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Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach.

In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ², multi-level regression, and t-tests.

Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 (p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent (p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent (p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001).

Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.

The popular total quality management (TQM) approach has tended to focus on internal processes, rather than external issues such as competitiveness and market appeal, and is more reactive and adaptive than anticipative. The time has come to go beyond TQM and to understand the nature and application of organizational learning. Learning organizations envision change, are committed to generating and transferring new knowledge and innovation, and have learned how to learn. TQM may be embedded in the learning organization, but TQM is but the first step or wave in transforming and creating organizations which continuously expand their abilities to change and shape their futures. This article first defines and identifies the characteristics of a learning organization, then explores some techniques to develop and transform an organization into a learning organization, and finally suggests some traditional and newer techniques, such as data envelopment analysis (DEA), as ways to measure and evaluate organizational learning.

Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives.

In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics.

Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions.

Lean implementation has shown to lead to greater transparency and increased shared visions.

Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

For change programs to succeed, it is vital to have a detailed understanding of employees’ views regarding the program, especially when the proposed changes are potentially contested. Gaining insight into employee perceptions helps managers to decide how to proceed. The authors conducted two workshops in a radiotherapy institute to assess the benefits and drawbacks, as well as their underlying causes, of a proposed Lean change program. Managers’ views on the workshops’ usefulness were charted. The paper aims to discuss these issues.

Two workshops were organized in which employees predicted positive and negative effects of a Lean program. The workshops combined a structured brainstorm (KJ-technique) and an evaluation of the expected effects. Eight top managers judged the workshops’ value on supporting decision making.

In total, 15 employees participated in the workshops. Participants from workshop 2 reported more expected effects (27 effects; 18 positive) than from workshop 1 (14 effects; six positive). However, when effects were categorized, similar results were shown. Three from eight managers scored the results relevant for decision making and four neutral. Seven managers recommended future use of the instrument. Increased employee involvement and bottom-up thinking combined with relatively low costs were appreciated most.

The workshop could serve as a simple instrument to improve decision making and enhance successful implementation of change programs, as it was expected to enhance employees’ involvement and was relatively easy to conduct and cheap.

The workshop increased insight into employee views, facilitating adaptive actions by healthcare organization managers.

Drawing on methods and metaphors from complexity science and organizational systematics, this chapter outlines a model for bringing about positive organizational transformation through the alignment of strategy, culture, and social networks. A key concept behind this model is that uncertainty and volatility arising from within or outside an organization must be met with purposeful and informed leadership intervention. The act of organizational alignment must become a core skill for the modern manager. Finally, the process and outcomes of taking such an approach to organizational change are illustrated through a case example.

The purpose of this paper is to explore associations between different mentor behavioral profiles and mentees’ perceptions of the quality of mentoring relationship, the usefulness of the mentoring, and their college adjustment during the first year of college.

The study used a quasi-experimental design and involved the participation of 253 student mentees and 246 students from a control group. Cluster analysis on the responses of mentees on the mentor behavior scale was used to identify behavioral profiles of academic mentors.

Four distinct behavioral profiles were identified: optimal (high scores on mentor structure, involvement, autonomy support, and competence support); sufficient (moderate on all scales); controlling (low on autonomy support but high on other scales); and inadequate (low on all scales). Compared to mentees exposed to sufficient and inadequate profiles, mentees exposed to the optimal profile perceived the mentoring relationship and its usefulness as more positive. Furthermore, they reported better social adjustment in college compared to a control group, whereas mentees exposed to the inadequate profile reported poorer adjustment. Interestingly, mentees exposed to the controlling profile found the mentoring relationship useful.

This study provides new empirical bases for the behavioral profiles of mentors that best meet mentees’ academic adjustment challenges. Limitations of the study include the absence of the mentors’ perceptions in the creation of behavioral profiles and the fact that the profiles were analyzed based on a single program.

Behavioral profiles of academic mentors were examined through the lens of a strong theoretical model that emphasizes the important role of structure, involvement, autonomy support, and competence support in the academic adjustment of mentees.

Many firms have adopted one or more “radical” management remedies in a quest for breakthroughs in performance. But their goal of “discontinuous” improvements usually has an unspoken stipulation: change that causes breakdowns is not acceptable. A few innovative companies have found, however, that process and offering breakthroughs can't occur without carefully orchestrated management system conflict and breakdowns.

This article uses stories from organisations to show how the “Helvig Square” can be an accessible and stimulating tool for managers learning to manage paradox. Many of us have been socialised and educated into binary, “either/or” thinking. As managers we find it hard to cope with current management dilemmas, such as how to plan and stay flexible, how to devolve decisions and keep corporate focus. In this article we build on the work of Pascale who uses the concept of paradox and working with “contending opposites”. This is important thinking, but we show how people can still be entrenched in opposing camps and unable to engage in meaningful dialogue. We explore how managers can expand their thinking through using the Helvig Square. This framework provides a tool which represents the problem more fully, offers a means of analysis and enables a focus on action.