och kontinuerligt utveckla vidare. Kärnpunkten i att vara en agil verksamhet är att snabbt kunna agera på förändringarpå marknaden eller omgivningen med ett fokus på kundens behov som kräver anpassade snarare än standardiserade produkter.

Agilitet inbegriper många olika begrepp som idag cirkulerar kring förmågan att snabbt anpassa sig och förändra sin produktion eller sin organisation till förändringar på marknaden. Relaterade begrepp är flexibilitet, rekonfigurerbarhet och resiliens.

Rekonfigurerbarhet innebär att göra det möjligt att lägga till, ta bort och / eller ordna om element/beståndsdelar i produktionssystemet på ett snabbt och kostnadseffektivt sätt som kan resultera i en önskad uppsättning alternativa konfigurationer.

Denna handbok är framtagen för att ge ett stöd till tillverkande svensk industri vid utveckling av agila och rekonfigurerbara produktionssystem. Detta innefattar både att använda agila projektmetoder och att skapa agila och rekonfigurerbara produktionssystem.

Oavsett om företaget står inför en större förändring av befintliga produktionssystem eller ska utforma något alldeles nytt är handboken användbar. Den är ett stöd både för projektgenomförandet och för hur det faktiska produktionssystemet ska utformas utifrån agila principer. Handboken behandlar således både projektmetod (kap 2) och utformning av ett agilt och rekonfigurerbart produktionssystem(kap 3).

BACKGROUND: Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals' quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to.

METHODS: A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803 h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway).

RESULTS: Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness.

CONCLUSIONS: We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.

Working life of today faces challenges. There is a fast pace in technical and organisational development and continual demands for increased performance. In order to manage the increasing complexity in work systems, there is a need to take a holistic view on operations. One such view is the systems concept of Humans, Technology and Organisation (HTO). The aim of this report is to describe the HTO concept, how it was developed, and how it can be used to develop work and work systems, understand humans at work, and understand contributing factors to organisational performance and individual well-being. The core of the HTO model is human work activity and how it is carried out within a work system consisting of humans, technology and the organisation. Focussing on human work activity generates knowledge about work conditions, needed competences and collective interaction, but also understanding about outcomes of the activities – the systems performance. H, the Humans in the work system, can be understood from different perspectives, for example as biological systems, information processing systems, individuals with unique personal traits and experiences, or as members of social groups. The H can thus in itself be regarded as a sub-system within HTO. In a similar way, T, Technology, includes several facets, such as tangible tools and machinery, intangible IT systems and software, and environmental characteristics that are technologically designed. The same applies for O, Organisation, consisting of both formal aspects (e.g. written work instructions and follow-up systems) and informal aspects (e.g. organisational culture and informal work practice). Applying HTO in practice generates several types of outcomes: 1) HTO to design products shows that it can be beneficial for productivity, quality and individual safety; 2) HTO to analyse and understand complex work may shed light on complex work in practice, the influences between the individual and the work system, and gaps between prescribed, standard work and how it is carried out in practice; 3) HTO to understand safety shows that it is achieved through systems thinking, thus technology needs to be designed to match human capabilities, and HTO barriers should be in place to prevent accidents; and 4) HTO to improve health and productivity may result in workplace redesign, increased individual well-being and business productivity. HTO has several uses, such as a theoretical framework, an analytical tool, and a method for a holistic view on human work, but also as a tool for visualisation and design. 

The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems.

The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments.

There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions.