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Quick workarounds may be needed if patients cannot wait for the promised care.12 However, only by applying second-order problem-solving can real process improvements be made.Gemmel The importance of effective ‘Lean leadership’ during lean implementations is widely recognised.8 A few studies in healthcare have suggested that lean leadership can be linked to transformational leadership theory.9 13 Under transformational leadership, followers are motivated to do more than originally expected and to feel trust, loyalty, respect and admiration towards their leader.14 Transformational leaders develop their followers through four key dimensions.
Second, since lean leaders are seen as essential in enhancing the problem-solving abilities of healthcare staff,8 we expect effective lean leadership to strengthen the relationship between lean maturity and second-order problem-solving.
This research involves 14 case studies of nursing teams in different departments of a Dutch hospital, all in different phases of a lean-based quality improvement programme: ‘The Productive Ward – Releasing Time to Care’ (from now on referred to as PW).
We answer the following research questions: The concept of lean maturity needs careful consideration if one is to accurately assess the impact of lean implementation on the problem-solving behaviour of nursing teams.3 Malmbrandt and Åhlström11 argue that the extent of an organisation’s lean adoption can be measured using an instrument that incorporates measures to assess lean enablers, lean practices and performance.
Lean enablers represent the supporting structure or preconditions of lean, including the training of employees and dedicating time and resources to improvement work.
by acting as a coach.14 Transformational leadership is different from transactional leadership.
The latter is merely an exchange process to motivate follower compliance, where a leader clarifies performance criteria, states expectations and determines what followers receive in return.14 The link between transformational leadership theory and lean leadership is relatively under-researched.9 In healthcare, there are only a few empirical studies investigating lean leadership practices.9 10 ,3 we expect greater lean maturity to potentially lead to an elevated degree of second-order problem-solving in nursing teams.
In addition, we explore the meaning attached to lean leadership on nursing wards and discover how lean leadership moderates the lean maturity—second-order problem-solving relationship.
In our study of the lean leadership concept, we focus solely on identifying leadership practices on nursing wards (ie, in terms of team leadership).
He peed like a racehorse (and was NOT happy with me for making that happen! And he was off of oxygen before he went down to get his pacemaker. She was on a dilaudid PCA and still complaining of awful pain. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. Diabetics with neuropathy would talk about similar pain… “So if this works for their nerve pain, could it work for a patient who has had an amputation? I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain, after I described my patient’s type of pain and thought process. I’ll write for it and we’ll see if we can get her off the opioids sooner.” She wrote for it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort was significantly reduced.
My patient just had her right leg amputated above her knee. I thought about other patients that report similar pain.. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.