Hoshin Kanri – the Japanese way of piloting : An exploratory study of a Japanese strategic management system

Strategy is a highly topical subject among managers and since the world is constantlychanging it is also an important subject for companies’ competitive advantage and survival.At the same time experts in the field of strategic management describe western techniques ascomplex and ineffective while the Japanese techniques have been seen as unambiguous andcharacterized by focus on quality, productivity and teamwork. This calls for greaterknowledge in the Japanese management systems. Hoshin Kanri is a collection of Japanesebest strategic management practices and therefore an interesting target for our study. Thus, onthe one hand this study investigates the theory of Hoshin Kanri in order to give structure to itand provide a way for practitioner into the management system. On the other hand this studyinvestigates Hoshin Kanri in order to reveal how Japanese subsidiaries based in Sweden haveimplemented this strategic management system. This is firstly done by reviewing the existingliterature on the subject and secondly by a collective case study with in-depth interviewsconducted with managers at Japanese owned subsidiaries based in Sweden. There are somelimitations in this study. One is that the results of the study do not include all Japanesesubsidiaries in Sweden as not all companies participated in the study. Moreover, the study islimited by one individuals’ knowledge and perception of Hoshin Kanri in each of the threecompanies. The study contributes to the existing literature on the topic of Hoshin Kanri by;(1) structuring the literature and the existing models under one of two categories, namelycyclical or sequential; (2) providing a model that aims at making it more understandable andattractive for practitioner to apply; (3) initiating the mapping of the spread of Hoshin Kanriamong Japanese subsidiaries in Sweden and (4) providing a Swedish model for theapplication of HK in Japanese subsidiaries.

Using health-related quality of life instruments for children with long-term conditions : On the basis of a national quality registry system

Introduction: There has been a continuous development of new technologies in healthcare that are derived from national quality registries. However, this innovation needs to be translated into the workflow of healthcare delivery, to enable children with long-term conditions to get the best support possible to manage their health during everyday life. Since children living with long-term conditions experience different interference levels in their lives, healthcare professionals need to assess the impact of care on children’s day-to-day lives, as a complement to biomedical assessments. Aim: The overall aim of this thesis was to explore and describe the use of instruments about health-related quality of life (HRQOL) in outpatient care for children with long-term conditions on the basis of a national quality registry system. Methods: The research was conducted by using comparative, cross-sectional and explorative designs and data collection was performed by using different methods. The questionnaire DISABKIDS Chronic Generic Measure -37 was used as well as semi-structured interviews and video-recordings from consultations. Altogether, 156 children (8–18 years) and nine healthcare professionals participated in the studies. Children with Type 1 Diabetes (T1D) (n 131) answered the questionnaire DISABKIDS and children with rheumatic diseases, kidney diseases and T1D (n 25) were interviewed after their consultation at the outpatient clinic after the web-DISABKIDS had been used. In total, nine healthcare professionals used the HRQOL instrument as an assessment tool during the encounters which was video-recorded (n 21). Quantitative deductive content analysis was used to describe content in different HRQOL instruments. Statistical inference was used to analyse results from DISABKIDS and qualitative content analysis was used to analyse the interviews and video-recordings. Results: The findings showed that based on a biopsychosocial perspective, both generic and disease-specific instruments should be used to gain a comprehensive evaluation of the child’s HRQOL. The DISABKIDS instrument is applicable when describing different aspects of health concerning children with T1D. When DISABKIDS was used in the encounters, children expressed positive experiences about sharing their results with the healthcare professional. It was discovered that different approaches led to different outcomes for the child when the healthcare professionals were using DISABKIDS during the encounter. When an instructing approach is used, the child’s ability to learn more about their health and how to improve their health is limited. When an inviting or engaging approach is used by the professional, the child may become more involved during the conversations. Conclusions: It could be argued that instruments of HRQOL could be used as a complement to biomedical variables, to promote a biopsychosocial perspective on the child’s health. According to the children in this thesis, feedback on their results after answering to web-DISABKIDS is important, which implies that healthcare professionals need to prioritize time for discussions about results from HRQOL instruments in the encounters. If healthcare professionals involve the child in the discussion of the results of the HRQOL, misinterpreted answers could be corrected during the conversation. Concurrently, this claims that healthcare professionals invite and engage the child.