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Role of lean leadership in the lean maturity-second-order problem-solving relationship : a mixed methods study

(2019) BMJ OPEN. 9(6).
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Organization
Abstract
Objectives: To investigate the relationship between lean adoption and problem-solving behaviour in nursing teams, and to explore the practices of lean leaders on nursing wards to reveal how they can stimulate second-order problem-solving within their teams. Design: A mixed-methods retrospective multiple case study using semistructured interviews. Interview data were used to assess the level of lean maturity (based on a customised validated instrument) and the level of second-order problem-solving (based on scenarios). Within-case and cross-case analyses were employed to identify lean leadership practices. Setting: 14 nursing teams, with different levels of lean maturity, in a Dutch hospital. Participants: Three members of each nursing team were interviewed: the team leader, one nurse from the ward's core team for the lean-based quality improvement programme and one nurse outside the core team. Interventions: The nursing teams were in various phases of a lean-based quality improvement programme: 'The Productive Ward -Releasing Time to Care'. Results: A strongly significant positive relationship between lean maturity and second-order problem-solving was found: beta=0.68, R-2=0.46, p<0.001. Further, the results indicated a potential strengthening effect of lean leadership on this relationship. Seven lean leadership practices emerged from the data collected in a nursing ward setting: (1) convincing and setting an example; (2) unlocking individual and team potential; (3) solving problems systematically; (4) enthusing, actively participating and visualising; (5) developing self-managing teams; (6) sensing, as orchestrator, what is needed for change; and (7) listening, sharing information and appreciating. These practices have a strong link with transformational leadership. Conclusions: As lean matures, nursing teams reach a higher level of second-order problem-solving. In later stages, lean leaders increasingly relinquish responsibility by developing self-managing teams.
Keywords
HEALTH-CARE, IMPROVEMENT, WORK

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Please use this url to cite or link to this publication:

MLA
Bijl, Arie, et al. “Role of Lean Leadership in the Lean Maturity-Second-Order Problem-Solving Relationship : A Mixed Methods Study.” BMJ OPEN, vol. 9, no. 6, 2019.
APA
Bijl, A., Ahaus, K., Ruel, G., Gemmel, P., & Meijboom, B. (2019). Role of lean leadership in the lean maturity-second-order problem-solving relationship : a mixed methods study. BMJ OPEN, 9(6).
Chicago author-date
Bijl, Arie, Kees Ahaus, Gwenny Ruel, Paul Gemmel, and Bert Meijboom. 2019. “Role of Lean Leadership in the Lean Maturity-Second-Order Problem-Solving Relationship : A Mixed Methods Study.” BMJ OPEN 9 (6).
Chicago author-date (all authors)
Bijl, Arie, Kees Ahaus, Gwenny Ruel, Paul Gemmel, and Bert Meijboom. 2019. “Role of Lean Leadership in the Lean Maturity-Second-Order Problem-Solving Relationship : A Mixed Methods Study.” BMJ OPEN 9 (6).
Vancouver
1.
Bijl A, Ahaus K, Ruel G, Gemmel P, Meijboom B. Role of lean leadership in the lean maturity-second-order problem-solving relationship : a mixed methods study. BMJ OPEN. 2019;9(6).
IEEE
[1]
A. Bijl, K. Ahaus, G. Ruel, P. Gemmel, and B. Meijboom, “Role of lean leadership in the lean maturity-second-order problem-solving relationship : a mixed methods study,” BMJ OPEN, vol. 9, no. 6, 2019.
@article{8647533,
  abstract     = {Objectives: To investigate the relationship between lean adoption and problem-solving behaviour in nursing teams, and to explore the practices of lean leaders on nursing wards to reveal how they can stimulate second-order problem-solving within their teams. 
Design: A mixed-methods retrospective multiple case study using semistructured interviews. Interview data were used to assess the level of lean maturity (based on a customised validated instrument) and the level of second-order problem-solving (based on scenarios). Within-case and cross-case analyses were employed to identify lean leadership practices. 
Setting: 14 nursing teams, with different levels of lean maturity, in a Dutch hospital. 
Participants: Three members of each nursing team were interviewed: the team leader, one nurse from the ward's core team for the lean-based quality improvement programme and one nurse outside the core team. 
Interventions: The nursing teams were in various phases of a lean-based quality improvement programme: 'The Productive Ward -Releasing Time to Care'. 
Results: A strongly significant positive relationship between lean maturity and second-order problem-solving was found: beta=0.68, R-2=0.46, p<0.001. Further, the results indicated a potential strengthening effect of lean leadership on this relationship. Seven lean leadership practices emerged from the data collected in a nursing ward setting: (1) convincing and setting an example; (2) unlocking individual and team potential; (3) solving problems systematically; (4) enthusing, actively participating and visualising; (5) developing self-managing teams; (6) sensing, as orchestrator, what is needed for change; and (7) listening, sharing information and appreciating. These practices have a strong link with transformational leadership. 
Conclusions: As lean matures, nursing teams reach a higher level of second-order problem-solving. In later stages, lean leaders increasingly relinquish responsibility by developing self-managing teams.},
  articleno    = {e026737},
  author       = {Bijl, Arie and Ahaus, Kees and Ruel, Gwenny and Gemmel, Paul and Meijboom, Bert},
  issn         = {2044-6055},
  journal      = {BMJ OPEN},
  keywords     = {HEALTH-CARE,IMPROVEMENT,WORK},
  language     = {eng},
  number       = {6},
  pages        = {7},
  title        = {Role of lean leadership in the lean maturity-second-order problem-solving relationship : a mixed methods study},
  url          = {http://dx.doi.org/10.1136/bmjopen-2018-026737},
  volume       = {9},
  year         = {2019},
}

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