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Value Stream Mapping in healthcare: ergonomic implications and the significance of adding an ergonomic module - The NOVO Multicentre Study I

Conference paper
Authors Jörgen Winkel
Kasper Edwards
Caroline Jarebrant
Birna Dröfn Birgisdóttir
Jan Johansson Hanse
Ulrika Harlin
Kerstin Ulin
Sigrún Gunnarsdóttir
Published in The 12th NOVO symposium : Care integration, systems reform and sustainability in health care, Helsinki, 15-16 November
ISBN 978-952-343-195-9
Publisher Juvenus Print - Finnish University Print Ltd
Place of publication Helsinki, Finland
Publication year 2018
Published at Department of Sociology and Work Science
Department of Psychology
Institute of Health and Care Sciences
Language en
Keywords Production Ergonomics, Intervention Research, Organizational Sustainability, Musculoskeletal, Mental
Subject categories Production Engineering, Human Work Science and Ergonomics, Work Sciences, Applied Psychology, Environmental Health and Occupational Health


Background: During the recent decade “Lean production” has become a prevalent rationalization methodology in healthcare. A commonly applied Lean tool is Value Stream Mapping (VSM). It is a participatory tool, i.a. used to identify non-Value-Adding-Work (non-VAW) in patient flows. The process results in an Action Plan suggesting interventions aiming at minimizing non-VAW in order to increase the proportion of value creation. Scientific evidence indicates that non-VAW often represents periods of physical and mental recovery. Reduction of non-VAW may therefore cause ”Work intensification”. On this background the VSM tool has been complemented by an ergonomic module (ErgoVSM) to be used in the healthcare sector (Jarebrant et al., 2010). The aim of the present study was to investigate differences in Action Plans regarding expected impact on ergonomics and performance issues when using ErgoVSM rather than VSM. Material and Methods: Fourteen hospital wards were investigated, six in Denmark, two in Iceland and six in Sweden (one VSM ward refused to complete). In each country half the wards used VSM according to their ordinary Lean routines and the other half used ErgoVSM. All action plans were collected and each proposal was analysed based on triangulations between different stakeholder assessments. Data were analysed using Fisher's exact test of contingency tables of impact on four factors: Work Environment (WE, +/0/-), task/job content/system and efficiency according to VSM/ErgoVSM. Results: Of a total of 175 proposals from all the investigated wards 106 were assessed as causing WE+, 8 WE-, 20 WE0, and 41 Not Assessable. Of the 106 WE+ proposals 78% aimed at system level changes (job content and work situation), the remaining at task level changes or not assessable. This is in contrast to the intervention proposals generally investigated in the ergonomic intervention literature focusing almost exclusively interventions at task and individual level. Using ErgoVSM rather than VSM in Sweden and Iceland resulted in a higher proportion of proposals aiming at reduction of ergonomic risks compared to the Danish wards (p=0.02). Using ErgoVSM did not result in fewer proposals aiming at improving efficiency (p=0.5). Conclusions: Integration of ergonomic criteria into the rationalization tool VSM seems to imply a potential for more comprehensive ergonomic improvements without inhibiting the development of proposals improving efficiency. However, this impact of ErgoVSM seems to be modified by contextual factors.

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