Purpose This study aims to examine the effect of human resource management (HRM) in mitigating negative effects of Lean management and Six Sigma (LM&SS) on employee well-being in health care. The authors subdivide well-being into three components: happiness, trust and health. Design/methodology/approach This is a cross-sectional, multisite survey study in internal service units of hospitals. Data analyzed using multivariate regression come from a sample of 1,886 survey respondents (42 units, N = 218 supervisors, N = 1,668 employees) in eight Dutch academic hospitals that have implemented LM&SS. Findings The present study findings show no or weak effects of LM&SS on the happiness and health component of employee well-being. In addition, the authors found a significant but weak direct positive effect (ß = 0.07) of the LM&SS bundle on the trusting relationships component of well-being. Therefore, moderating effects of HRM practices on the relationship between LM&SS and employee well-being seem less relevant because an existing relationship between LM&SS and employee well-being is a prerequisite for moderation (Hayes, 2009). There were unexpected side effects. Inspired by research that discusses direct effects of HRM on employee well-being, the authors tested this relationship and found that HRM has a direct positive effect on trust and happiness of employees in health care. For the health component of well-being, the present results show a weak negative effect of HRM. Practical implications This study results in a cautiously optimistic view about LM&SS in health care, provided that it is applied in a targeted manner (to improve the performance of their processes) and that HRM is strategically aligned with the goals of LM&SS to improve employees’ happiness and trusting relationships. Originality/value Unique features of the study are the focus on the consequences for employees’ well-being related to LM&SS in health care, the role of HRM in regard to this relationship and the participation of all eight Dutch academic hospitals in this research.

PurposeThis study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.Design/methodology/approachA cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.FindingsA systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.Research limitations/implicationsThis study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.Practical implicationsIn their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.Originality/valueThis is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

Dit artikel beschrijft een kwalitatief exploratief onderzoek naar de toepassing van Value Based Healthcare (VBHC) in de Nederlandse zorgpraktijk. Daarbij focussen we op randvoorwaarden van VBHC en het effect van de methodiek op de rol van zorgprofessionals (N = 22 interviews). De resultaten laten zien dat de definitie en de toepassing van VBHC verschilt per specifieke zorgcontext en dat vier randvoorwaarden cruciaal zijn voor een bredere en succesvolle implementatie van VBHC: een patiënt die in staat is om mee te beslissen over zijn of haar zorg, beschikbare en betrouwbare data, vertrouwen, en financiering op basis van uitkomsten (waarde). Daarnaast verandert de rol van de zorgprofessional. Ten eerste besluit de patiënt explicieter samen met de zorgprofessional, op basis van medische en patiënt gerapporteerde uitkomsten, over het behandeltraject. Ten tweede, samenwerken in een team rondom een aandoening met gemeenschappelijke integrale verantwoordelijkheid voor elkaars functioneren is nieuw voor artsen. Om zorgprofessionals duurzaam te equiperen voor deze verandering is onze aanbeveling om de VBHC-aanpak te verbreden met zowel een specifieke set van Human Resource-praktijken, als een duidelijk op VBHC gericht organisatieklimaat. Met als gevolg dat VBHC duurzaam wordt geïmplementeerd en leidt tot positieve uitkomsten voor zowel patiënten als zorgprofessionals.

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