ABSTRACT

THE EFFECTS OF CHANGE MANAGEMENT ON EMPLOYEE ENGAGEMENT:

USING LEAN PRINCIPLES TO INCREASE ENGAGEMENT

By

Jared V. Baker

December 2011

Employee engagement can have a direct impact on an organization's productivity.

Disengaged employees waste valuable resources and are costly, while engaged

employees can drive innovation. According to the literature, organizational change can

affect employee engagement levels negatively as well as positively. The aim of the

present study was to show that employee engagement can be increased through the use of

Lean methodologies. Additionally, the effects of age and seniority on the potential

change were measured.

Quantitative and qualitative data were collected from Lean Rapid Process

Improvement workshop attendees. Data quantifying engagement levels were collected

before the workshop and again at completion. Twelve persons participated in the

quantitative survey. Qualitative data were collected from seven workshop attendees and

three members of management. The quantitative data did not produce significant

findings to support the hypothesis. Qualitative data collected during the interviews did

provide evidence that these workshops can increase employee engagement.

THE EFFECTS OF CHANGE MANGEMENT ON EMPLOYEE ENGAGEMENT:

USING LEAN PRINCIPLES TO INCREASE ENGAGEMENT

A THESIS

Presented to the Department of Health Care Administration

California State University, Long Beach

In Partial Fulfillment

of the Requirements for the Degree

Master of Science in Health Care Administration

Committee Members:

Hannah Hanh-Nguyen, P.h.D. (Chair)

Janice Frates, P.h.D.
Tony Sinay, P.h.D.

College Designee:

Tony Sinay, P.h.D.

By Jared V. Baker

B.A., 2009, California State University, Long Beach

December 2011
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 TABLE OF CONTENTS

Page

LIST OF TABLES v

CHAPTER

1. INTRODUCTION 1

Overview 1
Employee Engagement 3
Level of Engagement 4
Effects of Active Employee Engagement 5
Organizational Development 6
Definition 6
Theories in Change Management 6
KurtLewin 6
JohnKotter 7
Taiichi Ohno 9
Lean Rapid Process Improvement Workshops 11
Link between Employee Engagement and Change 13
Impacts of Change on Employee Engagement 13
How to Increase Employee Engagement 14
The Present Study 15
Scope 15
Hypotheses 15
Hypothesis 1 16
Hypothesis 2 16
Hypothesis 3 16

2. METHOD 17

Participants 17
Procedure 17
Measures 19
Quantitative Survey 19
Employee engagement 19
Demographic questions 19

iii
CHAPTER Page

Qualitative Interview 20
Demographic survey 20
RPI impact questions 20
Materials 21

3. RESULTS 22

Descriptive Statistics 22
Hypothesis Testing 23
Effects of Rapid Process Improvement 23
Interview Findings 30
Valuable Use of Time 30
Confidence about Long-Term Effects of Changes 30
Ownership 31
Tools Needed to Do the Job 32
Improved Patient Safety 32
Management Observations 33
Age and Seniority as Moderators 35

4. DISCUSSION 36

Summary of Results 36
Limitations of the Study and Recommendation for Future Research 37
Conclusion 38

APPENDICES 39

A. ORGANIZATION CONSENT 40

B. CSULB IRB CONSENT 42

C. CONSENT TO PARTICIPATE 44

D. PRE WORKSHOP SURVEY 48

E. POST WORKSHOP SURVEY 51

F. INTERVIEW PROTOCOL 54

G. DEBRIEFING FORM 57

REFERENCES 60

iv
 LIST OF TABLES

TABLE Page

1. Pre and Post Workshop Engagement Scores 24

2. Age Moderated Pre and Post Workshop Engagement Scores 26

3. Seniority Moderated Pre and Post Workshop Engagement Scores 29

v
 CHAPTER 1

INTRODUCTION

Overview

Change is a natural aspect of organizational development and evolution;

organizations that resist change will find themselves behind the curve (Robins, 1990).

The need for change arises from many different sources. According to Borkowski

(2005), planned changes usually develop in response to changes in organizational goals.

This may be manifest from a revised mission, a newly created vision or even as reaction

to external pressures. Unplanned changes may be the result of marketplace shifts,

economic events, mergers (although these can be planned as well) or sudden loss of a key

executive.

The health care industry is no exception to this rule. Urden and Walston (2001)

describe the tumultuous health care industry for the past few decades as "similar to an

earthquake with its unpredictability [and] lack of control [with] the hospital at the

epicenter" (p. 203). One of the many driving forces creating these disturbances is

increasing regulations. For example, the Health Insurance Portability and Accountability

Act of 1996 (HIPAA) called for changes across all aspects of health care, such as

administrative simplification, privacy, and security rulings. Administrative

Simplification calls for national identifiers and standardized transactions and code sets;

1
Privacy sets limitations on uses and disclosure of information, and Security, the physical

protection of the data (Health Insurance Portability and Accountability Act, 1996). The

administrative effects of these rulings required health care organizations to review and

revise many of their existing policies and procedures, especially those surrounding hiring

and employee termination. Additionally, the Security and Privacy rules prompted new

physical safeguards, such as securing data centers, implementing access controls, revising

password polices and encryption mechanisms (Callas & Brockmeier, 2001).

Another environmental force of change in health care today is the Centers for

Medicare and Medicaid Services (CMS) Meaningful Use of Electronic Health Records,

also known as Meaningful Use. The Health Information Technology for Economic and

Clinical Health (HITECH) Act, a component of the American Recovery and

Reinvestment Act of 2009 (ARRA), provides financial stimulus for providers and health

care organizations to implement Electronic Health Records (EHR). Health care providers

who adopt certified EHR technology and attest to meaningful use criteria can receive up

to $63,750 in incentives. Hospitals' incentives begin at a base of $2 million (Electronic

Health Record Incentive Program Final Rule, 2010). Hospitals and medical practices all

over the country are rushing to implement EHRs in order to take advantage of this

funding. A recent study noted that almost half of all institutions have meaningful use

listed as their number one information technology priority for 2011 (Classen & Bates,

2011).

Substantial organizational changes can have both positive and negative impacts

on the organizations (e.g., financial implications), their patients (e.g., inconveniences

2
such as a delay in treatment while the staff becomes acquainted with the new processes)

and their employees. For the scope of the present study, a specific outcome of an

organizational change technique was investigated: the level of employment engagement

after staff has gone through a Lean Rapid Process Improvement workshop. This study

aimed at illustrating how the use of incremental change initiatives, specifically Lean

Rapid Process Improvement workshops (RPI), could increase employees' engagement

levels (e.g., via empowering employees, garnering process ownership). Additionally, the

researcher analyzed the possible effects of age and seniority as moderators to the change

in employee engagement.

Employee Engagement

There are many definitions of employee engagement. The concept was first

mentioned in 1990 by Kahn, with the definition of employee engagement as "the

simultaneous employment and expression of a person's 'preferred self in tasks and

behaviors that promote connections to work" (p. 700). Similarly, Harter, Schmidt, and

Hayes (2002) defined employee engagement as an individual's involvement, satisfaction,

and enthusiasm for work. In 1999, the concept gained mass popularity due to the Gallup

Organization's publication of First Break All the Rules (Buckingham & Coffman, 1999).

Since then, consulting firms have created various programs dedicated to increasing

employee engagement.

It is important to note that employee engagement and employee satisfaction are

not the same (Fox, 2010). Although satisfaction is an important component of

engagement, according to the Walker Loyalty Report (2005), satisfied employees might

3
merely pay lip service to their company. They are not fully committed. They may "jump

ship tomorrow for a job with slightly more pay or a better benefits package" (Fernandez,

2007, p. 524). Engaged employees, on the other hand, are dedicated and loyal to the

employer. For example, engaged employees would respond affirmatively to one key

question on employee engagement surveys, "It would take a lot to get me leave this

organization" (Atchison, 2010, p. 30).

Level of Engagement

The Gallup Organization identifies three levels of engagement (2010). Each

employee will fall into one of these categories: engaged, not engaged, and actively

disengaged. Engaged employees are committed to the organization. They are productive

and provide excellent customer service. They go above and beyond and they would

recommend their company to potential customers as well as to friends as a great place to

work. These are the employees who would endorse the aforementioned statement of "it

would take a lot to get me to leave this organization." A non-engaged (or not engaged)

employee merely considers the job as a means to obtain a paycheck. They are indifferent

to aspects of their organization. They may be decent performers, but they are still at risk

for jumping ship. They may not say negative things about the company, but they

definitely will not freely promote it either.

Actively disengaged employees are the source of concern. These employees act

out their contempt (Avery, McKay & Wilson, 2007). This contempt generally manifests

as passive-aggressive acts which slowly whittle down morale (Shuck & Wollard, 2010).

4
They have high levels of absenteeism; they complain often, and they lack an overall

interest in their work and the goals of their organization (Taylor, 2007).

Effects of Active Employee Engagement

Regarding the effect of employee engagement, Harter et al. (2002) note that

engaged employees are emotionally and cognitively connected to their company. They

know what is expected of them and they can see a correlation between their job and the

goals of the organization. Fox (2010) also explains that engaged employees work with

passion and feel a profound connection to their company. They drive innovation and

move the organization forward. There are strong correlations between employee

engagement and customer satisfaction, loyalty, profit and productivity (Harter et al.,

2007). Specifically, according to a recent survey, 54% of the U.S. workforce is not

engaged and 20% is actively disengaged (Gallup Organization, 2010). Actively

disengaged employees cost the US economy a whopping $350 billion annually (Fleming,

Coffman & Harter, 2005). In other words, employee engagement directly impacts

retention and replacing employees is expensive.

Furthermore, actively disengaged employees may even sabotage an employer's

success (Shaw, 2008). As previously noted, actively disengaged employees may tarnish

the company's name. Only actively engaged employees will proactively speak well of

the organization. In healthcare, word of mouth is of paramount importance: What would

better persuade patients to seek care at a particular facility than the good words of an

employee (Sheridan, 2010).

5
 Organizational Development and Change Management

Definition

Organizational Development (OD) can be traced back the early 1900's when

Frederick Taylor published his work on Scientific Management (Borkowski, 2005).

According to Borkowski, OD is "a systematic process of addressing organizational issues

or implementing change strategies" (2005, p. 376). Organizational Development has

evolved to assist leaders in efficiently facilitating change by using tools and methods

designed with the employees' psyche in mind. Research has been performed on how

employees reacted to changes in organizations and multiple theories of OD have been

formulated. Three notable leaders in the area of change management are Kurt Lewin, and

more recently, John Kotter and Taiichi Ohno.

Theories in Change Management

Kurt Lewin. A humanitarian, Kurt Lewin believed the only way to improve the

human condition was through conflict resolution. His work at Harwood Manufacturing

Corporation helped lay the ground work for future work place studies: Lewin studied

workplace dynamics and focused on performance improvement and staff management,

providing evidence to support his three-step change model (Unfreezing, Changing and

Refreezirig^Burnes, 2007)

Unfreezing is the process in which workers are made aware of the issues; this is

the time to highlight the differences between the current state and the future proposed

state (Borkowski, 2005). Once the goals have been established, it is time to make the

change. Change usually appears in the form of new policies and procedures or operating

6
practices. When these changes are rolled out it is important that the workforce fully

understands the reasons behind the change, transparency is important (Burnes, 2007;

Borkowski, 2005). The final step is Refreezing, Once the changes are in place, they need

to be solidified. If these new methods are not institutionalized, the change will be short

lived and the environment will return to its previous point (Borkwoski, 2005; Burnes,

2007).

Lewin viewed behaviors as dynamic forces that could be manipulated (Kritsonis,

2005). When it comes to change, there are driving forces which serve to facilitate the

change and there are restraining forces which oppose the change. In order to enact

change there must be an imbalance in the two forces. Either the driving forces must be

increased, or the restraining forces reduced (Borkowski, 2005; Spratt & Dickson, 2008).

The Lewin model is used to shift the balance in the direction of the planned change

(Kritsonis, 2005)

John Kotter. In 1995, John Kotter authored an article, "Leading Change," for the

Harvard Business Review, which was the ground work for like titled book. In this article

he laid out an eight-step framework for change. Building upon Lewin's model, Kotter

identifies more detail on how to unfreeze, change, and refreeze. Additionally, he

promotes the emotional involvement of the workforce. He notes that appealing to

emotions is more effective that applying logic to the situation. Emotionally charged

employees are more likely to stay dedicated to the cause than ones enacting the change

because it makes logical sense. Kotter's method for this process is broken down into

eight steps: (1) establish a sense of urgency, (2) create a powerful guiding coalition, (3)

7
 develop a vision, (4) communicate the vision, (5) empower others to act, (6) plan for and

create short term wins, (7) consolidate improvements and produce more change, and (8)

institutionalize new approaches (Borkowski, 2005; Kotter, 1996).

Specifically, building on Lewin's, unfreezing phase, Kotter calls for the

establishment of urgency. Management needs to covey to their staff that this change is

needed and needed now. This can be done by appealing to emotions behind the need for

change (1998). Once the urgency has been established, management needs to build the

guiding coalition to engage the right talent. "Coalition building is not simply reaching

out to whoever happens to be 'in charge'" (Kotter, 1998, p. 30). Kotter also builds on

Lewin's previous observation of the importance of involving the workforce in the change

process. Buy-in is much easier to establish if affected parties feel as if they own the

change (A. Gilley, Dixon & J. Gilley, 2008).

After the coalition team has been established, they must develop a clear vision.

This vision must not be merely a set of future strategies and structures, but must include

new behaviors of senior managers that are aligned with the future state (Kotter, 1998):

"Effective visions are focused enough to guide decision making yet are flexible enough

to accommodate individual initiative and changing circumstances" (p. 31). Kotter points

out that most leaders under-communicate, or the communication methods they choose are

often ineffective. The dissemination of the vision must be concrete. All those involved

need to fully understand the vision and the means for its accomplishment.

Harnessing Lewin's concept of opposing forces, Kotter (1996) reiterates the need

to remove barriers to change. By eliminating obstacles and resistive forces, management

8
can empower others to act on the vision. One of the most detrimental aspects to any

project is the tendency for participants to become disengaged. One way to combat this is

to plan for and create short-term wins. This gives the workforce a tangible view of

progress. Rewarding those involved keeps them motivated (Borkowski, 2005; Kotter,

1998).

As momentum increases, opportunities for future change arise. Kotter (1998)

recommends to use this increased credibility to change systems, structures and polices

that do not fit the vision. Consolidating improvements and producing more change is the

pinnacle of Kotter's model (Kotter, 1996). Finally, pulling again from Lewin, Kotter

finalizes the process with institutionalization of the new approaches (1998).

Taiichi Ohno. Relevant to the present study is the work of Taiichi Ohno, who is

credited for launching the movement of Lean management (Liker, 2004; Womak &

Jones, 1996; Zidel, 2006). Although Ohno did not set out to develop change

management tools, he did so inadvertently. His goal was to improve the production

process at Toyota Motor Corporation. Under the guide of Taiichi Ohno, the Toyota

Production System (TPS) was born. While Ohno was pivotal in the foundation of TPS,

most of the concepts were already in place at Toyota. What this company needed was

someone to pull all the pieces together. Taking concepts from Fredrick Taylor's time and

motion studies, Ford's standardized assembly process, existing just-in-time (JIT)

processes, W. Edwards Deming and Joseph Juran's statistical research (later to evolve

into Six Sigma) and even U.S. grocery store restocking procedures, Ohno helped

establish a set of tools, methodologies and culture that would drastically increase

9
Toyota's level of quality without increasing costs (Liker, 2004). As Toyota succeeded,

other industries began to take notice of these concepts. TPS eventually evolved into what

is now called Lean. Lean methodologies have been applied to almost every industry,

including health care.

The basic tenet behind Lean is elimination of waste. In their book, Lean

Thinking, James Womack and Daniel Jones (1996) describe Lean as a five step process:

defining the customer value, defining the value stream, making it flow, pulling from the

customer back, and striving for excellence. Lean calls for a waste free process in which

the demand for production (pull) is driven directly by the customer. Product (or service)

flows through the process with minimal or no waiting or queuing (Liker, 2004). Waste is

defined by Lean as delays, over processing, inventory, transportation, motion,

overproducing, and defects. According to Hirano (2009), most waste develops as a result

of workarounds. These alternate solutions are developed and implemented casually and

eventually become the standard (i.e., institutionalized). Lean provides five basic tools

and methodologies for eliminating waste: 5 Whys, 5S, Kanban, Visual Controls, and

Standard Work.

The 5 Whys method involves starting with the problem and asking iterative

questions until the root cause is determined (Liker, 2004). The response to the first

question will in turn be questioned, and the response to that questioned again. This

process repeats five times. In Lean, 5S refers to an organization method. The five S's

are: sort, straighten, scrub, standardize, and sustain. A Kanban is a visual indicator that

something is out of stock or will be soon. A Kanban may simply be an empty shelf.

10
Visual indicators ensure that everything is available when and where it is needed. These

may be signage, alarms, or self-locking needle boxes. Standard work involves

standardization of processes. Through documentation and training it can be ensured that

processes are performed in the same manner every time, by every person (Womack &

Jones 1996). One popular method for implementing changes using Lean principals is

through the use of Rapid Process Improvement Workshops.

Lean Rapid Process Improvement Workshops

The implementation of Lean, in most cases, involves the identification of value

streams; areas of importance which can be made more efficient. The change needed in

these areas is usually effected through a series of coordinated Rapid Process

Improvement workshops (RPIs; Buggy & Nelson, 2008). RPIs are three to five day

events in which participants are pulled away from their normal daily duties to focus on

the change at hand. Participants are selected from the pool of line staff (i.e., those that

actually do the work on a daily basis). Prior to the event, management meets with Lean

leaders to plan the event. Among other issues, such as logistics of the event, the leaders

and management define the general direction and desired outcomes for the event; the

scope and charter are established. Within this scope and charter, the line workers will

develop solutions and make decisions on how to best implement the change using Lean

methods.

RPI workshops begin with training on Lean concepts (Arbuckle, 2009). The

participants learn about the theories of Lean such as Kaizen (continuous improvement),

elimination of Muda (waste), the types of Muda, work standardization, and the 5S

11
process. Following training, workshop leaders walk the participants through developing

a process map for the current state of the workflow. Using this map, they identify

checkpoints, queues and other wasteful steps. The end goal is to remove all (or as many

as possible) non-value added steps. Value added steps are those which add value from

the perspective of patients. Once as much waste as possible has been eliminated, a

future state map is developed. A list of small projects which are needed in order to

achieve this new state is drafted. Over the next several days, the RPI participants work to

complete these projects. They are given unprecedented access to resources (e.g., plant

operations, information technology, administration) to accomplish these projects quickly.

While some projects remain to be completed following the workshop, the goal is to

complete all work prior to the close of the fifth day.

Research has been done on the application of Lean techniques to the healthcare

environment. Most of this literature focuses on execution (how to implement Lean), its

effects on quality, or its effects on cost control. For example, Campbell (2009) outlined

the five major tenets of Lean and correlated each one to an aspect of health care. He

focused on the Lean concept of reducing waste and provided health care related examples

(e.g., redundant questions and forms which patients are required to complete as

information waste; hospital acquired infections as physical waste). A recent study

detailed the efficiencies gained at Seattle Children's Hospital using Lean methods

(Waldhausen, Avansino, Libby & Sawin, 2010). The researchers collected baseline data

including patient volume, throughput, time with provider, and patient satisfaction scores.

12
Data were collected at 30 days, 60 days and one year. Their results showed increases in

efficiencies of 20% - 60%) sustained at one year.

Link between Employee Engagement and Change

Impacts of Change on Employee Engagement

As Borkowski (2005) and Robins (1990) both noted, employee engagement is key

to an organization's success. On the other hand, employee engagement might be

influenced by organizational changes negatively as well as positively. Grunberg, Moore,

Greenberg and Sikora (2008) conducted a longitudinal study at a large designer and

manufacturer of technology products and observed both ends of this spectrum. The study

began with a sample of 3,700 randomly selected employees, which yielded an initial

sample of 2,279. At the end of the 10-year period, the sample had diminished to 525.

The research consisted of four surveys conducted approximately 3 years apart. Over the

course of 10 years, changes within the company were observed via employees' survey

scores. At Times 2 and 3, survey scores were lower than that at Time 1. The researchers

noted this observation as of "anxiety and uncertainty" (Grunberg et al., 2008, p. 229). At

Time 4, a significant increase in survey scores was observed; this increase was correlated

with the installation of a new management style. Qualitative responses collected

supported this finding. One worker mentioned, "I feel more responsible and respected.

[I'm] allowed to make my own decisions" (Grunberg et al., 2008, p. 229).

Another study also found a significant correlation between change and employee

engagement. Bennet and Durkin (2000) conducted a case study at a large financial

institution which had been undergoing a lot of changes. Their study consisted of both

13
 quantitative and qualitative data. A 12 item scale measuring three dimensions of

employee commitment was administered to a sample of 200 employees; the final sample

size was 70. Based on the results, the researchers concluded that change does have a

significant detrimental effect on commitment to the organization (Bennet & Durkin,

2000). Given that change is inevitable, and equally necessary for organizational survival

as employee engagement, can a change technique directly increase employee

engagement?

How to Increase Employee Engagement

The literature on employee engagement notes various methods for increasing the

levels of engagement (Fox, 2010; Seymour & Dupre, 2008; Wiley, 2010). One of which

is increasing employees' self-motivation. This occurs when the employees feel close to

the work, when they 'own' the processes (Atchison, 2010). Experimental psychologist

Edward Deci performed an experiment in 1971 which illustrates this concept. Dubbed

the "Soma cube experiment," the study consisted of two groups of subjects. Each group

was given the same task of completing a puzzle. One group was told they would be

financially rewarded based on their progress. After a while, Deci returned to the groups

and told them they would have only ten more minutes to complete the puzzles. The

group who was informed of financial compensation (an extrinsic motivation) stopped

working the puzzles. On the other hand, the group not aware of any compensation

feverishly continued working (Deci, 1971). Deci coined this phenomenon as an Intrinsic

Motivation or self-motivation.

14
 Another key factor is recognition. Most employees report that simply receiving

recognition for a job well done is the number one satisfier (Bradley, 2010). In addition to

recognition, employees like getting attention from leaders (Dewhurst, Guthridge & Mohr,

2010). Performing a challenging task is another satisfier. Most people want to be

challenged because when they complete that challenge, the reward is even more

heightened (Fernandez, 2007). Employees need to feel that their contributions to the

organization are important; they need to see that their job directly impacts the

organization's performance (Bradley, 2010; Lavigna, 2010). Therefore, employee tasks

should be linked to the organization's goals.

Considering the Lean principles as described above, and given the literature on

the implementation of Lean RPI and its impacts in the healthcare industry, it is assumed

that successfully executing a Lean RPI would also promote employee engagement via

increasing the aforementioned motivators and satisfiers. Little research has been done to

directly test this assumption, hence the potential contribution of the present study.

The Present Study

Scope

In order to illustrate the effects of Lean RPIs on employee engagement, this study

involved primary data collection before and after an RPI workshop. Participants were

directly involved in the RPI workshop. The dependent variable was the level of

employee engagement and the independent variables (including two moderators) were the

participation in the RPI (before and after), participants' age and seniority (number of

years with the organization).

15
Hypotheses

A review of the literature shows that employee engagement might be impacted by

change within an organization. Grunberg et al. (2008) found both an increase and a

decrease in levels of engagement. The increased engagement was correlated to the

implementation of Lean thinking in management. Atchison (2010), Kahn (1990), Harter,

Schmidt and Hayes (2002), and Buckingham and Coffman (1999) agreed that employee

engagement increases when the employees' sense of ownership or connection to the

company increases. Therefore, the researcher hypothesized as follows:

Hypothesis 1. Lean Rapid Process Improvement workshops will increase

employee engagement. Specifically, the Lean RPI attendees will report a higher level of

engagement after the RPI workshop than before the workshop.

Hypothesis 2. Age will act as a moderator in the relationship between

participation in a workshop and increased employee engagement. Specifically, younger

employees will show larger increases in engagement scores following a workshop as

compared to older employees.

Hypothesis 3. Seniority will act as a moderator in the relationship between

participation in a workshop and increased employee engagement. Employees with less

seniority will show greater engagement improvement as compared to employees with

more seniority.

16
 CHAPTER 2

METHOD

Participants

This study was conducted at a not-for-profit healthcare facility in Southern

California. The participants were all employees of the organization and included nurses,

dieticians, perfusionists, patient care assistants, and other support staff. Fifteen

participants (iV= 15) from two different RPI workshops were asked to participate in the

study. All participants completed the pre-workshop survey. Only twelve participants

completed the post-workshop survey. All those who participated in the RPI workshop

were also invited to participate in a follow up interview. No incentive was offered to

participants. Seven participants agreed to be interviewed. Additionally, three members

of the management team were interviewed.

Procedure

The present study was conducted using a mixed methods approach: both

qualitative as well as quantitative data were collected. Quantitative data were collected

using a web-based survey tool (www.surveymonkey.com). Each survey took participants

no longer than two minutes to complete. Questions included demographic data as well as

Likert-type scaled responses (see the next section for details). Participants were asked to

respond to two surveys, one before the rapid process improvement workshop began, and

17
a second one after the workshop concluded. Participants were debriefed after responding

to the first workshop survey.

Because of the nature of these workshops, the sample size of the RPI groups was

small. One workshop consisted of 10 employees and the other had five. Therefore,

additional qualitative data were collected to enhance the richness and validity of the

results. The qualitative data were collected in seven interviews. These interviews were

conducted after the workshop on hospital grounds and averaged twenty minutes in length.

Rather than simple quantifiable answers, the semi-structured interview allowed for

participants to offer subjective responses to the questions. Additionally, the answers

were not as structured and confined as the multiple-choice survey questions. Participants

were allowed to elaborate on their responses and the researcher was able to ask more

detailed, probing questions as appropriate.

The interviews began with an explanation of the procedures of the study and

participants were provided with the informed consent form approved by the California

State University Long Beach Institutional Review Board (see Appendix C). The

researcher took notes of the interviews. With permission from the participants, an audio

recording was obtained during the interview for checking the accuracy of the researcher's

notes.

18
 Measures

Quantitative Survey

In addition to the demographic questions, the quantitative survey consisted of five

core questions. See Appendices D and E for the complete survey. The survey was

administered twice: before and after the RPI workshop.

Employee engagement. The five core questions were adapted from the Gallup

Organization's Q12 employee engagement survey (2010). These items prompted for 5-

point Likert-type scale responses (1 = strongly disagree, 2 = disagree, 3 = neither agree

nor disagree, 4 = agree, and 5 = strongly agree). These questions are as follows: (1) at

work, my opinion seems to matter; (2) I am aware and understand my organization's

goals; (3) my job contributes to my organization's goals; (4) the mission or purpose of my

organization makes me feel my job is important; and (5) within the last year, I have had

opportunities at work to learn and grow. To test the reliability of the data, Cronbach's

alphas were obtained. The Cronbach's alpha for the pre-workshop data was acceptable

(a = 0.624). Post-workshop data was adequate (a = 0.748). These results indicate that

the items within the survey were internally consistent.

Demographic questions. These included age, gender, and length of employment.

The responses to the age and length of employment questions were collected as

continuous variables. Gender was a discrete, categorical value.

19
Qualitative Interview

Demographic survey. The participant was first asked to complete a short

demographic survey. This survey included: age, gender, and length of employment. To

maintain anonymity, each participant was assigned a pseudo name to be used in place of

their real name.

RPI impact questions. Following the demographic survey, the participants were

asked the following questions:

1. Do you feel the workshop was a valuable use of your time? Why or why not?

2. How confident are you that the changes made in the workshop will remain in

effect? Could you give an example about any noticeable changes in the work process or

work environment that make you believe this?

3. Do you think that improved productivity should be seen as a result of the

changes made during this workshop?

4. Some people have mentioned that they have a sense of ownership to the newly

created workflow/process? Is that something you experience? Do you personally feel

connected to this process? How or why?

5. Do you feel that you have the tools needed to do your job effectively and

efficiently as the result of workshop? Can you give an example?

6. Would you participate in another workshop? Why or why not?

7. What was the most effective aspect of the workshop?

20
 The qualitative data aimed at providing evidence of high levels of employee

engagement amongst participants of rapid process improvement workshops. This will be

illustrated mainly by:

1. Whether participants feel like they have accomplished a task that will improve

the organization's success.

2. Whether participants believe in and are committed to the newly created

process(es).

Materials

The researcher obtained permission from each of the respondents to use their

responses in this study through the use of an informed consent (Appendix C). Approval

was also granted by the organization (Appendix A). All participants were given a copy

of the debriefing form (Appendix G).

21
 CHAPTER 3

RESULTS

Descriptive Statistics

Demographic data collected includes age, gender, and length of employment. The

respondents were 13% (2) male and 87% (13) female. The ages of the respondents

ranged from 24 years to 57 years, yielding a median age of 47 years, a mean age of 44

years (SD= 11), and a mode of 54 years. The respondent with the greatest seniority had

33 years with the organization while the person with the least seniority had been with the

organization for two years. Measuring for central tendency, length of employment

showed a median of 16 years, a mean of 15 years (SD=10), and a mode of two years.

The RPI trainees who participated in the follow-up interviews shared similar

characteristics with the RPI full sample. Eight of the original participants opted out of

the follow-up interview, yielding a sample size of seven; one (14%>) male and six (86%)

female. Mean age of this subsample was 44 (SD=\2). Mean seniority was 15 years

(£D=11).

Managers responsible for the areas affected by the workshops where also

interviewed. Two were mid-level managers and one was a service line executive

director. Two were female and one male. Their mean age was 45.

22
 Hypothesis Testing

Effects of Rapid Process Improvement workshops on employee engagement

Hypothesis 1, stating that workshops would increase employee engagement for

attendees, was tested by conducting a repeated measures Analysis of Variance

(ANOVA). Employee engagement scores were compared before and after participation

in a workshop. This analysis was performed for each survey item individually, as well as

for the scale mean (average engagement).

None of the analyses were statistically significant (Table 1). Compared with the

pre-workshop responses, the mean engagement measured post-workshop slightly

increased for these statements: Item 2 "I am aware and understand my organization's

goals," Item 3 "My job contributes to my organization's goals," Item 4 "The mission or

purpose of my organization makes me feel my job is important," Item 5 "Within the last

year, I have had opportunities at work to learn and grow." (So did the overall post-

workshop mean engagement.) Only Item 1: "At work, my opinion seems to matter"

showed a decrease from pre- to post-workshop. Given that no findings reached

significance, the researcher failed to reject the null hypothesis. There was no difference

in the level of employee engagement before or after they participated in the workshop.

Therefore, Hypothesis 1 was not supported.

23
 TABLE 1. Pre and Post Workshop Engagement Scores.

M(SD) MS
Variable Pre-Workshop Post-Workshop F(df)

1. At work, my opinion seems to matter 3.83 (.58) 3.50 (.90) 1.7(1,11) .394 .22

2.1 am aware and understand my

4.08 (.67) 4.17 (.58) .13(1,11) .314 .72
organization's goals

3. My job contributes to my organization's

3.92 (.67) 4.08 (.52) .48(1,11) .348 .50
goals
4. The mission or purpose of my
organization makes me feel my job is 3.83 (.72) 3.92 (.79) .31(1,11) .133 .59
important
5. Within the last year, 1 have had
4^ 4.00(1.21) 4.08 (.67) .07(1,11) .587 .80
opportunities at work to learn and grow

Mean Engagement 3.93 (.52) 3.95 (.50) .02(1,11) .096 .90

 Hypothesis 2 stated that age would act as a moderator on the effect of workshop

participation on employee engagement. A repeated measures Analysis of Variance

(ANOVA) was conducted to test the effect of age on the amount of change in employee

engagement following participation in an RPI workshop (Table 2). This analysis was

performed using data from each survey item individually as well as the mean

engagement. The researcher classified participants into an older group (48-57) and a

younger group (24-47) using the median split (median age = 47). When testing the

effects of age as a moderator, none of the results were significant.

However, both age groups showed a minor decrease in engagement score for Item

1 "At work, my opinion seems to matter," although older employees showed a greater

change (M= 0.42) than their younger counterparts (M= 0.20). When asked "Within the

last year, I have had opportunities at work to grow" (Item 5), younger employees had a

decrease in score by 0.40. Meanwhile, the older employees showed no change. For Item

2 " I am aware and understand my organization's goals," Item 3 "My job contributes to

my organization's goals," and Item 4 "The mission or purpose of my organization makes

me feel my job is important," there were increases in scores for the younger group, while

the older group's scores remained constant. Given that no tests showed significance, the

researcher failed to reject the null hypothesis. There was no significant difference in the

level of employee engagement between age groups before or after they participated in the

workshop. Therefore, Hypothesis 2 was not supported.

25
TABLE 2. Age Moderated Pre and Post Workshop Engagement Scores.

M(SD)
Variable Age Pre-Workshop Post-Workshop F(df) MSE P

1. At work, my opinion 24-47 4.00 (.71) 3.80(1.09)

.18(1,11) .43 .68
seems to matter
48-57 3.71 (.49) 3.29 (.76)

2.1 am aware and understand 24-47 4.00 (.71) 4.20 (.45)

• 17(1,11) .34 .69
my organization's goals 48-57 4.14 (.69) 4.14 (.69)

3. My job contributes to my 24-47 3.80 (.45) 4.20 (.45)

.65(1,11) .36 .44
organization's goals 48-57 4.00 (.82) 4.00 (.58)

4. The mission or purpose of 24-47 3.60 (.89) 3.80(1.09)

my organization makes me •42(1,11) .14 .53
feel my job is important 48-57 4.00 (.58) 4.00 (.58)

5. Within the last year, I 24-47 4.60 (.55) 4.20 (.84)

have had opportunities at 1.79(1,11) .55 .20
work to learn and grow 48-57 3.57(1.40) 4.00 (.58)

24-47 4.00 (.45) 4.04 (.55)

Mean Engagement .02 (1,11) .11 .88
48-57 3.88 (.60) 3.88 (.49)
 Hypothesis 3 stated that seniority would act as a moderator on the effect of

workshop participation on employee engagement. This was tested using a repeated

measures Analysis of Variance (ANOVA) to analyze employee engagement data

collected both before and again after respondents' participation in a Lean RPI workshop

(Table 3). This analysis was performed for each item individually as well as for the mean

engagement. The researcher classified participants into a senior (17-33) and a junior (2-

16) group using the median split (median seniority = 16). None of these measures were

significant, therefore the null hypothesis cannot be rejected.

Closer analysis of the means, their deltas and comparison between groups

supports this conclusion. Both groups showed a decrease for Item 1 "At work, my

opinion seems to matter." Item 2 "I am aware and understand my organization's goals,"

and Item 4 "The mission or purpose of my organization makes me feel my job is

important" had small increases in mean item scores (M= 0.20) for the more junior group

and showed no change for the senior group. When asked "My job contributes to my

organization's goals" (Item 3), the more senior group had an increase in mean item score

while the junior group had no change. The greatest difference between the two groups is

seen in Item 5 "Within the last year, I have had opportunities at work to learn and grow."

The items scores of employees with less seniority decreased by 0.40 from pre- to post-

workshop, whereas those with greater seniority increased by 0.43 for a total difference

between groups of 0.83.

27
 The overall means engagement showed that junior employees' mean engagement

decreased (Af = 0.08) and that of senior employees increased (M= 0.08). Given that no

tests showed significance, the researcher failed to reject the null hypothesis. There was

no significant difference in the level of employee engagement between seniority groups

before or after they participated in the workshop. Therefore, Hypothesis 3 was not

supported.

28
TABLE 3. Seniority Moderated Pre and Post Workshop Engagement Scores.

M(SD)
Variable Seniority Pre-Workshop Post-Workshop F(dfi MSE P

1. At work, my opinion 2-16 4.20 (.45) 3.80(1.09)

.04(1,11) .43 .84
seems to matter 17-33 3.29 (.76)
3.57 (.53)

2.1 am aware and understand 2-16 4.00 (.71) 4.20 (.45)

.17(1,11) .34 .69
my organization's goals 17-33 4.14 (.69) 4.14 (.69)

3. My job contributes to my 2-16 4.00 (.71) 4.00 (.71)

.32(1,11) .37 .58
organization's goals 17-33 3.86 (.69) 4.14 (.38)

4. The mission or purpose of 2-16 3.60 (.89) 3.80(1.09)

my organization makes me .42(1,11) .14 .53
feel my job is important 17-33 4.00 (.58) 4.00 (.58)

5. Within the last year, 1 2-16 4.80 (.45) 4.40 (.55)

have had opportunities at 1.83(1,11) .55 .20
work to learn and grow 17-33 3.43(1.27) 3.86 (.69)

2-16 4.12 (.46) 4.04 (.55)

Mean Engagement .39(1,11) .10 .54
17-33 3.80 (.55) 3.88 (.49)
 Interview Findings

Valuable Use of Time

When asked about the value of the workshop, two interviewees (29%) answered

indifferently, "Partially," and "I am not sure." The other five (71%) respondents agreed

that it was a valuable use of their time. Most attributed this value to the rapid

implementation and results of the change:

"It allowed a critical review for current processes and valuable input on how to
improve those processes."

"I'm not sure our goals could have been accomplished without it being a Lean
workshop."

"There was a huge need to reorganize and reduce the inventory"

One (14%) participant found so much value in the new methodologies that she

has found use for them outside of the work environment:

"I learned about how lean works. Some of the things I learned from the workshop
I could apply in everyday life."

Confidence about Long-term Effect of Changes

When asked if they thought the changes made would remain in effect, most

interviewees (9; 85%) felt strongly that they would. The following are some of the

participants' comments regarding their colleagues' responses when their returned to their

units with the new changes:

"Staff was acceptable of changes made and agreed that changes were needed."

"People asked questions and accepted the answers. They did not complain or
suggest other locations."

"I do believe that the changes will continue to work. So far we have not run out of
formula and if we needed a certain type that was low already, then she [central

30
 supply technician] came right away. She has been a wonderful resource for us. If
we continue to adjust the pars to perfect it then I believe that it will continue to be
a great change."

Ownership

According to The Gallup Organization (2010), employees who feel connected to

their work are more likely to be actively engaged. Workshop participants were asked if

they felt a sense of ownership or personally connected to the new process. Two (28 %)

of the seven respondents said they did not feel that sense of ownership. The other 73%

(5) did feel connected and took ownership of the change. They were committed to the

success of the project and its ongoing maintenance:

"I feel responsible for maintaining the project and for the success of the project.
The project continues even though the meetings have ceased. It isn't really
finished. There needs to be an evaluation and adjustments. The project continues."

"I did when it came to my units work flow. At first they were not so open to
resolve some of my issues however after seeing the resistance or unique situations
on my unit they did listen and I felt that I made a difference on my unit
specifically."

Another noted that, "failure is not an option." When looking at seniority as a

moderator, two (66 %) of the three respondents in the more senior group did not feel any

increase in their sense of ownership of the processes following the workshop. In the

more junior group, all respondents noted an increase in their sense of ownership. The

negative responses were split between the two age groups.

31
Tools Needed to Do the Job

Another item on the Gallup Q12 Employee Engagement survey (2010) is a

prompt about having the necessary tools to do your job effectively. During the

interviews, participants were asked about the tools which they were provided. One

person remarked that they already had access to the tools they needed prior to the

workshop. Everyone else cited examples about the advantage of having the tools easily

accessible at the workshop:

"The opportunity to have the tools to organize at our fingertips and the
availability of the facilities engineer reduced the frustration. We all want and
need to organize however when you don't have the supplies needed it becomes a
waste of time and frustrating."

"Yes. Communication styles matter when working with others to problem solve."

"Pretty much. Working on getting more tools, just takes a long time when other
departments involved are slow to respond."

"Everything we need is readily available and in a central location on each hall."

Improved Patient Safety

In a hospital, regardless of position, everyone's main priority is patient safety.

Staff members take pride and strive to provide that safe care on a daily basis. Being able

to take pride in your work feeds that level of engagement. The participants had this to

say about increases in patient safety as a direct result of the workshop:

"This project improved patient safety for us because it limited the amount of
possible expired formula and possibility of giving the wrong calorie formula due
to too many available calorie counts for the same formula."

"Patient safety improved by removing certain ready to feed formulas with short
shelf life stocked in 17 locations. Now it is ordered for specific patient reducing
the likelihood of having expired formula on a shelf."

32
 "Orders will be cleaned up and MDs will be trained on how to correctly order
formulas. This will definitely improve patient safety as before the workshop
orders were incorrectly ordered."

"Sterility and integrity of the products on the shelf will be maintained. No out
dated or compromised products will be used on patients."

"More time can be spent with the patient instead of looking for supplies."

Management's Observations

Additionally, the management teams were asked to judge employee engagement

prior to and following completion the workshops in their departments. According to their

responses, one of the workshops was staffed with employees who seemed to be more

engaged. The manager stated that they were "above average, engaged." The other

workshop was comprised of mostly disengaged employees. They were the "most

resistant employees." A member of the management team commented:

"Engagement has been a real challenge. The program was really small, and now
the program has exploded. Many of my staff have become resistant to all this
change."

When asked why they had selected different workers for the two workshops,

some leaders revealed that one group of participants had been selected for the purpose of

effecting a change in the processes, which is expected. The end goal was to improve

functionality and efficiency. The other management team, while desiring to improve

processes, had another ulterior motive: They intentionally chose some staff to attend the

workshop to improve the employees' engagement level. Therefore, they specifically

selected staff from their unit who they perceived as having lower levels of engagement.

Regarding the response from their team when they first informed their staff of the

upcoming workshop, the managers noted, "They were a little resistant and hesitant at

33
first. They didn't believe in the program." According the managers, several of the

employees did not believe the workshop would actually materialize. They mostly

complained about getting behind in their work while being out of the office for the

workshop.

Perceived value was a topic of the management interviews as well. One of the

leaders mentioned that since the workshop, several of his staff members have

implemented small changes in the department using Lean methodologies. Two of the

leaders reported that more than one of their employees had shared stories of how they

have done "Lean" projects at their homes since the workshop.

"One of my employees told me he 'Leaned' his garage. They are working with
their own idea. They are much happier with the workflow; things are much more
efficient."

One of the main tenets of Lean is to reduce or eliminate waste. Two of the leaders

identified the elimination of waste from their department's processes. They are spending

less on supplies; par levels are down, and stock on hand has been reduced. Additionally,

the supply ordering process has been streamlined:

"We changed the process for ordering. It takes less time for fewer people to do
the ordering. We have an organized manner. Before incoming orders were
dumped in the hallway, now things are organized so people are less likely to
ignore the incoming orders and walk away."

Age and Seniority as Moderators

Qualitative data collected from the personal interviews tended to support a

positive change in engagement. Following the workshop, one leader remarked "I have

different people working for me now. It gave them real ownership." When asked to

consider the effects of age and seniority on the change in levels of engagement among

34
their staff, the management teams did not identify any differences. One felt that all of her

employees were engaged following the workshop, although she did mention that those

with less seniority had been more resistant to the initial idea of attending the workshop.

Additionally, all of her employees that participated the RPI were approximately the same

age. The other manager also did not notice any change she could attribute to age or

seniority. She reiterated that she felt all her employees that participated were already

fairly well engaged. As the majority of responses were positive and management's

observations were general, it was not possible to evaluate the effects of age and seniority

as moderators.

35
 CHAPTER 4

DISCUSSION

Summary of Results

The purpose of this study was to evaluate the impact of participation in a Lean

Rapid Process Improvement workshop on employee engagement. Additionally, the age

and seniority of employees were expected to moderate the effect of the RPI workshop on

the change in levels of engagement. Participants responded to a series of five items

before the workshops began and again at the conclusion of the workshop. Some

participants also agreed to be interviewed.

Although none of the statistical findings were statistically significant, the results

did show some interesting trends. Younger employees improved their engagement level,

but older ones were not affected. Employees with greater seniority also improved their

engagement level, whereas employees with less seniority were not affected. In general,

the effects of the workshop seemed to have the least effect on older employees. With the

exception of Item 1: "At work, my opinion seems to matter," and Item 5: "Within the last

year, I have had opportunities at work to learn and grow," all results yielded no change

neither did the overall mean engagement. These results did not support the researcher's

hypothesis regarding the effect of RPI in improving participants' engagement level.

However, these results were consistent with those in the aforementioned study by

Grunberg et al. (2008), who found that initially, participants in their sample did not

36
display any improvement in engagement, some even experiencing a decrease. One

possible explanation is that the majority of participants had been selected for their higher

level of engagement; therefore, the RPI workshop itself did not change their original

point of view. A statistical explanation is that the sample size was small, not allowing the

researcher to detect significant results, even though some means item did change from

pre-workshop to post-workshop.

The interview data showed a different pattern of results: the majority of those who

agreed to be interviewed regarded the RPI workshop favorably, mentioning meaningful

changes in their work and/or their life as the result of their RPI participation. In other

words, the qualitative information provided empirical support to the researcher's

hypotheses. Additionally, qualitative data collected from the management team who had

selected the RPI participants show a convergence of evidence: based on their own

observations, the leaders testified that those who attended the RPI workshops had shown

a great deal of engagement and ownership in the process at their workplace.

Limitations of the Study and Recommendation for Future Research

This study had a few limitations. First, the sample size was small (N = 12). This

limitation lies in the inherent nature of RPI workshops, which are typically run with a

small number of participants in any workshop (e.g. less than fifteen). Additionally, there

were only two workshops scheduled during the data collection period. The implications

are that the researcher might not have sufficient statistical power to test the hypotheses in

the present study. However, the researcher intentionally used a pretest, posttest design to

increase the number of data points to the best of his ability. In the future, a larger sample

size would allow for a more accurate representation of population, or if longitudinal data

37
are to be collected, a robust data set could be obtained. Replication of the study to other

organizations would also allow a larger sample and increased external validity.

Another limitation is the absence of a control group. The study sought to measure

a change in employee engagement as a direct result of participation in a workshop. The

change initiated by the workshop itself may have influenced engagement levels of other

employees in the organization, not just those who participated. The inclusion of a control

group (i.e., a group of employees who did not participate directly in the workshop but

who might be impacted by the change), may serve to answer this question.

Future research should also focus on employees with lower levels of engagement

who attend RP's because the target effect of RPI's may become more apparent. Highly

engaged (actively engaged) employees have less room to increase their engagement,

whereas employees with lower engagement levels (not engaged or disengaged) may be

more susceptible to the influence of the workshop.

Conclusion

The study sought to draw a link between participation in Lean Rapid Process

Improvement workshops and an increase in employee engagement. Although the

quantitative data did not produce significant findings to support this hypothesis, the

qualitative data collected from interviewing both the RPI participants and their managers

provided evidence consistent with the theory.

38
APPENDICES

39
 APPENDIX A

ORGANIZATION CONSENT
January 11,2010

California State University Long Beach

Institutional Review Board
1250 Bellflower Blvd.
Long Beach, CA 90840

Dear Institutional Review Board,

Jared Van Baker has been granted permission by [organization name omitted] to conduct
research on Lean Rapid Process Improvement (RPI) workshops and employee
engagement for the purposes of collecting data for his Masters thesis; "The Effects of
Change Management on Employee Engagement: Using Lean Principals to Increase
Engagement." Jared Baker is an employee of [organization name omitted] and will be
directly participating in an RPI to observe and experience the process, [organization
name omitted] is further aware that Mr. Baker will be conducting surveys before and
after this RPI. Additionally, he will personally interview participants of the RPI
following the event.

Sincerely,

[signature omitted]

41
 APPENDIX B

CSULB IRB CONSENT

 CALIFORNIA STATE UNIVERSITY LONG BEACH
OrFICE Of UN1VLRSI1Y RESEARCH

April 25 2011

Mr Jaied Baker

Re The Effects ot Change Management on Employee Lngagement Using Lean Principals to

Increase Engagement" PHS 11-213s

Dear Mr Baker

This is to advise you that the Institutional Review Board for the Protection of Human Subjects (IRB) ot
California State University Long Beach has reviewed your protocol application

Your application is approved The requested revisions have been received reviewed, and accepted

Approval is foi a period of one year from the date of this letter and conditional upon your willingness to
carry out your continuing responsibilities under University policy If you would like to continue this
leseareh after this one year period, please submit a renewal application and an annual report to the Office of
Univeisitv Research two months prior to your expiration date of April 24, 2012

1 You must clearly indicate in the header or footer of each page of your approved Informed Consent
form the approval and expiration dates of the protocol as follows 'Approved from April 25,
2011 to April 24, 2012 by the CSULB IRB".
2 You are required to inform the Director or Senior Associate Director Office of University
Research, in writing (email is acceptable) within twenty-four hours of any advcise event in the
conduct of research involving human subjects The report shall include the nature of the adverse
event, the names of the persons affected, the extent of the injury or breach of security, if any, and
any other information material to the situation
3 You may not change your research procedure involving human subjects without written
[ ermission from the Director Office of University Research or the Chair of the IRB Please use
tie Protocol Modification Form to request any changes
4 Maintain your research records as detailed in the protocol

Should you have any questions about the conduct of your research under this protocol particularly about
providing informed consent and unexpected contingencies, please do not hesitate to call the Office of
Universitx Research at (562) 985 5314 We wish you the best of success in your research

Suieerely

PM/|h
e Hannah Hanh Nguyen Psychology

12S0 BEllflOWbk BOUlrVARD lONO M AC H CM IFORNIA 908 10 S62/98S 5314 JAX 562/985 866S

43
 APPENDIX C

CONSENT TO PARTICIPATE
 CONSENT TO PARTICIPATE IN RESEARCH STUDY

The Effects of Lean Workshops

You are being asked to participate in a research study to be conducted by Jared V. Baker,
a Master's candidate from the department of Healthcare Administration at California
State University, Long Beach. The results of this study will be incorporated in my
Master's thesis. You were recruited to participate in this study because you have been
identified as a participant in an upcoming Lean Rapid Process Improvement workshop.

PURPOSE
The purpose of this study is to observe the effects of change management (i.e., Lean tools
such as Rapid Process Improvement workshops).

PROCEDURES
Should you choose to participate in this study, I will ask you to complete two short
surveys. Each survey should take less than 2 minutes to complete. One will be
administered at the start of the workshop on paper form, and the second will be after the
workshop concludes and will be online. Additionally, I would like to ask you to
participate in a follow up interview. The interview may last about an hour and will cover
your in-depth experiences with the Lean Rapid Process Involvement Workshop. If you
agree to participate in this interview and with your consent, the interview will be audio
recorded for transcription purpose only. If you prefer not to be recorded, I can take
detailed hand written notes of the interview. Upon request, the transcription will be made
available for you to edit or delete. In order to maintain privacy of all study participants,
the audio recording will not be available for editing or review, as the recording may
contain multiple participants.

45
POTENTIAL RISKS AND DISCOMFORTS
There should be minimal risks involved. Some potential risks involved with this study
include (a) feeling discomfort in answering some questions, and (b) the possibility of
participants' confidentiality being compromised. However, in terms of any discomfort,
you have the right to refuse to answer any questions you don't want to answer or that
make you feel uncomfortable and still remain in the study. To protect your
confidentiality, I will use a pseudonym for you when I record any data that I collect from
you during the surveys and/or interview, so that no information that you provide can be
traced back to you by others. This pseudonym will be random identifier generated by a
computer program. Nobody else in the organization except me will have access to my
data, and your responses will not be made available to your employer. The results for my
thesis will be reported and/or published using aggregated data and the pseudonyms of
participants only.

POTENTIAL BENEFITS
There are no direct benefits to you from participating in this study. Participants will not
receive payment or other form of compensation. You will receive a brief on the results of
this study when it is concluded.

CONFIDENTIALITY
All audio recordings used for this study will be destroyed after the conversation has been
transcribed. I will keep this signed consent form separately from all interview data and
interview data will be de-identified by use of a pseudonym. All consent forms,
transcripts and hand written notes will be kept for three years after the study is
completed; they will then be destroyed. Any information that is obtained in connection
with this study and that can be identified with you will remain confidential and will be
disclosed only with your permission or as required by law.

PARTICIPATION AND WITHDRAWAL

Your participation in this study is purely voluntary. Should you change your mind, you
may withdraw at any time without consequence. Participation or non-participation will
have no bearing on your employment; it will not affect your treatment or any other
consideration or right. You may also refuse to answer any questions you don't want to
answer and still remain in the study. The investigator may withdraw you from this
research if circumstances arise, which in the opinion of the researcher, warrant doing so.
If you volunteer to participate in my study, please note in which sections you wish to
participate, sign this informed consent form, and return it to me.

46
IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please feel free to contact me at
[contact information omitted]. You can also call my thesis advisor, [contact information
omitted].

RIGHTS OF RESEARCH SUBJECTS

You may withdraw your consent at any time and discontinue participation without
penalty. You are not waiving any legal claims, rights or remedies because of your
participation in this research study. If you have questions regarding your rights as a
research subject, contact the Office of University Research, CSU Long Beach, [contact
information omitted].

SIGNATURE OF RESEARCH SUBJECT

I understand the procedures and conditions of my participation described above. My
questions have been answered to my satisfaction, and I agree to participate in this study. I
have been given a copy of this form.

I agree to participate in the following:

• Pre-workshop survey

• Post-workshop survey

• Interview

Name of
Subject:_

Signature of
Subject:

Date:

I agree to the interview being audio recorded.

Signature

47
 APPENDIX D

PRE WORKSHOP SURVEY

 PRE WORKSHOP SURVEY

The Effects of Change Management on Employee Engagement: Using Lean Principals to

Increase Engagement

Thank you for taking the time to complete this survey. The results will be used to
support my Masters Thesis on Lean processes and employee engagement. This
survey should take less than 2 minutes to complete. The results of this survey will be
completely de-identified. Answers will only be associated with a random anonymous
identifier. Your name will not be linked to these answers in any manner.

1. Anonymous identifier (used to link pre and post surveys without revealing
respondent's identity)

2. What is your age?

3. What is your gender?

4. How long have you worked for this organization?

5. At work, my opinion seems to matter.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

6. I understand my organizations goals.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

7. My job contributes to my organization's goals.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

49
8. The mission or purpose of my organization makes me feel my job is important.
a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

9. Within the last year, I have had opportunities at work to learn and grow.
a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

50
 APPENDIX E

POST WORKSHOP SURVEY

 POST WORKSHOP SURVEY

The Effects of Change Management on Employee Engagement: Using Lean Principals to

Increase Engagement

Thank you for taking the time to complete this survey. The results will be used to
support my Masters Thesis on Lean processes and employee engagement. This
survey should only take about 3 minutes to complete. While the results of this survey
will be shared with this organization, they are completely de-identified. Answers will
only be associated with a random anonymous identifier. Your name will not be
linked to these answers in any manner.

1. Anonymous identifier (used to link pre and post surveys without revealing
respondent's identity)

2. What is your age?

3. What is your gender?

4. Since the workshop, my opinion seems to matter at work.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

5. I understand my organizations goals.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

6. The workshop made me feel that My job contributes to my organization's goals.

a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

52
7. The mission or purpose of my organization makes me feel my job is important.
a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

8. Within the last year, I have had opportunities at work to learn and grow.
a. Strongly agree
b. Agree
c. Neither agree nor disagree
d. Disagree
e. Strongly disagree

53
 APPENDIX F

INTERVIEW PROTOCOL
 QUALITATIVE INTERVIEW PROTOCOL

The Effects of Change Management on Employee Engagement: Using Lean Principals to

Increase Engagement

Materials: audio recording device, demographic survey, informed consent form.

Researcher thanks interviewee for participation and give him/her an informed consent
document to read and sign.

"Thank you for participating in this study. This consent form is for you to review so
that you may understand the purpose and focus of my study. If you agree to continue
please sign this form."

Researcher explains the confidentiality of the interview

"I would like to record this interview for accuracy. I will be transcribing this
recording and when I do so, I will destroy this audio copy. To protect your
anonymity, I will not refer to you by your legal name. Instead identification will be
done using a random identifier, yours is . If you agree to the recording of
this interview, please sign the section on the consent form where is says, 'I agree to
the interview being audio recorded.'"

Researcher hands interviewee a demographic survey and asked him/her to complete.

"Before we begin, would you mind filling out this demographic survey. It will allow
me to relate your responses to the demographic data such as age, gender and length of
employment."

Researcher collects the informed consent and the demographic survey and begins the
interview.

1. Do you feel the RPI was a valuable use of your time?

2. How confident are you that the changes made in the RPI will remain in effect?
What about the process or environment makes you believe this?

3. Do you think that improvements in productivity will truly be seen as a result of

the changes made during this RPI?

4. Do you feel that waste has been eliminated from your day?

5. Do you feel that these changes have (or will) improve patient safety? Why or why
not?

55
6. Some people have mentioned that they have a sense of ownership to the newly
created workflow/process? Is that something you experience? Do you personally
feel connected to this process? How or why?

7. Do you feel that you have the support from management to ask questions, make
suggestions, and bring forward problems as they are identified?

8. Do you feel that you have the tools needed to do your job effectively and
efficiently?

9. Would you participate in another workshop? Why or why not?

10. What was the effective aspect of the workshop?

11. What, if anything, could have been done differently?

56
 APPENDIX G

DEBRIEFING FORM
 DEBRIEFING FORM

The Effects of Change Management on Employee Engagement: Using Lean Principals to

Increase Engagement

Thank you for participating in my master's thesis research project.

Purpose of the Study

The purpose of this study is to observe the effects of change management on employee
engagement. I would like to determine if Lean tools, such as Rapid Process Improvement
workshops, can be used to increase employee engagement.

Expected Outcomes

The hypotheses for the present study are as follows:

Hypothesis 1: Lean Rapid Process Improvement (RPI) workshops will increase employee
engagement. Specifically, the Lean RPI attendees will report a higher level of
engagement after the RPI workshop than before the workshop.

Hypothesis 2: Age will act as a moderator in the relationship between participation in a

workshop and increased employee engagement. Specifically, younger employees will
show larger increases in engagement scores following a workshop as compared to older
employees.

Hypothesis 3: Seniority will act as a moderator in the relationship between participation

in a workshop and increased employee engagement. Employees with less seniority will
show greater engagement improvement as compared to employees with more seniority.

Implication

The results of this study will provide insight into the effects of Lean Rapid Process
Improvement workshops on employee engagement. Most research to date shows a
negative correlation between change in the workplace and employee engagement.
Should the study hypotheses, specifically, hypothesis 1, be accepted this thesis will
provide support for using Lean Rapid Process Improvement workshops to not only to
preserve employee engagement during a change, but to increase it as a direct result of the
change effort.

58
Confidentiality

All audio recordings used for this study will be destroyed after the conversation has been
transcribed. Interview data will be de-identified by use of a pseudonym. All consent
forms, transcripts and hand written notes will be kept for three years after the study is
completed, they will then be destroyed. Any information that is obtained in connection
with this study and that can be identified with you will remain confidential and will be
disclosed only with your permission or as required by law. You have the right to access,
review and edit the recorded transcription upon request. If you are interested in the
results of the study, please feel free to contact me at [contact information omitted].

Contact Information

If you have any questions or concerns about the research, please feel free to contact me at
[contact information omitted]. You can also call my thesis advisor, [contact information
omitted]. If you have questions regarding your rights as a research subject, contact the
Office of University Research at [contact information omitted].

Again, thank you for your participation.

Jared Van Baker

[contact information omitted]

59
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60
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