Change search
ReferencesLink to record
Permanent link

Direct link
Hospital management from a high reliability organizational change perspective: A Swedish case on Lean and Six Sigma
University of Skövde, School of Business. University of Skövde, Enterprises for the Future. (Medarbetarskap och organisatorisk resiliens, Followership and Organizational Resilience (FORE))ORCID iD: 0000-0001-5718-0100
2017 (English)In: International Journal of Public Sector Management, ISSN 0951-3558, E-ISSN 1758-6666, Vol. 30, no 1, 67-84 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO).

Design/methodology/approach – Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n 17) nurses at two Swedish hospitals.

Findings – The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement.

Practical implications – Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned.

Originality/value – The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2017. Vol. 30, no 1, 67-84 p.
Keyword [en]
Six Sigma, Lean, Nurses, Healthcare development, High reliable organizations
National Category
Business Administration
Research subject
Humanities and Social sciences
URN: urn:nbn:se:his:diva-13294DOI: 10.1108/IJPSM-12-2015-0221OAI: oai:DiVA.org:his-13294DiVA: diva2:1061954
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2017-01-04

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Eriksson, Nomie
By organisation
School of BusinessEnterprises for the Future
In the same journal
International Journal of Public Sector Management
Business Administration

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 6 hits
ReferencesLink to record
Permanent link

Direct link