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Zusammenfassung. Hintergrund: Knappe Ressourcen im Gesundheitswesen erfordern einen anforderungsgerechten Einsatz der Mitarbeitenden. Um den Skill-Grade-Mix zu optimieren, initiierte ein Schweizer Universitätsspital ein Projekt, das auf «Lean Management»-Prinzipien basierte. Das Projektteam begleitete jede Pflegeabteilung individuell durch das Projekt und führte eine wissenschaftliche Evaluation der Ergebnisse durch. Ziel: Das Ziel dieser qualitativen Teilstudie bestand darin, erfolgskritische Faktoren des Projekts zu identifizieren. Methode: Vier Fokusgruppen dienten dazu, die Projekterfahrungen der Teilnehmenden zu diskutieren. Die Rekrutierung erfolgte aus Abteilungen, welche die Wirkung des Projekts rückwirkend entweder eher positiv oder eher kritisch eingeschätzt hatten. Der Grad der direkten Einbindung in das Projekt bildete ein zusätzliches Unterscheidungskriterium. Ergebnisse: Während der Grad der direkten Einbindung in das Projekt keine Rolle spielte, kamen in den Gruppen mit eher positiver oder kritischer Projektbewertung gegensätzliche Meinungen und Erfahrungen zum Tragen. Transparenz, Kontext und Haltung erwiesen sich als ausschlaggebende erfolgskritische Faktoren. Schlussfolgerungen: Projektverantwortliche sollten die Transparenz des Projektverlaufs sicherstellen und eine Passung der Projektstruktur hinsichtlich der lokalen Gegebenheiten gewährleisten, um die Betroffenen in ihrer kritischen bzw. positiven Haltung dem Projekt gegenüber zu unterstützen.

PurposeThe purpose of this paper is to investigate whether intervention participants’ process appraisals relate to change in well-being and lean outcomes of entire teams. For this purpose, the study focussed on two main characteristics of a lean implementation process – workshop quality and outcome expectancy – and their interaction with the participation rate, and examined their association with leaner work processes and affective well-being in nursing teams.Design/methodology/approachData were collected from a lean implementation project within 29 nursing wards of a university hospital. Employee surveys covering lean work processes and affective well-being at work were conducted before the implementation of four-day lean workshops in each nursing ward and six months after. The participating employee representatives evaluated the workshop quality and outcome expectancy of the workshops.FindingsMultilevel analyses indicated that workshop quality did not relate to leaner work processes, but was associated with enhanced affective well-being after six months. By contrast, outcome expectancy was associated with leaner work processes, but did not relate to well-being. No moderation effects with participation rate were found.Practical implicationsThe study shows the importance of monitoring process indicators in the early stages of implementation and optimising workshop contents and formats accordingly to ensure positive outcomes for entire teams.Originality/valueThe present study considers intervention participants’ process appraisals of workshop quality and outcome expectancy as good indicators of future change in lean work processes and the well-being of entire teams.

To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model’s applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

This study investigates the relationship between outcome expectancy for an individual stress management course and the total perceived impact of a comprehensive stress management intervention (SMI). It is based on data from three different measurement points from a longitudinal SMI in Switzerland. Individual and organizational outcome expectancies for stress management courses were captured with two newly developed items (SMI outcome expectancy) immediately after course completion. Perceived individual and organizational impacts of the overall intervention captured with two items of a retrospective impact assessment scale (perceived SMI impact) at the two year follow up survey were used as the outcome measurement. Baseline individual and organizational change commitments (as rated by participants) were included in the analyses as possible moderators. Regression analyses show that individual and organizational outcome expectancies in respect of stress management courses can to some extent predict the perceived impact of the intervention as a whole. At the individual level an intervention will be perceived as most successful when participants already have a high individual change commitment and develop high outcome expectancies during stress management courses.