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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

“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.

It seems today to be an indisputable fact that ISO 9000 is a powerful instrument, which cannot be disregarded. It is, far and away, the most influential initiative that grew from the quality movement of the late 1980s. This paper contains an evaluation of results from a survey on ISO 9000 certified companies and aims to present some aspects of the current state of the standard in Swedish industry. This study is focused on motives for implementation, perceived benefits and key implementation factors. The predominant reasons identified for seeking certification were the desire to improve corporate image and quality. Like many previous studies this study underlines the need for management commitment and participation. The very important conclusion drawn from this survey is that the motivation for certification may influence the performance of ISO 9000. The overall benefits which the companies gain from the standard showed dependence on the motivation which initiated the drive for the certification.

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.

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.

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.

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.

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.

The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.

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.

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.

This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.

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.

The 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).

Three 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.

ISO 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.

The 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.

The 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.

The 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.

This 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.

This 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.

The 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.

Empirical results obtained in Sweden may differ to some extent in other countries.

This 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.

The paper provides valuable insights into the current state of quality improvement activities in Swedish industry, as seen from the perspective of the production manager.

ISO 14000 is based on the concept that better environmental performance can be achieved when environmental aspects are systematically identified and managed. Despite the growing interest in voluntary environmental management standards, little empirical information exists and only a few survey studies have been made. This paper contains an evaluation of results from a survey on ISO 14000 and ISO 9000 companies. The study presents experiences from the standards implementation processes in Sweden. It focuses on motives for implementation, perceived benefits and key implementation factors. Further, comparisons are made between ISO 14000 and ISO 9000 systems. Swedish companies mainly use the standard to demonstrate their commitment to environmental protection. Most benefits are also perceived in the improved relations with stakeholders and in marketing advantages. Since the standard requires companies to set their environmental policy and objectives themselves, the identification of environmental aspects was stated as most important and also as the factor requiring most effort. Organizations require their suppliers to implement ISO 9000 to a greater extent than ISO 14000.

The 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?

The 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.

When 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.

Adopting patients' diaries as a way to activate and promote co‐creation of values is at an embryo stage, and hence more research is needed.

One 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.