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Williamsson, A., Dellve, L. & Karltun, A. (2019). Nurses' use of visual management in hospitals: A longitudinal, quantitative study on its implications on systems performance and working conditions. Journal of Advanced Nursing, 75(4), 760-771
Open this publication in new window or tab >>Nurses' use of visual management in hospitals: A longitudinal, quantitative study on its implications on systems performance and working conditions
2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 4, p. 760-771Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to examine potential benefits provided by daily visual management tool use and explore its association with systems performance and working conditions among hospital nurses.

BACKGROUND: Visual management tools used in everyday work and improvement work in health care theoretically contribute to shared understanding of complex work systems and provide certain user benefits. Cognitive load, miscommunication within and between professional groups, and pressure to engage in care process redesign add to nurses' strained working conditions.

DESIGN: Quantitative longitudinal.

METHODS: Questionnaires were distributed at T0, (N = 948, 66% response rate), T1 (N = 900, 70% response rate), and T2 (N = 621, 72% response rate) to nurses at five hospitals. Three groups of users (daily users, start users, and non-daily users) were compared by means T1-T2 (significance tested with Wilcoxon signed rank test) and by mixed model repeated measures T0, T1, T2.

RESULTS: Daily use associated to better overview of work, collaboration, social capital, and clinical engagement. Job resources were rated higher by daily users. Mental stress increased and development opportunities decreased over time among non-daily users. There were associations between use and perceptions of systems performance, though the differences between groups were small.

CONCLUSION: This study specifically explores visual management tool use in the hospital setting, which contributes to research by broadening the understanding of cognitive, social, and emotional benefits provided by visual management tool use. Daily use was associated to positive working conditions, small but positive differences in systems performance, and indicated a buffering effect on nurses' mental stress.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
care process redesign, cognitive load, longitudinal, nurses, quantitative, visual management tools, working conditions
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:hj:diva-41996 (URN)10.1111/jan.13855 (DOI)000462161100008 ()30230003 (PubMedID)2-s2.0-85055294333 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2019-04-11Bibliographically approved
Karltun, J., Karltun, A., Havemose, K. & Kjellström, S. (2019). Positioning the study of first line managers’ resilient action strategies. In: 8th REA Symposium on Resilience Engineering: Scaling up and Speeding up: Proceedings. Paper presented at 8th REA Symposium on Resilience Engineering: Scaling up and Speeding up, Kalmar, Sweden, June 24-27, 2019.
Open this publication in new window or tab >>Positioning the study of first line managers’ resilient action strategies
2019 (English)In: 8th REA Symposium on Resilience Engineering: Scaling up and Speeding up: Proceedings, 2019Conference paper, Published paper (Refereed)
Abstract [en]

This paper introduces a study on the action strategies of first line managers (FLMs) using a resilience perspective and the aim is to position the study in the theoretical field of resilience management and engineering. One important key to an organization's long-term competitiveness are the first line managers’ ability to handle the role as a leader in daily work. In the role of a FLM, there are a lot of conflicting objectives to manage, for example, regarding available resources, subordinates’ views versus superiors’, centralized and/or local control, optimization of cost and capability (quality and delivery). Moreover, at the operational level of detail, FLMs have to balance daily deliveries in relation to development activities, i.e. technical development, product development, implementation of new system and management concepts. Regardless of the complexity in work and organisational change over time, a FLM’s most important task is to contribute to a high and stable production output out of an input that is characterized by variability and disturbances. To do so in a sustainable way, the FLMs must develop action strategies about ways of working and problem solving that systematically facilitate coping with the situation and managing their own workload. We consider this as developing resilient actions strategies that allow the FLMs to handle the upcoming problems without getting problems on their own. In this paper we describe and develop the theoretical underpinnings of the study as well as how we position our own research in relation to the different theoretical strands of resilience management. We further suggest some methodological ideas on how to capture the work and nature of first line managers’ resilient action strategies. The focus in our work will thus be on how FLMs handle and can improve the more or less chaotic mix of activities in daily work in a resilient way.

Keywords
First line managers, resilience, manufacturing industry
National Category
Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:hj:diva-45850 (URN)978-91-88898-95-1 (ISBN)
Conference
8th REA Symposium on Resilience Engineering: Scaling up and Speeding up, Kalmar, Sweden, June 24-27, 2019
Available from: 2019-09-09 Created: 2019-09-09 Last updated: 2019-09-20Bibliographically approved
Anderson, J. E., Robert, G., Nunes, F., Bal, R., Burnett, S., Karltun, A., . . . The QUASER Team, . (2019). Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the ‘QUASER Hospital Guide’. International Journal for Quality in Health Care
Open this publication in new window or tab >>Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the ‘QUASER Hospital Guide’
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2019 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy.

Design: The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide.

Setting: The research was carried out in two hospitals in each of five European countries.

Participants: In total, 389 interviews with healthcare practitioners and 803 hours of observations.

Intervention: None.

Main outcome measure: None.

Results: The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper.

Conclusion: The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
: Quality improvement, hospital care, patient safety, quality improvement guide, translational research, leadership
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-46483 (URN)10.1093/intqhc/mzz055 (DOI)31187862 (PubMedID)
Note

The QUASER Team Group members: Charles Vincent, Kathryn Charles, Heide Poestges, Anna Renz, Susie Edwards, England; Hester van de Bovenkamp, Julia Quartz, Anne-Marie Weggelaar, the Netherlands; Pär Höglund, Tony Andersson, Johan Calltorp, Sweden; Sara Gomes, and Alexandra Fernandes, Portugal; Christian von Plessen, Norway.

Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-10-04Bibliographically approved
Karltun, A. & Karltun, J. (2018). Benefits of the Human-Technology-Organization Concept in Teaching Ergonomics – Students Perspective. In: Sebastiano Bagnara, Riccardo Tartaglia, Sara Albolino, Thomas Alexander, Yushi Fujita (Ed.), Advances in Intelligent Systems and Computing: . Paper presented at 20th Congress of the International Ergonomics Association, IEA 2018; Florence; Italy; 26 - 30 August 2018 (pp. 627-636). Springer, 821
Open this publication in new window or tab >>Benefits of the Human-Technology-Organization Concept in Teaching Ergonomics – Students Perspective
2018 (English)In: Advances in Intelligent Systems and Computing / [ed] Sebastiano Bagnara, Riccardo Tartaglia, Sara Albolino, Thomas Alexander, Yushi Fujita, Springer, 2018, Vol. 821, p. 627-636Conference paper, Published paper (Refereed)
Abstract [en]

The human-technology-organization (HTO) concept has been used for creating systems understanding of ergonomics in three engineering educations at the School of Engineering in Jönköping. Students from courses given in two undergraduate and one graduate program (n = 122) participated in the study, which involved a course evaluation questionnaire to assess the understanding of ergonomics as discipline and HTO as a means for creating systems understanding. The questionnaire included both ranking and personal comments to the questions. The results show that the students in general considered knowledge of ergonomics and HTO as beneficial for their future work and that the HTO concept did contribute to their understanding of workplace ergonomics. However, there was a significant difference between undergraduate and graduate students in all these aspects where undergraduates ranked all these aspects lower than graduates. This was also reflected in personal comments on the questions. Conclusions that can be drawn are that understanding systems is generally difficult and the HTO concept can assist in helping students to overcome these difficulties. However, the differences between the student groups must be explicitly considered as well as increasing students’ awareness of the relevance of ergonomics for engineers. 

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Engineering education, HTO concept, Systems understanding, Ergonomics, Surveys, Teaching, Course evaluations, Graduate program, Graduate students, School of engineering, Student groups, Students
National Category
Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:hj:diva-41501 (URN)10.1007/978-3-319-96080-7_75 (DOI)2-s2.0-85051741239 (Scopus ID)978-3-319-96079-1 (ISBN)978-3-319-96080-7 (ISBN)
Conference
20th Congress of the International Ergonomics Association, IEA 2018; Florence; Italy; 26 - 30 August 2018
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2019-03-19Bibliographically approved
Karltun, A., Karltun, J., Berglund, M. & Eklund, J. (2017). HTO – A complementary ergonomics approach. Applied Ergonomics, 59, Part A, 182-190
Open this publication in new window or tab >>HTO – A complementary ergonomics approach
2017 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 59, Part A, p. 182-190Article in journal (Refereed) Published
Abstract [en]

The field of human factors and ergonomics constitutes a strong potential in systems analysis, design and improvement. However, it is difficult to communicate its potential value. This paper addresses how the human-technology-organization (HTO) concept can be defined and supports the understanding, communication and development of the systems' character and potential of human factors and ergonomics. Empirical examples from the authors’ experiences of working with the HTO concept in R&D and teaching are illustrated, including its usefulness as: 1) a conceptual model; 2) an analysis framework; 3) a meta methodology; 4) a pedagogical tool; and 5) a design tool. The use of HTO provides guidance on how the system can be designed to better support health, individual and systems performance. It is further suggested that there is a strong potential for developing the theory, applications and methodological aspects of HTO.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Human-technology-organization, Systems approach, Interaction, Activity
National Category
Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:hj:diva-31904 (URN)10.1016/j.apergo.2016.08.024 (DOI)000390642000020 ()27890126 (PubMedID)2-s2.0-84995804142 (Scopus ID)
Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2018-09-20Bibliographically approved
Karltun, A., Karltun, J. & Rydell, M. (2017). New legislation on organizational and social work environment: A case study. In: Conference Proceedings: 48th Annual Conference of the Association of Canadian Ergonomists, 12th International Symposium on Human Factors in Organizational Design and Management, Organizing for High Performance, July 31-August 3, 2017, Banff, Alberta, Canada. Paper presented at 48th Annual Conference of the Association of Canadian Ergonomists & 12th International Symposium on Human Factors in Organizational Design and Management, July 31-August 3, 2017, Banff, Alberta, Canada (pp. 109-114). Association of Canadian Ergonomists
Open this publication in new window or tab >>New legislation on organizational and social work environment: A case study
2017 (English)In: Conference Proceedings: 48th Annual Conference of the Association of Canadian Ergonomists, 12th International Symposium on Human Factors in Organizational Design and Management, Organizing for High Performance, July 31-August 3, 2017, Banff, Alberta, Canada, Association of Canadian Ergonomists , 2017, p. 109-114Conference paper, Published paper (Refereed)
Place, publisher, year, edition, pages
Association of Canadian Ergonomists, 2017
Keywords
road and construction industry, unhealthy workload, working hours, victimization, leadership
National Category
Production Engineering, Human Work Science and Ergonomics
Identifiers
urn:nbn:se:hj:diva-38889 (URN)
Conference
48th Annual Conference of the Association of Canadian Ergonomists & 12th International Symposium on Human Factors in Organizational Design and Management, July 31-August 3, 2017, Banff, Alberta, Canada
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-09-11Bibliographically approved
Salim, R., Mapulanga, M., Saladi, P. & Karltun, A. (2016). Automation in the wood products industry: challenges and opportunities. In: : . Paper presented at The 7th Swedish Production Symposium, 25th to 27th October 2016, Lund, Sweden.
Open this publication in new window or tab >>Automation in the wood products industry: challenges and opportunities
2016 (English)Conference paper, Published paper (Refereed)
Abstract [en]

A stagnation of productivity increase has been observed in the Swedish wood product industry. The manufacturers believe that there is a need to invest further in automation in order to stay competitive. For this reason, the paper seeks to understand the role of automation in the Swedish wood product industry, and focuses on identifying the challenges and opportunities of automation. The following research question was addressed: What are the challenges and opportunities of automation in the wood product industry? In order to answer the research question, four case studies were conducted, each case representing a different business area. The research question was examined in terms of internal – and external challenges and opportunities. The internal challenges and opportunities examine the manufacturing, while the external challenges and opportunities examine the influence of the business environment. Findings indicate that lack of manufacturing strategies, and lack of awareness of automation technologies were some of the main challenges. Regarding the opportunities, increased profitability and competitiveness were emphasized. The identification of the challenges and opportunities of automation in the wood product industry can provide insights and be used as underlying decisions for automation investments.

Keywords
Levels of Automation (LoA), material utilization, production flexibility
National Category
Robotics
Identifiers
urn:nbn:se:hj:diva-31957 (URN)
Conference
The 7th Swedish Production Symposium, 25th to 27th October 2016, Lund, Sweden
Available from: 2016-10-11 Created: 2016-10-11 Last updated: 2017-05-11Bibliographically approved
Burnett, S., Mendel, P., Nunes, F., Wiig, S., van den Bovenkamp, H., Karltun, A., . . . Fulop, N. (2016). Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries. Journal of Health Services Research and Policy, 21(2), 109-117
Open this publication in new window or tab >>Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries
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2016 (English)In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 21, no 2, p. 109-117Article in journal (Refereed) Published
Abstract [en]

Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands.

Methods: An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals.

Results: How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures.

Conclusions: The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required.

Keywords
finance, health care, institutional theory, quality
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-28699 (URN)10.1177/1355819615622655 (DOI)000371306800006 ()26683885 (PubMedID)2-s2.0-85007575431 (Scopus ID)HHJKvalitetIS, JTHIndustriellIS (Local ID)HHJKvalitetIS, JTHIndustriellIS (Archive number)HHJKvalitetIS, JTHIndustriellIS (OAI)
Note

SAGE Choice article (Open Access)

Available from: 2015-12-21 Created: 2015-12-21 Last updated: 2018-10-16Bibliographically approved
Karltun, A. & Berglund, M. (2015). Emphasizing the interactive systems view in a master’s programme in Ergonomics and HTO. In: Proceedings 19th Triennial Congress of the IEA, International Ergonomics Association: . Paper presented at 19th Triennial Congress of the IEA, Melbourne, 9-14 August, 2015.. International Ergonomics Association
Open this publication in new window or tab >>Emphasizing the interactive systems view in a master’s programme in Ergonomics and HTO
2015 (English)In: Proceedings 19th Triennial Congress of the IEA, International Ergonomics Association, International Ergonomics Association , 2015Conference paper, Published paper (Refereed)
Abstract [en]

Ergonomics spans over several disciplines and carries a strong potential in designing and improving systems performance. However, from an educational perspective, bringing forward the systems perspective may be challenging from different point of views e.g. what areas of Ergonomics should be taught and in what way and how should the systems perspective be realized in an educational setting. The aim of this paper is to highlight experiences and lessons learned when emphasizing and developing an interactive systems perspective within a master’s programme in Ergonomics and HTO (Human, Technology, Organization) at the Royal Institute of Technology (KTH), Sweden. The interactive systems perspective is conveyed through a separate HTO-course to emphasize the systems perspective and a developed interdisciplinary approach. It further pervades the programme from selection of students, pedagogical structure of the programme and the teachers’ multidisciplinary backgrounds. Although working with a full educational programme gives substantial room for room for manoeuvre, some experiences and ideas from this education may serve as inspiration in other ergonomics and human factors educational contexts.

Practitioner Summary: Ergonomics is a multidisciplinary field, which contributes to developing a systems view to design products and systems. Bringing forward the systems view in an educational setting, however, may be challenging. This paper highlights experiences and lessons learned when emphasising and developing an interactive systems perspective within a master’s programme in Ergonomics and HTO (Human, Technology, Organization) at The Royal Institute of Technology (KTH), Sweden. The interactive systems perspective is developed through student and teachers with different academic backgrounds, linking between different courses in the programme, and an HTO-course, which emphasizes the systems perspective in Ergonomics.

Place, publisher, year, edition, pages
International Ergonomics Association, 2015
Keywords
teaching, multidisciplinary, humans, technology, organization
National Category
Engineering and Technology
Identifiers
urn:nbn:se:hj:diva-29289 (URN)
Conference
19th Triennial Congress of the IEA, Melbourne, 9-14 August, 2015.
Available from: 2016-02-01 Created: 2016-02-01 Last updated: 2016-10-05Bibliographically approved
Karltun, A. (2014). A novel approach to understand nested layers in quality improvement. In: O. Broberg, N. Fallentin, P. Hasle, P.L. Jensen, A. Kabel, M.E. Larsen, T.Weller (Ed.), Proceedings of Human Factors in Organizational Design and Management – xi Nordic Ergonomics Society Annual Conference – 46, Copenhagen, August 17-20: . Paper presented at Human Factors in Organizational Design and Management – xi Nordic Ergonomics Society Annual Conference – 46, Copenhagen, August 17-20. (pp. 343-348). Nordic Ergonomics Society
Open this publication in new window or tab >>A novel approach to understand nested layers in quality improvement
2014 (English)In: Proceedings of Human Factors in Organizational Design and Management – xi Nordic Ergonomics Society Annual Conference – 46, Copenhagen, August 17-20 / [ed] O. Broberg, N. Fallentin, P. Hasle, P.L. Jensen, A. Kabel, M.E. Larsen, T.Weller, Nordic Ergonomics Society, 2014, p. 343-348Conference paper, Published paper (Refereed)
Abstract [en]

Studies on healthcare quality improvement (QI) increasingly point at the importance of understanding multilevel organizational issues, especially interaction between national, hospital and clinical level. In a EU-study involving ten hospitals in five countries one hospital stood out in successful multilevel QI work, which is elaborated in this paper. It is suggested that there is a potential in using linkages and dependencies in terms of organisational development and resource support (O) and method, process and IT support (T) affecting the individual caregiver (H), to understand the nestedness and interaction between operational system levels in QI.

Place, publisher, year, edition, pages
Nordic Ergonomics Society, 2014
Keywords
HTO, Healthcare, Complex systems, Interaction between system levels
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-25665 (URN)10.4122/dtu:2310 (DOI)
Conference
Human Factors in Organizational Design and Management – xi Nordic Ergonomics Society Annual Conference – 46, Copenhagen, August 17-20.
Projects
Quality and Safety in European Union Hospitals (QUASER)
Funder
EU, FP7, Seventh Framework Programme
Available from: 2015-01-15 Created: 2015-01-15 Last updated: 2018-09-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4853-3140

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