Revolution or 30-year fad? A role for I-O psychology in Lean management

Expanding scope of Kirkpatrick model from training effectiveness review to evidence-informed prioritization management for cricothyroidotomy simulation

Modified Kirkpatrick model has been adopted to evaluate training effectiveness by 6 categories, including activity accounting (training objectives/success in organization change) at Level-0, reaction (satisfaction) at Level-1, learning (acquisition of surgical airway skills) at Level-2, behavior (post-training change in personal strengths) at Level-3, result (organizational or clinical outcomes) at Level-4, and Return on Investment (ROI) or Expectation (ROE) (monetary and societal values following training and other quality and safety related measures) at Level-5. The purpose of this hospital-based prospective observational study was twofold: i) To evaluate potential impacts on monetary and societal values and successful organization change following implementation of advanced Cricothyroidotomy simulator and standardized curriculum in healthcare simulation training, ii) To inform decisions of resource allocation by reviewing overall values and prioritization strategies for i) general surgeon/emergency physician ii) with seniority >5 years and iii) prior porcine training experience based on findings at Kirkpatrick Level-0, Level-4, and Level-5. Seventy doctors and 10 nurses completed Cricothyroidotomy training and follow-up questionnaires within 2021/22. All training usability scoring measured by Scales of Emergency Surgical Airway Simulator (SESAS-17) achieved over 4 out of 5 (Level-4) with effects in favor of emergency physicians or general surgeons (p < .5), regardless of seniority and prior training experience. Success in organization change (Level-0) and cost-effectiveness (Level-5) were hypothetically established using theoretical framework of Gleicher's formula and Roger's Diffusion of Innovation Theory. Overall training effectiveness, in terms of advantage in usability, cost-benefits and successful organizational changes, provided sound evidence to support continuous investment of new curriculum and innovative simulator and "Surgeon-and-emergency-physician-first" policy when it comes to resources allocation strategies for Cricothyroidotomy training. [ACGME competencies: Practice Based Learning and Improvement, Systems Based Practice.].

Harnessing power of simulation training effectiveness with Kirkpatrick model in emergency surgical airway procedures

Objectives

Training effectiveness indicates how good a program has met pre-set training objectives or organizational goals for the best benefit of healthcare professionals and service users in the community. The study aimed to evaluate training effectiveness following implementation of new training curriculum of emergency surgical airway procedures (Cricothyroidotomy) organized by the Queen Elizabeth Hospital.

Design

This training evaluation relied on observational descriptive study design. Timed task on Cricothyroidotomy procedures and standardized post-training questionnaire were applied to assess the first 3 levels of Kirkpatrick's model: (Level-1) Reaction by training satisfaction; (Level-2) Learning by acquisition of knowledge and skills assessment passing rate; (Level-3) Behavior by personal strengths.

Setting

This program was operated in the Multi-Disciplinary Simulation and Skills Centre, a hospital-based high-fidelity simulation training center accredited by the Society for Simulation in Healthcare.

Participants

The study recruited 80 trauma service providers, including 35 general surgeons, 15 emergency physicians, 10 anesthesiologists or intensivists, 6 neurosurgeons, 4 orthopedic surgeons, and 10 emergency nurses from five trauma centers under the Hospital Authority. All underwent the Advanced Trauma Life Support training in advance.

Results

Compared with reference score from previous training sessions, the result of program using new training curriculum and simulator demonstrated significant training satisfaction of participants (Level-1), and high level of assertiveness, mental preparedness, self-efficacy, and internal locus of control and responsibility (p < .01, for all in Level-3). All participants (N = 80) completed entire Cricothyroidotomy procedure in 2 min without technical errors (Assessment passing rate = 100%) (Level-2).

Conclusions

Under Kirkpatrick model, simulation training in Cricothyroidotomy procedure using new curriculum and simulators has been proven to be useful for healthcare professionals involved in trauma service management. The result suggests that application of a state-of-the-art training tools to advanced surgical skills training could improve training satisfaction, knowledge and skills acquisition, and personal strengths transferable to clinical practice.

ACGME competencies

Practice Based Learning and Improvement.

Investigating the promise and pitfalls of pulse surveys

Despite the growing popularity and marketing of pulse surveys, there is little research concerning this practice. To this end, this practice forum reports the results of a four-wave pulse survey that was conducted in a health care organization. Pulse surveys provided reliable estimates of overall engagement, but scores remained stable across 8 months. Practically no differences in group scores or trends could be found despite high participation (≍ 50%). Item responses displayed little differences between groups, ICC(1) ranging from .03 to .18, and poor discriminant validity. Based on these results, pulse surveys may be adequate for estimating overall employee sentiment but not useful for detecting change over time or differences between groups. These limitations should be considered when designing or implementing pulse surveys.

Is lean a theory? Viewpoints and outlook

Purpose

Lean remains popular in a wide range of private and public sectors and continues to attract a significant amount of research. However, most of this research is not grounded in theory. This paper presents and discusses different expert viewpoints on the role of theory in lean research and practice and provides guidelines for future research.

Design/methodology/approach

Seven experienced lean authors independently provide their views to the question “is Lean a theory?” before Rachna Shah summarizes the viewpoints and provides a holistic outlook for lean research.

Findings

Authors agree, disagree and sometimes agree to disagree. However, a close look reveals agreement on several key points. The paper concludes that Lean is not a theory but has plenty of theoretical underpinnings. Many lean-related theories provide promising opportunities for future research.

Originality/value

As researchers, we are asked to justify our research drawing on “theory,” but what does that mean for a practice-driven phenomenon such as lean? This paper provides answers and directions for future research.

Improving high lean team performance through aligned behaviour-value patterns and coactive vicarious learning-by-doing

Purpose

Why are some lean workfloor teams able to improve their already high performance, over time, and others not? By studying teams' and leaders' behaviour-value patterns, this abductive field study uncovers a dynamic capability at the team level.

Design/methodology/approach

Various methods were employed over three consecutive years to thoroughly examine five initially high-performing lean workfloor teams, including their leaders. These methods encompassed micro-behavioural coding of 59 h of film footage, surveys, individual and group interviews, participant observation and archival data, involving objective and perceptual team-performance indicators. Two of the five teams continued to improve and perform highly.

Findings

Continuously improving high lean team performance is found to be associated with (1) team behaviours such as frequent performance monitoring, information sharing, peer support and process improvement; (2) team leaders who balance, over time, task- and relations-oriented behaviours; (3) higher-level leaders who keep offering the team face-to-face support, strategic clarity and tangible resources; (4) these three actors' endorsement of self-transcendence and openness-to-change work values and alignment, over time, with their behaviours; and (5) coactive vicarious learning-by-doing as a “stable collective activity pattern” among team, team leader, and higher-level leadership.

Originality/value

Since lean has been undertheorised, the authors invoked insights from organisational behaviour and management theories, in combination with various fine- and coarse-grained data, over time. The authors uncovered actors' behaviour-value patterns and a collective learning-by-doing pattern that may explain continuous lean team performance improvement. Four theory-enriching propositions were developed and visualised in a refined model which may already benefit lean practitioners.

Leadership concepts in manufacturing environments: A brief historical review and conclusion with recommendations for education and training of I-O psychologists

Viewing production-line workers from a historical standpoint, the attention on manufacturing in the 19th and into the 20th centuries was on production (Fifelski, 2014) and production-oriented leadership style, in contrast to employee-oriented leadership style (Likert, 1961; see also Kosicek, Soni, Sandbothe, & Slack, 2012).Around the turn of the 20th century, changes took place, and it appears as if two different approaches were taken in manufacturing environments: research–practitioner-based leadership approaches and management-based leadership approaches; the latter approach is less a leadership style and more a social management philosophy em+phasizing business operation (Vitolla, Rubino, & Garzoni, 2017). This review should bring awareness that industrial and organizational (I-O) psychologists once took on the lead to major successes that arose from work in manufacturing companies; however, today there is hardly any contribution by I-O psychologists to the manufacturing sector.