| Summary: | 1.Conceptual framework and PurposeIn healthcare Value Stream Mapping (VSM) is a common Lean tool used to improve the efficiency of patient flows by identifying and minimizing waste (Keyte & Locher, 2004). It is a participatory tool, i.e. those affected by this type of rationalization are performing the analyses and subsequently suggesting appropriate interventions. Participation has been shown to be crucial to obtain ownership of the suggested interventions and thereby increase impact. VSM has been shown to be a powerful rationalization tool. However, the resulting interventions may imply physical work intensification and impaired psychosocial work environment. Due to this, Lean is often perceived as a “threat” by employees at hospitals (Härenstam et al 2000, personal communications). Physical and psychosocial working conditions should therefore be taken into account in the rationalization process to obtain sustainable solutions, i.e. solutions that allow for competitive performance and acceptable work environment in a long term perspective. On this background we have complemented the VSM tool by an ergonomic module assisting the users to consider also physical and psychosocial implications of the suggested interventions. This ErgoVSM tool is now evaluated in a Nordic Multicenter Study including Denmark, Iceland and Sweden (Winkel et al, 2012). The aim of this paper is to present observations that may indicate facilitating and inhibiting factors for the VSM process.2.MethodsSeven wards have used the ErgoVSM and seven the traditional VSM. Information was obtained by screening key hospital documents and interviewing participants in the VSM processes.3.ResultsIn Sweden one out of three wards using VSM decided not to fulfil the VSM process. On Iceland the only ward using VSM also decided not to fulfil their VSM process. The hospitals of the investigated wards using VSM in Sweden and Iceland had a strong primary focus on financial balance of the business according to key documents. Decisions on when and which ...
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