Human resource management, Lean processes and outcomes for employees: towards a research agenda

Lean management or lean thinking is a process improvement technique that along with Six Sigma is used in an increasing range of workplaces. This special issue focuses on the use of Lean in developed countries. This increased usage reflects a growing propensity for managers to launch initiatives to upgrade the efficiency and productivity of the enterprises that they manage, usually in an attempt to enhance the cost- effectiveness of operations. This special issue of the IJHRM includes eight articles in addition to this one on various aspects of the connections between lean management, human resource management (HRM) and outcomes for employees. The present article reviews the context for the increasing popularity of lean ideas among managers. Drawing on research in a range of countries, the articles in the special issue provide interesting insights into the relationships between process improvement innovations and HRM, as well as raise further important questions for research, which enable us to suggest an agenda for future research. This includes asking: what are the differences in the ways that Lean is implemented, for example the differences that may reflect industry, regional and national variables

The relationship between work-life balance, the need for achievement, and intention to leave: Mixed-method study

Aims To examine the mediating role of employee well-being on the relationship between work-life balance practices, the need for achievement and intention to leave among nurses in Malaysia. Background Work-life balance practices are associated with employee perceptions of the need for achievement and well-being which subsequently influence their intention to leave the organization. This study contributes new knowledge to nursing studies on work-life balance in an Asian and Islamic society where the expectations for women are to focus on family rather than career. Design A cross-sectional, explanatory mixed methodology. Methods This is a two-phase study conducted between 2015–2017 with 401 nurses in East Malaysia. In Phase 1, researchers surveyed 379 nurses to test eight hypotheses and in Phase 2 researchers interviewed 22 nurses to explore the results of Phase 1. Results Phase 1 revealed job satisfaction mediates the relationship between work-life balance practices (e.g. flexibility and choice in working hours, supportive supervision), financial success, and intention to leave. However, life satisfaction and money as a motivator did not mediate such relationships. Phase 2 identified four important factors that cast light on survey results: working conditions of Malaysian nurses; inadequate compensation in the public healthcare sector; team-based practices; and pressure on senior nurses in both administrative and clinical roles. Conclusion This is one of the first studies to investigate work-life balance issues among nurses in Malaysia. Outcomes of this study extend the debates on work-life balance and employee well-being in an Asian Islamic social context. Impact The use of flexible working arrangements and collectivist teamwork approaches, improving compensation and employment benefits and eliminating the ‘time-based job promotion’ policy may help to mitigate work-life balance issues and intention to leave among nurses in Malaysia

New development: 4P recommendations for implementing change, from research in hospitals

How are hospital staff involved in process improvement initiatives such as Lean? What can we learn from Lean implementation experiences about the sustainability of such initiatives? The authors considered such questions in a study of workplace change in Australia and Canada. They found that Lean is more likely to be sustained when leaders adopted the 4P recommendations presented in this article

Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification?

This article analyses a process improvement project based on Lean Six Sigma (LSS) techniques in the emergency department (ED) of a large Australian hospital. We consider perspectives of the clinical and managerial staff involved in the project implementation, its implications for empowerment and work intensification. We find that the project appeared to improve patient flow from the ED to the wards and to have positive implications for some staff. However, these achievements tended to be the result of senior staff using the project to leverage resources and create desirable outcomes, rather than the result of the use of LSS, in particular. We found some evidence of work intensification, but this was attributable to wider systemic issues and budget constraints, rather than being a direct consequence of the use of LSS. We argue that translating LSS from a manufacturing context into the politicised and professionalised context of healthcare changes the usual questions about empowerment or work intensification to questions about the influences of powerful stakeholders

Engaging professionals in sustainable workplace innovation: Medical doctors and institutional Work

This paper investigates the role of medical professionals in the success and longevity of the implementation of workplace innovation and organizational change in the Accident and Emergency (A&E) Departments of two large public hospitals, in Australia and Canada, during the introduction of process improvement using Lean Management (LM) methodologies. We ask why and how doctors resist, influence or enable LM initiatives in healthcare. Using a qualitative methodology, we contribute to institutional work theory by unpacking the complex forms of boundary and practice work undertaken by key actors who effectively use their professional status and power to enable practice changes to be embedded. Our findings lend support to the importance of the involvement and ownership of senior doctors in the design, introduction and implementation of successful workplace innovation and organizational change. Senior doctors use their professional expertise, positional and political power at the industry, organization and workplace levels to influence strategically the use of resources designated for workplace innovation to improve efficiencies, quality of patient care and maintain their dominance. The significant organizational change achieved reflected the ownership and leadership of the workplace innovation by senior doctors in ‘hybrid roles’ who captured the rhetoric and minimized adversarialism among key stakeholders

Process redesign for time-based emergency admission targets

Purpose: Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach: A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010. Non-probability sampling identified interview subjects who, through their participation in the redesign initiative, had a detailed understanding of the implementation and outcomes of the initiative. Between April 2012 and January 2013 26 in-depth semi-structured interviews were conducted and analysed with thematic content analysis. Findings: There were four important findings. First, when asked to comment on the impact of the LSS implementation, without prompting the staff spoke of quality of care. Second, there was little agreement among the participants as to whether the project had been successful. Third, despite the recognition of the need for a coordinated effort across the hospital to improve ED access, the redesign process was not successful in reducing existing divides among clinicians and among managers and clinicians. Finally, staff expressed tension between production processes to move patients more quickly and their duty of care to their patients as individuals. Originality/value: One of the first studies to explore the impact of process redesign through in-depth interviews with participating staff, this study adds further evidence that organisation implementing process redesign must ensure the supporting management practices are in place

Intervention strategies for cesarean section-induced alterations in the microbiota-gut-brain axis

Microbial colonization of the gastrointestinal tract is an essential process that modulates host physiology and immunity. Recently, researchers have begun to understand how and when these microorganisms colonize the gut and the early-life factors that impact their natural ecological establishment. The vertical transmission of maternal microbes to the offspring is a critical factor for host immune and metabolic development. Increasing evidence also points to a role in the wiring of the gut-brain axis. This process may be altered by various factors such as mode of delivery, gestational age at birth, the use of antibiotics in early life, infant feeding, and hygiene practices. In fac(t), these early exposures that impact the intestinal microbiota have been associated with the development of diseases such as obesity, type 1 diabetes, asthma, allergies, and even neurodevelopmental disorders. The present review summarizes the impact of cesarean birth on the gut microbiome and the health status of the developing infant and discusses possible preventative and restorative strategies to compensate for early-life microbial perturbations

Factors affecting the job stress and job satisfaction of Australian nurses: implications for recruitment and retention

Against a background of nurse shortages in Australian hospitals, a significant challenge facing the healthcare sector is the recruitment and retention of nurses. The job stress and job satisfaction of nurses have been associated with recruitment and retention. The aim of this study is to consider two factors that may contribute to the job satisfaction and job stress of nurses: social support and empowerment. Using a sample of 157 registered nurses in a private hospital in Melbourne, Australia, we found that social support derived from the nurse's supervisor and work colleagues lowered job stress and at the same time increased job satisfaction. The presence of nurse empowerment, meaning, impact, competence and self-determination, also lowered job stress and increased job satisfaction. Finally, we discuss contributions of this study and implications for recruitment and retention of nurses in the health sector