Using kaizen to improve employee well-being: Results from two organizational intervention studies

The Fulfillment Center Intervention Study: Protocol for a group-randomized control trial of a participatory workplace intervention

Warehousing and storage is an economically vital industry, with 1.2 million workers in 2020. The Fulfillment Center Intervention Study focuses on workers in fulfillment centers in the e-commerce segment of this industry. Fulfillment centers are a growing yet understudied work environment which provides a unique setting to further examine how working conditions and worker voice influence health. The Study involves a group-randomized controlled trial comparing participants in worksites randomized to launch the participatory intervention (Health and Well-Being Committees, or HaWCs) with participants working for the same firm in control sites. HaWCs serve as a new formal voice channel where a small group of frontline workers and supervisors solicit workers' concerns and ideas about safety (e.g., physical hazards), the psychosocial environment (e.g., how workers feel about their treatment at work), and work organization (e.g., workflow, training opportunities, scheduling) and then develop and implement improvement projects in response. The primary objectives of the study are to evaluate the efficacy of the HaWC intervention and its effect on mental health outcomes and changes in the conditions of work within fulfillment centers, and to conduct a process evaluation of key contextual factors that support effective intervention implementation and sustained engagement. To our knowledge, this will be the first trial of a participatory intervention within a fulfillment center setting. Anticipated challenges include competing demands and company initiatives that may limit management support and high turnover. Should the intervention be shown to be feasible, the outcomes from this study will inform future randomized controlled trials of participatory interventions. Trial registration: This trial is registered with the ClinicalTrials.gov registry (NCT05199415) and approved by the Institutional Review Board (IRB) at the Massachusetts Institute of Technology (Protocol: 200800024).

Enabling Effective Implementation of Occupational Safety and Health Interventions

Background

The design, implementation, and evaluation are three important stages of occupational safety and health (OSH) interventions. Historically, there has been a tendency to prioritize implementation, often neglecting detailed design and rigorous outcome evaluation. Currently, much has changed, and contemporary approaches recognize the interdependence of these stages, considering them integral to the success of any intervention. This work presents a comprehensive procedure for implementing interventions, not only to ensure short-term effectiveness but also their long-term sustainability through continuous monitoring. The focus is on a national OSH project introducing a near-miss management system (NMS) in Italy.

Methods

Initial meetings were convened among project partners, complemented by interviews with diverse stakeholders, to plan implementation steps and test the NMS. Tailored questionnaires were designed for diverse stakeholder groups - initial promoters, company managers and employers, and employees - facilitating targeted implementation, and three case studies were started in Italian regions to assess the structured implementation, involving intervention promoters and collaborating companies.

Results

The primary outcome is the development of practical tools, specifically three questionnaires, which are considered valuable for establishing an effective human-centered implementation strategy, meticulously designed to facilitate ongoing monitoring of processes and continual enhancement of instruments intended for NMS integration within companies.

Conclusions

This work lays the foundation for successful NMS implementation in Italy and, although the outlined procedure had specific objectives, it also provides valuable insights applicable in enhancing the effectiveness and sustainability of interventions across diverse contexts. It underscores the importance of comprehensive planning, stakeholder engagement, and continuous evaluation in achieving lasting OSH interventions.

Delegation and consultation on operational and tactical issues: Any difference in their potentialities for a healthier psychosocial work environment?

Background

Despite the growing number of studies on direct participation labor‐management practices, little is known about the role of their different discretionary degrees (delegation or consultation) and topics in their relationship with the psychosocial work environment by occupational groups.

Methods

Cross‐sectional study on the relationship between direct participation and work‐related psychosocial risks (using COPSOQ‐ISTAS21 v3) on a representative sample of the salaried and wage‐earning employees in Spain (n = 1807). Prevalence ratios were calculated using adjusted Poisson regression models, controlling for 10 other labor‐management practices, sex, and age, and stratified by occupational group.

Results

The use of direct participation was either associated consistently with a healthier psychosocial work environment (mostly in manual occupations, which presented twice as many positive associations as nonmanual occupations, and of greater strength, mostly in the control and social support dimensions) or there were no significant associations (mostly among nonmanual occupations and in relation to work pace). More frequent and stronger associations were observed when consultation and delegation were used in combination. If used separately, consultation achieved better results among manual occupations and delegation among nonmanual occupations. Direct participation topics were not important for results in manual occupations whereas results were better on tactical (vs. operational) issues in nonmanual occupations.

Conclusions

Direct participation does not change power structure, but it may be a useful intervention at the company level to reduce work‐related psychosocial exposures and associated diseases among workers in manual occupations, and consequently for decreasing occupational exposures and health inequalities.

Testing middle range theories in realist evaluation: a case of a participatory organisational intervention

Purpose

Realist evaluation seeks to answer the question of “what works for whom in which circumstances?” through developing and testing middle range theories (MRTs). MRTs are programme theories that outline how certain mechanisms of an intervention work in a specific context to bring about certain outcomes. In this paper, the authors tested an initial MRT about the mechanism of participation. The authors used evidence from a participatory organisational intervention in five worksites of a large multi-national organisation in the US food service industry.

Design/methodology/approach

Qualitative data from 89 process tracking documents and 24 post-intervention, semi-structured interviews with intervention stakeholders were analysed using template analysis.

Findings

The operationalised mechanism was partial worksite managers’ engagement with the research team. Six contextual factors (e.g. high workload) impaired participation, and one contextual factor (i.e. existing participatory practices) facilitated participation. Worksite managers’ participation resulted in limited improvement in their awareness of how working conditions can impact on their employees’ safety, health, and well-being. Based on these findings, the authors modified the initial MRT into an empirical MRT.

Originality/value

This paper contributes to the understanding of “what works for whom in which circumstances” regarding participation in organisational interventions.

From training to learning: Transition of a workplace for industry 4.0

BACKGROUND: Transition into Industry 4.0 has had many significant impacts. Customization symbolizes leanness, flexibility, adaptability, and agility. A business operator needs to recognize the factors that contribute to better utilization of the talents of its workforce and more effective workplace learning. OBJECTIVE: The study aims to provide a construct which highlights effective workplace learning. In this context, a construct represents a broad view of various interrelated ideas and concepts which can point to academic and practical implications. METHODS: The study applies action research which is suitable when observing a transformative change. The study intends to observe and notice how the environmental factors have changed and try to predict their impacts on human capital development. To help verify the suitability of these impacts, a comparison with similar studies or findings is made. Focuses on literature reviews which look at the impacts from Industry 4.0 (on a need to tackle the waste of the talents in a workplace), recent developments of learning (on an emerging importance of informal learning), and survey’s data (on a shift in a workplace’s expectation on the workers). RESULTS: Workplace learning has gradually replaced training and education. The proposed construct can help tackle the underutilization of the talents in a workplace as the workers are nowadays expected to perform the tasks and learn at the same time. CONCLUSIONS: Sustaining learning in a workplace needs to understand behavior, motivation, emotion, and workplace engagement. Informal learning, which reflects the individualization of learning, can enable an organization to deal with workplace learning.

Work Redesign for the 21st Century: Promising Strategies for Enhancing Worker Well-Being

Work is a key social determinant of population health and well-being. Yet, efforts to improve worker well-being in the United States are often focused on changing individual health behaviors via employer wellness programs. The COVID-19 health crisis has brought into sharp relief some of the limitations of current approaches, revealing structural conditions that heighten the vulnerability of workers and their families to physical and psychosocial stressors. To address these gaps, we build on existing frameworks and work redesign research to propose a model of work redesign updated for the 21st century that identifies strategies to reshape work conditions that are a root cause of stress-related health problems. These strategies include increasing worker schedule control and voice, moderating job demands, and providing training and employer support aimed at enhancing social relations at work. We conclude that work redesign offers new and viable directions for improving worker well-being and that guidance from federal and state governments could encourage the adoption and effective implementation of such initiatives. (Am J Public Health. 2021;111(10):1787-1795. https://doi.org/10.2105/AJPH.2021.306283).

Developing Initial Middle Range Theories in Realist Evaluation: A Case of an Organisational Intervention

(1) Background: Realist evaluation is a promising approach for evaluating organisational interventions. Crucial to realist evaluation is the development and testing of middle range theories (MRTs). MRTs are programme theories that outline how the intervention mechanisms work in a specific context to bring about certain outcomes. To the best of our knowledge, no organisational intervention study has yet developed initial MRTs. This study aimed to develop initial MRTs based on qualitative evidence from the development phase of an organisational intervention in a large multi-national organisation, the US food service industry. (2) Methods: Data were collected through 20 semi-structured interviews with the organisation's managers, five focus groups with a total of 30 employees, and five worksite observations. Template analysis was used to analyse data. (3) Results: Four initial MRTs were developed based on four mechanisms of participation, leadership commitment, communication, and tailoring the intervention to fit the organisational context to formulate 'what may work for whom in which circumstances?' in organisational interventions; (4) Conclusions: Our findings provide insights into 'how' and 'which' initial MRTs can be developed in organisational interventions.

Positive Participatory Organizational Interventions: A Multilevel Approach for Creating Healthy Workplaces

In the following perspective paper, we argue for the importance of conducting research on positive participatory organizational interventions. We propose that these types of interventions are important because they not only focus on eliminating or reducing adverse job demands but focus also on developing job resources. To achieve the best effects, actions should be taken to address demands and resources at the individual, group, leader and organizational levels. We furthermore suggest that the participatory intervention process itself may also build resources at these four levels.

Implementing practices focused on workplace health and psychological wellbeing: A systematic review

RATIONALE

Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

OBJECTIVE

We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development.

METHODS

We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies).

RESULTS

Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance.

CONCLUSIONS

The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].

On the contribution to the alignment during an organizational change: Measurement of job satisfaction with working conditions

INTRODUCTION

Modern approaches to Occupational Health and Safety have acknowledged the important contribution that continuous improvements to working conditions can make to the motivation of employees, their subsequent performance, and therefore to the competitiveness of the company. Despite this fact, organizational change initiatives represent a path less traveled by employees. Specialized literature has drawn on the fact that employees' satisfaction presents both the foundation and catalyst for effective implementation of improvements to working conditions.

METHOD

This paper conceptualizes the alignment of employees through measurement of job satisfaction and uses the Bayesian Network to assess the influence of human factors, particularly the cognitive, emotional, and behavioral aspects. Toward this aim, the Bayesian Network is evaluated through a cross-validation process, and a sensitivity analysis is then conducted for each influential dimension: emotional, cognitive, and behavioral.

RESULTS

The results reveal that these three dimensions are interrelated and have a direct influence on job satisfaction and employees' alignment during the organization change. Further, they suggest that the best strategy for enhanced alignment and smooth conduct of organizational changes is simultaneous enhancement of the three dimensions. Practical applications: This study shows the influence of emotional, cognitive, and behavioral dimensions on job satisfaction and employees' alignment during the organizational change. Furthermore, it elaborates the way to develop efficient and effective strategies for a successful change implementation and sustained alignment.

H-WORK Project: Multilevel Interventions to Promote Mental Health in SMEs and Public Workplaces

The paper describes the study design, research questions and methods of a large, international intervention project aimed at improving employee mental health and well-being in SMEs and public organisations. The study is innovative in multiple ways. First, it goes beyond the current debate on whether individual- or organisational-level interventions are most effective in improving employee health and well-being and tests the cumulative effects of multilevel interventions, that is, interventions addressing individual, group, leader and organisational levels. Second, it tailors its interventions to address the aftermaths of the Covid-19 pandemic and develop suitable multilevel interventions for dealing with new ways of working. Third, it uses realist evaluation to explore and identify the working ingredients of and the conditions required for each level of intervention, and their outcomes. Finally, an economic evaluation will assess both the cost-effectiveness analysis and the affordability of the interventions from the employer perspective. The study integrates the training transfer and the organisational process evaluation literature to develop toolkits helping end-users to promote mental health and well-being in the workplace.

How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles

Research on organizational interventions needs to meet the objectives of both researchers and participating organizations. This duality means that real-world impact has to be considered throughout the research process, simultaneously addressing both scientific rigour and practical relevance. This discussion paper aims to offer a set of principles, grounded in knowledge from various disciplines that can guide researchers in designing, implementing, and evaluating organizational interventions. Inspired by Mode 2 knowledge production, the principles were developed through a transdisciplinary, participatory and iterative process where practitioners and academics were invited to develop, refine and validate the principles. The process resulted in 10 principles: 1) Ensure active engagement and participation among key stakeholders; 2) Understand the situation (starting points and objectives); 3) Align the intervention with existing organizational objectives; 4) Explicate the program logic; 5) Prioritize intervention activities based on effort-gain balance; 6) Work with existing practices, processes, and mindsets; 7) Iteratively observe, reflect, and adapt; 8) Develop organizational learning capabilities; 9) Evaluate the interaction between intervention, process, and context; and 10) Transfer knowledge beyond the specific organization. The principles suggest how the design, implementation, and evaluation of organizational interventions can be researched in a way that maximizes both practical and scientific impact.

Development of a Generic Workshop Appraisal Scale (WASC) for Organizational Health Interventions and Evaluation

This study presents the development of a generic workshop appraisal scale (WASC) for the evaluation of organizational health interventions. Based on the session evaluation questionnaire (SEQ) by Stiles (1980), we developed a short, generic 10-item scale with pairs of adjectives, covering five facets: comprehensibility, relevance, novelty, activation, and valence. Our study is based on N = 499 employees from four organizations who participated in 41 workshops and filled out an evaluation questionnaire on-site. The questionnaire contained the newly developed WASC, as well as items capturing satisfaction with the developed output and outcome expectancies. Results from confirmative factor analysis confirmed the hypothesized five-factor structure of the WASC. The factor structure was found to be nearly invariant across the four organizations, a result that needs to be replicated in larger samples. Analysis of intra-class correlations indicated that 25% of the variance in workshop appraisal can be explained at workshop level. Hereby, perceived relevance and novelty exhibited lower amounts of shared variance, indicating that corresponding workshop appraisals are influenced more by individual factors and less by group dynamics. Furthermore, results from mediation analysis revealed that participants’ workshop appraisals were significantly related to their outcome expectancies, and that this relationship was mediated by output satisfaction. Again, the facets showed differential effects: Relevance and comprehensibility seem to contribute most to the total effect on outcome expectancy, followed by activation, whereas valence and especially novelty play a minor role. Taken together, participants’ workshop appraisals – together with output satisfaction and outcome expectancy – may be helpful for monitoring the implementation process and allow for corrective action if necessary.

Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture

Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.

Continuous Technological Improvement Using Systems Engineering Principles to Achieve Sustainability

The design of a continuous plan would benefit society, as seen in systems engineering. To understand complex systems and to uphold the principles of stability, systems engineering has shown that it is a discipline of great importance. The principle of continuous technological improvement has augmented this idea, as the quality improvement of the design to meet inherent objectives would be the focus. This study aims to present the necessity of continuous technological improvement through systems engineering principles for socioeconomic and community-oriented growth. Thus, the context that would tackle global concerns and facilitate humanity's growth toward knowledge would be the application of technology. The context at hand, the design of systems thinking, and the overall approach taken to promote deeper perspectives has been illustrated in various literature. Healthcare, chemical production and organizational development are various fields of distinction that have shown evidence from the investigation into related literature. To streamline quality, as well as to maintain high quantities of production, all employed systems engineering have focused on technological improvements. In the field of industrial engineering, for a stable industry in which the system operates, this line of thinking is crucial.

Improving Working Conditions and Job Satisfaction in Healthcare: A Study Concept Design on a Participatory Organizational Level Intervention in Psychosocial Risks Management

This paper contributes to the literature on organizational interventions on occupational health by presenting a concept study design to test the efficacy of a Participatory Organizational-level Intervention to improve working conditions and job satisfaction in Healthcare. The Participatory Organizational-level Intervention is developed using the Italian methodology to assess and manage psychosocial risks tailored to Healthcare. We added an additional step: evaluation, aiming to examine how the intervention works, what worked for whom and in which circumstances. This ongoing study is conducted in collaboration with two large Italian hospitals (more than 7000 employees). The study design comprises a quasi-experimental approach consisting of five phases and surveys distributed pre- and post-intervention aiming to capture improvements in working conditions and job satisfaction. Moreover, to evaluate the efficacy of the Intervention in terms of process and content, we use a realist evaluation to test Context-Mechanisms-Outcome (CMO) configurations. We collect contextual factors at baseline and during and post-intervention process data on the key principles of line manager support and employees participation. This study is expected to provide insights on methods and strategies to improve working conditions and employees’ job satisfaction and on national policies in the occupational health framework.

Application of Systems Engineering to Risk Management

System engineering is an interdisciplinary field of engineering and engineering management that focuses on the design and management of the system. The system as a whole is the concern, which is followed by more technical aspects of the system, the design of everything, and the management of a complex system. Inspecting and making the system more efficient is the focus for system engineers. Additionally, risk management is being able to predict, evaluate, and solve risks that are going to happen or may happen in the future. There are three models that help system engineers with making a complex system look simpler and less frightening: the Vee, Spiral, and Waterfall models. While system thinking is a very important part of system engineering, there always has to be a collection of data to study for making decisions. As of now, there is no explanation in literature how these variables, their concepts, and models are beneficial to project management. This has created a research gap, so the study examined the most current variables, their concepts, and models in operations and project management. Furthermore, a design-science-investigate strategy was used to approve a valuable growth reveal for both reasonable and hypothetical application. As a result, an assessment model was generated to fill the research gap and to contribute to the engineering field through improved project success rates and team communication.

The Application of Systems Engineering to Project Management

This study investigated the application of systems engineering to project management. There is an increasing complexity to modern projects, and lifecycle-focused project management displays the inability to manage the risks associated with increased project complexity. A more adequate approach to these issues is presented in the systems engineering processes. It was proposed that the application of systems engineering concepts will allow improve the management of complex projects and the mitigation of risks. Additionally, qualitative research conducted via the collection and analysis of credible information yielded data that supported this proposition. Since systems engineering processes are adaptable, they are suited to manage complex problems. It was concluded that applying systems engineering to project management was beneficial, and the integration of methodologies was valuable to the successful completion of large scale, complex projects.

Measurement System Analysis and System Thinking in Six Sigma

This article investigated measurement system analysis and system thinking in Six Sigma, as well as the factors that influence these actions. If the measurement system being used to accumulate data from the process delivers dependable and accurate results, the measurement system analysis regulates it. Process improvement initiatives can be derailed by faulty measurement systems. Also, managers who have read faulty data can be misled into making wrong decisions. To collect trustworthy data, a reliable measurement system is established with this process. A method to assess an organization as a system and interpret its practices as a whole with Six Sigma is system thinking. Also, fixing a system as a whole helps to identify the real causes of issues and to know where to address them. This article addressed the contribution of these two methods to an overall success of an organization operating Six Sigma. The most current variables, concepts, and models were studied within operations and project management. By using a design-science-investigate strategy, this study approved of a valuable growth reveal for reasonable and hypothetical application. This study allowed us to generate a fitting assessment model that will fill the research void. Also, this study contributed to the engineering field with improved project success rates and team communication.

Frontline meetings as support for cross-boundary coordination in hospitals

Purpose

The purpose of this paper is to investigate frontline meetings in hospitals and how they are used for coordination of daily operations across organizational and occupational boundaries.

Design/methodology/approach

An in-depth multiple-case study of four purposefully selected departments from four different hospitals is conducted. The selected cases had actively developed and embedded scheduled meetings as structural means to achieve coordination of daily operations.

Findings

Health care professionals and managers, next to their traditional mono-professional meetings (e.g. doctors or nurses), develop additional operational, daily meetings such as work-shift meetings, huddles and hand-off meetings to solve concrete care tasks. These new types of meetings are typically short, task focussed, led by a chair and often inter-disciplinary. The meetings secure a personal proximity which the increased dependency on hospital-wide IT solutions cannot. During meetings, objects and representations (e.g. monitors, whiteboards or paper cards) create a needed gathering point to span across boundaries. As regards embedding meetings, local engagement helps contextualizing meetings and solving concrete care tasks, thereby making health care professionals more likely to value these daily meeting spaces.

Practical implications

Health care professionals and managers can use formal meeting spaces aided by objects and representations to support solving daily and interdependent health care tasks in ways that IT solutions in hospitals do not offer today. Implementation requires local engagement and contextualization.

Originality/value

This research paper shows the importance of daily, operational hospital meetings for frontline coordination. Organizational meetings are a prevalent collaborative activity, yet scarcely researched organizational phenomenon.

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

Lean management and related ideas have had a significant impact on organizations throughout North America and the world. Despite its popularity and impact, I-O psychologists have largely neglected Lean as a research topic and few I-O psychologists engage in applied practice in the area. In this focal article, we provide a working definition of Lean and present examples of Lean’s influence. Next, we outline possible reasons to explain I-O psychologists’ indifference to Lean. Finally, we provide some topic areas that I-O psychologists can use to contribute to the Lean literature. By using I-O psychologists’ skill in measurement and evaluation, along with our considerable organizational theory, we believe that I-O psychology can improve Lean and broaden their impact. We hope this focal article will inspire I-O psychologists to reconsider a research and practice area that they have previously ignored. In addition, we hope that this article causes I-O psychologists to reflect on their role to play in addressing popular management trends.

Kaizen event approach: a case study in the packaging industry

Purpose

The purpose of this paper is twofold: first, a case study on the application of lean production principles in a manufacturing facility is presented to demonstrate the impact of frequent and systematic use of a Kaizen event on quality and delivery performance. Second, the detailed description and analysis of the Kaizen event and its impact are provided, including a comprehensive analysis of the role of Kaizen events on employee participation and motivation.

Design/methodology/approach

The study utilizes a Kaizen event’s case study data with the help of various waste detection and elimination tools and techniques. Changes in overall productivity along with potential long-term improvements in the delivery process are also analyzed and documented.

Findings

Pre- and post-quality measures are provided to demonstrate the results of the event on the production quality and on the performance of the overall manufacturing processes. Qualitative findings regarding performance measurements and the impact on the employees are reported.

Research limitations/implications

The Kaizen team applied analytical techniques to one manufacturing site in North America of a company that has a manufacturing presence in 20 different countries.

Originality/value

Kaizen studies involving packaging operations are quite limited. This study fills this gap by detailing the Kaizen event implementation in a packaging delivery and dispensing systems manufacturer for the cosmetic industry. The implementation of this Kaizen event is detailed along with the data and techniques utilized for process improvement. The study also reports findings regarding the impact of the Kaizen event on employee participation.

Improving Working Conditions to Promote Worker Safety, Health, and Wellbeing for Low-Wage Workers: The Workplace Organizational Health Study

This paper addresses a significant gap in the literature by describing a study that tests the feasibility and efficacy of an organizational intervention to improve working conditions, safety, and wellbeing for low-wage food service workers. The Workplace Organizational Health Study tests the hypothesis that an intervention targeting the work organization and environment will result in improvements in workers' musculoskeletal disorders and wellbeing. This ongoing study is being conducted in collaboration with a large food service company. Formative evaluation was used to prioritize outcomes, assess working conditions, and define essential intervention elements. The theory-driven intervention is being evaluated in a proof-of-concept trial, conducted to demonstrate feasibility and potential efficacy using a cluster randomized design. Ten worksites were randomly assigned to intervention or control conditions. The 13-month intervention uses a comprehensive systems approach to improve workplace policies and practices. Using principles of participatory engagement, the intervention targets safety and ergonomics; work intensity; and job enrichment. The evaluation will provide a preliminary assessment of estimates of the intervention effect on targeted outcomes and inform understanding of the intervention implementation across worksites. This study is expected to provide insights on methods to improve working conditions in support of the safety and wellbeing of low-wage workers.

Effects of work conditions on provider mental well-being and quality of care: a mixed-methods intervention study in the emergency department

BACKGROUND

Emergency departments (EDs) are highly dynamic and stressful care environments that affect provider and patient outcomes. Yet, effective interventions are missing. This study evaluated prospective effects of a multi-professional organizational-level intervention on changes in ED providers' work conditions and well-being (primary outcomes) and patient-perceived quality of ED care (secondary outcome).

METHODS

A before and after study including an interrupted time-series (ITS) design over 1 year was established in the multidisciplinary ED of a tertiary referral hospital in Southern Germany. Our mixed-methods approach included standardized provider surveys, expert work observations, patient surveys, and register data. Stakeholder interviews were conducted for qualitative process evaluation. ITS data was available for 20 days pre- and post-intervention (Dec15/Jan16; Dec16/Jan17). The intervention comprised ten multi-professional meetings in which ED physicians and nurses developed solutions to work stressors in a systematic moderated process. Most solutions were consecutively implemented. Changes in study outcomes were assessed with paired t-tests and segmented regression analyses controlling for daily ED workload.

RESULTS

One hundred forty-nine surveys were returned at baseline and follow-up (response at baseline: 76 out of 170; follow-up: 73 out of 157). Forty-one ED providers participated in both waves. One hundred sixty expert work observations comprising 240 observation hours were conducted with 156 subsequent work stress reports. One thousand four hundred eighteen ED patients were surveyed. Considering primary outcomes, respondents reported more job control and less overtime hours at follow-up. Social support, job satisfaction, and depersonalization deteriorated while respondents' turnover intentions and inter-professional interruptions increased. Considering the secondary outcome, patient reports indicated improvements in ED organization and waiting times. Interviews revealed facilitators (e.g., comprehensive approach, employee participation) and barriers (e.g., understaffing, organizational constraints) for intervention implementation.

CONCLUSIONS

To the best of our knowledge, this is the first study to report prospective effects of an ED work system intervention on provider well-being and patient-perceived quality of ED care. We found inconsistent results with partial improvements in work conditions and patient perceptions of care. However, aspects of provider mental well-being deteriorated. Given the lack of organizational-level intervention research in EDs, our findings provide valuable insights into the feasibility and effects of participatory interventions in this highly dynamic hospital setting.

A novel Kaizen technique for service quality: case study in educational organization

Purpose

The development and application of systematic procedures enabling Kaizen methodology development are still very rare, especially in the service industry. The purpose of this paper is to suggest a set of innovative improvement methodologies of service quality to enhance the extent and depth of Kaizen in the service domain.

Design/methodology/approach

Combining the importance-performance analysis (IPA) method with impact matrix cross-reference multiplication applied to a classification (MICMAC), which is more convenient in calculation and application, and Fuzzy theory not only effectively integrates opinions of multiple experts, but also improves the conventional MICMAC method, which can only make binary judgment on the mutual influence of elements, by making it able to judge the degree of influence, thereby delivering more accuracy in evaluating the results.

Findings

This innovative method which integrates Fuzzy-MICMAC with IPA displayed its usability in the analysis and research of a certain university library on service quality, and significant differences were found on comparing it with the conventional IPA method. The comparison and suggestion were proposed.

Research limitations/implications

The number of the experts involved and samples under investigation were limited, hence findings were not comprehensive enough and cannot be generalized. This sets the direction for future research.

Originality/value

This proposed method helps in overcoming the lack of systematic procedures enabling Kaizen methodology for service quality. It has the advantage of integrating existing tools and models effectively, which not only improve the shortcomings of the conventional methods, but also result in more convenient calculation and application, to promote Kaizen in service domain.