Bonnie Poksinska
@liu.se
Logistics and Quality Management (LOGQ); Department of Management and Engineering (IEI)
Linköping University
RESEARCH INTERESTS
Operations management in healthcare
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Bonnie Poksinska and Malin Wiger
Emerald
PurposeProviding high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.Design/methodology/approachThe study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).FindingsThe authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.Practical implicationsThe authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.Originality/valueThe authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.
Promporn Wangwacharakul, Silvia Márquez Medina, and Bozena Bonnie Poksinska
Emerald
Purpose Customers from different cultures might have different expectations and perceptions of quality, leading to different levels of satisfaction. Together with the construct and measurement equivalence issues of cross-cultural surveys, this raises the question of the comparability of customer satisfaction measurements across countries. The purpose of this study is to evaluate the survey method of anchoring vignettes as a tool for improving the comparability of customer satisfaction measurements across countries and to shed some light on cultural influences on customer satisfaction measurements. Design/methodology/approach Based on the models of American Customer Satisfaction Index and European Performance Satisfaction Index, the authors designed and conducted a survey using the method of anchoring vignettes to measure and compare customer satisfaction with mobile phone services in four countries – Costa Rica, Poland, Sweden and Thailand. The survey was carried out with young adults aged 20–30 years, who were mostly university students. Findings This study demonstrates how anchoring vignettes can be used to mitigate cultural bias in customer satisfaction surveys and to improve both construct and measurement equivalence of the questionnaire. The results show that different conclusions on cross-cultural benchmarking of customer satisfaction would be drawn when using a traditional survey compared to the anchoring vignettes method. Originality/value This paper evaluates the survey method of anchoring vignettes as a potential quantitative research method for studying customer satisfaction across countries. The results also contribute to customer satisfaction research as these shed some light onto how culture influences customer satisfaction measurements. The practical implication for firms and managers is that allocating resources among different countries based on traditional customer satisfaction surveys may be misleading.
Thomas Rotter, Christopher Plishka, Adegboyega Lawal, Liz Harrison, Nazmi Sari, Donna Goodridge, Rachel Flynn, James Chan, Michelle Fiander, Bonnie Poksinska,et al.
SAGE Publications
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization’s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
Magdalena Smeds and Bozena Bonnie Poksinska
Emerald
Purpose The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation. Design/methodology/approach A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation. Findings Three effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times. Originality/value “Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.
Jan Marcusson, Magnus Nord, Maria M Johansson, Jenny Alwin, Lars-Åke Levin, Petra Dannapfel, Kristin Thomas, Bonnie Poksinska, Annette Sverker, Anna Olaison,et al.
BMJ
IntroductionThe provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysisIn a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and disseminationApproved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.Trial registration numberNCT03180606.
Wiesław Urban, Emil Ratter, Promporn Wangwacharakul, and Bonnie Poksinska
Walter de Gruyter GmbH
Abstract This study aimed to explore the potential impact of the Lean Manufacturing methodology on the implementation and functioning of the BRC Standard for Packaging. The study highlighted many issues where the Lean Manufacturing concept supports and opposes the BRC Standard for Packaging. A framework for the coexistence of both approaches was determined. The study was of a conceptual nature; it adopted an analytical approach. The approach was based on in-depth consideration of each requirement in the BRC Standard for Packaging s and an assessment of the coherence with the Lean Manufacturing methodology. As a result, many conclusions, clues and challenges were found. The article indicates several areas, in which Lean Manufacturing supports the BRC Standard for Packaging, attributing a special positive role to Lean Tools & Techniques. Also, it indicates six areas, in which the BRC Standard for Packaging contradicts the Lean Manufacturing approach. A comprehensive analysis of the coexistence of both management systems allows a better understanding of challenges while implementing both of them in an organisation. The presented concept of the coexistence of both systems is valuable for management.
Bonnie Poksinska and Dag Swartling
Informa UK Limited
Many improvement programmes often fail to sustain over an extended period of time. Previous research suggests that a similar set of factors influence the success and sustainability of an improvement programme. The purpose of this paper is to make a distinction between the success and sustainability of improvement programmes, and to identify mechanisms that specifically contribute to the sustainability. In this paper, we study a sustainable improvement programme from the perspective of complexity theories that stress the importance of studying change as a dynamic process of interacting elements and events unfolding in time. We conducted a longitudinal, in-depth case study of a Swedish Lean Prize Award Winner where a Lean improvement programme was studied over 9 years. An improvement programme is successful if goals are achieved and the targeted problems are resolved. Furthermore, the first-order sustainability means the ability to sustain results and the second-order sustainability means the ability to keep an improvement programme alive. The lessons identified from complexity theories, such as destabilising the organisation, ensuring novelty and constant flow of change or self-organisation at the team level, are examples of mechanisms important to achieve the sustainability of the improvement programme.
Jelena Kurilova-Palisaitiene, Erik Sundin, and Bonnie Poksinska
Elsevier BV
Bozena Bonnie Poksinska and Peter Cronemyr
Informa UK Limited
Listening to citizens is seen as an important source of information about public service performance. In Sweden, to secure the quality of elderly care, the National Board of Health and Welfare conducts a yearly survey of in-home elderly care services and nursing homes. A central problem of the existing survey methodology is the interpersonal incomparability of survey responses due to differences in preferences and health conditions. One way to deal with this problem is to use the survey methodology with anchoring vignettes. The purpose of the paper is to investigate the possibilities and limitations of using anchoring vignettes as a general survey method and specifically to test the method for measuring elderly care quality. The vignettes were developed interactively with professionals working in elderly care and evaluated with 1600 users of in-home elderly care services and nursing homes. The results showed that anchoring vignettes reduce the impact of respondents’ personal characteristics on survey results. In general, anchoring vignettes give more robust answers that reduce the problem of incomparability. However, anchoring vignettes increase the complexity of the questionnaire and have limited value in elderly care. Our results indicate that the method might be applicable when using healthier and younger respondents.
Bozena Bonnie Poksinska, Malgorzata Fialkowska-Filipek, and Jon Engström
BMJ
Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.
Promporn Wangwacharakul and Bozena Bonnie Poksinska
Emerald
Purpose The aim of this paper is to suggest and demonstrate how anchoring vignettes, as a survey instrument, can be applied to study quality management (QM) across cultures. Cultural differences may create challenges in QM. Quantitative surveys are commonly used to study QM practices but do not consider the cultural bias in the survey results. An important question is how to study QM so that the results are comparable across cultures. Herein, the use of anchoring vignettes is suggested to reduce the problem of cross-cultural incomparability. Design/methodology/approach This paper focuses on developing and testing vignettes for studying QM. Based on previous survey studies, two vignettes for each QM dimension are developed. The vignettes are then tested with two pilot tests on the web-based survey platform. Findings The paper provides a concrete example of how a survey using anchoring vignettes could be designed and used to deal with cultural bias in QM survey Based on hypothetical examples from Swedish and Indian cultures, the results from pilot studies evaluating vignettes are promising and show the applicability of the proposed method. Anchoring vignettes may help to provide more accurate survey results and thereby contribute to understanding of cross-cultural differences in QM practices. One of the challenges is the design of vignettes, which requires high precision and several tests to make the method work. Originality/value The paper discusses the potential of using anchoring vignettes to study QM practices across cultures. This may contribute to better understanding of QM practices in an international context, and thereby help improve QM practices in multinational organisations.
A. Mosadeghrad and E. Ferlie
Routledge
Jostein Langstrand, Peter Cronemyr, and Bozena Poksinska
Informa UK Limited
The quality of teaching should be the central theme in the education on quality management (QM). Delivering bad courses about QM would reduce the legitimacy of the subject, since we do not practise what we preach. The purpose of this paper is to discuss how the quality of education can be enhanced through effective course design based on quality thinking and higher education theory. The study covers three university courses in the field of QM; an introductory course in QM, and courses in Six Sigma and Lean Production, respectively. Each course has been analysed and described in terms of factors affecting student learning and the perceived quality of the courses. The impact of course design on examination results and student evaluation has been studied and compared to historical data. The study demonstrates that course design can have a profound impact on student learning as well as course evaluation. Analysis of the three examples provided in this paper indicates that the QM principles can effectively be used in course design processes. Attention to the principles presented in this paper facilitates the design of courses that enhance learning and ensure higher student satisfaction. The application of QM principles in higher education has a long theoretical tradition. This paper provides three strong examples of how this can be done in practise.
Jon Engström, Mattias Elg, Bozena Poksinska, Lars Witell, and Hannah Snyder
Edward Elgar Publishing
In this chapter we focus on the role of customers in the development of public organizations. We aim to illustrate how customer involvement can be used not only to learn about customer needs, but also to create a tension for change. Following Van de Ven (1986), we view tension for change as dissatisfaction with current conditions that trigger change. Success for public organizations is dependent on their ability to satisfy the needs of their stakeholders (Bryson, 2004). As a consequence, key stakeholders are increasingly being considered an important resource in public sector reforms and change initiatives (Bingham et al., 2005; Tritter and McCallum, 2006). The customer – who receives private value at an agency’s business end – is conceived of as a stakeholder of vital importance for renewal and change (Osborne et al., 2014). The image of the citizen or customer as someone who is passive and submissive is gradually being replaced by someone who is active and engaged (Nordgren, 2008).
Petra Dannapfel, Bozena Poksinska, and Kristin Thomas
Emerald
Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. Design/methodology/approach – The Östergötland county council, Sweden (CCÖ) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark. Findings – The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable. Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations. Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
Erik Drotz and Bozena Poksinska
Emerald
PURPOSE
The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.
DESIGN/METHODOLOGY/APPROACH
The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.
FINDINGS
The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.
PRACTICAL IMPLICATIONS
Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance.
ORIGINALITY/VALUE
In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.
Bozena Poksinska, Dag Swartling, and Erik Drotz
Informa UK Limited
The aim of this paper is to contribute to a better understanding of managerial practices and leadership in Lean organisations. The results presented here are based on five case studies. The manager's role changed radically with the implementation of Lean production. The focus in managerial tasks changed from managing processes to developing and coaching people. Supporting structures were developed to empower employees and give them more responsibility for daily management activities. These supporting structures included visual control, goal deployment, short daily meetings, two-way communication flow, and a system of continuous improvement. Many leadership behaviours exhibited by Lean managers can be classified as transformational leadership behaviours. However, the need for transformational leadership behaviours was smaller, if the supporting management structure was strong.
Mattias Elg, Jon Engström, Lars Witell, and Bozena Poksinska
Emerald
PurposeThe purpose of this study is to develop and evaluate a model for patient co‐creation and learning based on diaries for use in health‐care service development. In particular, the study aims to investigate the process of patient co‐creation and different mechanisms through which health‐care service providers can learn from the patient.Design/methodology/approachThe study is based on an action research approach. First, a development phase for patient co‐creation and learning leading to a proposed model was conducted. Second, a test phase of the diary‐based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care.FindingsThe study suggests a model for co‐creation and learning in health‐care service development through three learning methods. First, the model may be used as a means for generating and collecting patient ideas; second, a single patient's story can be illustrated and can serve as incentive for health‐care service development and creation of patient‐centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services.Originality/valueThis study extends the research on diary‐based methods as an operationalisation of co‐creation in two ways. First, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Second, the study suggests a co‐creation approach of involving patients in health‐care service development through patient diaries.
Mattias Elg, Lars Witell, Bozena Poksinska, Jon Engström, Su Mi Dahlgaard‐Park, and Peter Kammerlind
Emerald
PurposeThe purpose of this paper is to develop an understanding of how patients experience their health problems and how they can generate innovative ideas about health care services. The research questions that guide the present study are: how can solicited diaries be used for capturing patient ideas? What type of data is generated from solicited diaries used for generating patient ideas? And what are the potential benefits and shortcomings of using patient diaries in generating ideas for improvement of health care services?Design/methodology/approachThe paper is based on an exploratory case study using patient diaries to solicit ideas about how health care services in Sweden can be improved. From the methodological viewpoint, the diaries are used as a tool for patient co‐creation of health care services.FindingsWhen analyzing dairies written by patients four different types of diaries emerged from the study: brief, reporting, descriptive and reflective diaries. Furthermore, 102 ideas for improvements within nine areas were identified from the contents of dairies.Research limitations/implicationsAdopting patients' diaries as a way to activate and promote co‐creation of values is at an embryo stage, and hence more research is needed.Originality/valueOne of the strengths of the paper includes its potential for practical implications, either clinical or methodological, by using patients' dairies. It focuses both on the content generated from the diaries for improving health services, as well as the use of the diaries for practicing the idea of patients as co‐creators in health care service.
Bozena Poksinska
Ovid Technologies (Wolters Kluwer Health)
Purpose: The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. Design/Methodology/Approach: A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Findings: Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.
Bozena Poksinska, Jostein Pettersen, Mattias Elg, Jörgen Eklund, and Lars Witell
Emerald
PurposeThis paper aims to present and discuss the current state of quality‐improvement activities in Swedish companies. The paper focuses on the drivers for quality improvement; types of approaches, tools and techniques, and organizational aspects influenced by quality improvement; and potential areas for improvement.Design/methodology/approachThis paper presents results from a survey on quality improvement work in Swedish industry. Data for this paper were collected using a web‐based questionnaire that was distributed to 800 production managers working in Swedish service and manufacturing organizations. Of the 800 questionnaires sent, a total of 118 questionnaires were filled out, which resulted in a response rate of 16 percent.FindingsThe result shows that the major drivers for quality improvement work in Swedish industry are economical aspects as the need for cost reduction, the need to become more competitive and the wish to increase market share. Drivers such as pressure from shareholders and trends in management have a minor role. The underlying approaches for quality improvement work are standards such as ISO 9000 and ISO 14000. A total of 72 percent of respondents stated that they work with quality management systems; 59 percent, with environmental management systems. The aspects that were most positively influenced by the improvement work were employee motivation, customer satisfaction, employee satisfaction, product/service quality, and flow in internal processes.Research limitations/implicationsEmpirical results obtained in Sweden may differ to some extent in other countries.Practical implicationsThis paper is intended as a source of inspiration for researchers, consultants, and managers who are interested in the current trends and future developments in the quality field.Originality/valueThe paper provides valuable insights into the current state of quality improvement activities in Swedish industry, as seen from the perspective of the production manager.
Bozena Poksinska
Inderscience Publishers
The aim of this paper is to discuss and explain the conditions under which ISO 9000 is likely to have positive effects on organisational performance and employee development. The results described in this paper are coming from a research project looking at ISO 9000 in a more integrated manner using the different research strategies. Both questionnaire surveys and case studies investigating the processes related to ISO 9000 implementation and operation in the organisational settings were used. The value of ISO 9000 differs between organisations and depends on several organisational and external conditions, such as motivation for ISO 9000 implementation, maturity level of quality management, implementation strategy, certification audits and involvement of people. For this reason benefits achieved from ISO 9000 are not the same for every organisation. They depend on the quality objectives set and the level of commitment to achieve business excellence.
Bozena Poksinska
Wiley
The aim of this article was to contribute to the discussion about whether standardization has a positive or negative impact on working conditions. The case studies of organizations certified to the quality management standard ISO 9000 served as the empirical base. The article shows that there is no clear and obvious answer about the impact of standardization on working conditions. The consequences for working conditions depend on many variables and may differ considerably from organization to organization. Three primary variables influencing the outcomes for working conditions were identified and discussed: (1) content of the standard, (2) the standardization process, and (3) the degree of standardization. © 2007 Wiley Periodicals, Inc. Hum Factors Man 17: 383–394, 2007.
Bozena Poksinska, Jens Jörn Dahlgaard, and Jörgen A. E. Eklund
Informa UK Limited
Abstract This paper presents the results of a questionnaire survey of the auditing practices and the value of certification audits in 269 Swedish ISO 9001:2000 certified organisations. Certification audits help to improve the quality management system and increase the motivation for quality work. Certified organisations want auditors not only to issue a certificate, but also to share their own experiences and give suggestions for improvements. Audit conclusions, which imply consultancy work, are a common practice among auditors. Furthermore, there exist great differences regarding the required conditions for certification. The differences primarily depend on the auditors, but also on the certification bodies. Finally, the study also indicates that the audit procedure has improved after the ISO 9000 revision in 2000.
Bozena Poksinska, Jörgen A.E. Eklund, and Jens Jörn Dahlgaard
Emerald
PurposeThe aim of the study is to investigate and to understand the practice of implementing and operating the QMS in an organisational context, providing an analysis of the way ISO 9001:2000 was implemented and operated and focusing on identifying factors which have negatively or positively influenced the effects of the quality management system (QMS).Design/methodology/approachThree case studies of small organisations were examined. The methodological approach was based on Porras and Robertson's model. The data collection methods included interviews, a questionnaire survey of all employees and document studies.FindingsISO 9001:2000 was implemented and operated with minimum effort and little change was experienced. QMS was not perceived as a tool for managing processes, but as a tool for handling documentation. Consequently, this was reflected in the benefits achieved. Despite the external benefits which followed from obtaining the certificates, only minor internal benefits were found. Internal motivation, engaged and trained employees, a competent quality manager, committed CEO and development‐oriented auditors were identified as critical, influencing the effects from ISO 9000. In general, in the way ISO 9001:2000 was implemented and operated many opportunities for improvement were lost.Research limitations/implicationsThe choice of small organisations for the case studies has important implications for the results. Small organisations often lack resources, which limits the initiatives that they can take.Practical implicationsThe QMS and its effects are not determined by the ISO 9001 requirements, but by the organisational context and the way the system is implemented and operated.Originality/valueThe paper provides an explanation why organisations achieve very different results from ISO 9001 implementation. It also shows that certification bodies may have an important role for the effectiveness of the QMS.