Using the socio-economic approach to management to augment Lean Six Sigma

Purpose

– The purpose of this paper is to present a framework and a case that delineates the coordinated use of the socio-economic approach to management (SEAM) and Lean Six Sigma (LSS) to facilitate operational change.

Design/methodology/approach

– This study uses action research and thematic analysis to explore the augmentation of existing process improvement and organizational assessment methodologies in a production environment.

Findings

– Organizations are under increasing pressure to improve all aspects of business. Project leaders and consultants often follow popular quantitatively oriented protocols like LSS to evaluate explicit operational processes. Including a qualitatively oriented protocol like SEAM expands the project leader’s capability through greater consideration of implicit organizational issues. This paper presents a case where LSS was complemented by SEAM to assess a process that was entangled with several latent organizational dysfunctions.

Practical implications

– SEAM and LSS are accepted protocols to facilitate process improvement and organizational change. Pairing the two protocols into a SEAM-LSS model offers the strengths of each approach, while compensating for the limitations of each. The result is a more inclusive change protocol that reduces potential oversights and inefficiencies that could occur if project leaders worked within the purview of only one methodology.

Originality/value

– This paper uses action research to propose a model to bring qualitative and quantitative methodologies together into a larger complementary framework to use when evaluating organizational problems and opportunities. This paper aims to stimulate discussion and research that would lead to more robust process improvement protocols.

Organizational interventions in response to duty hour reforms

BACKGROUND

Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms.

METHODS

The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome.

RESULTS

Twenty-five articles were included from the United States (n=18), the United Kingdom (n=5), Hong Kong (n=1), and Australia (n=1). They all described single-site projects; the majority used post-intervention surveys (n=15) and audit techniques (n=4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously.

CONCLUSIONS

Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.