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- Kjellström, Sofia, 1970-, et al.
(författare)
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Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden.
- 2017
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Ingår i: Journal of Health Organization and Management [1477-7266]. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:4, s. 487 -502
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose – The purpose of this paper is to explore work motivation among professionals at well-functioningprimary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach – Five primary healthcare centers in Sweden were purposively selectedfor being well-operated and representing public/private and small/large units. In total, 43 interviews werecompleted with different medical professions and qualitative deductive content analysis was conducted. Findings – Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematicquality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications – Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications – The design of the reforms and leadership are essential preconditions for work motivation. Originality/value – The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.
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| 2. |
- Nyström, Monica E., et al.
(författare)
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Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
- 2018
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Ingår i: BMC Health Serv Res. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention. Methods: The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge-all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. Results: The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. Conclusions: An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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| 3. |
- Nyström, Monica, et al.
(författare)
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Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg : Future wellfare services : New approaches to innovative service development in health and social care (Engelska)
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- En växande andel äldre i befolkningen i kombination med en minskande andel arbetskraft ställer allt tuffare krav på utveckling av vård och omsorg. För att klara dessa utmaningar och utveckla framtidens välfärdtjänster krävs nya innovativa arbetssätt. Vi arbetar nu med ett projekt som handlar om verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet drivs i samarbete med ett tvärvetenskapligt forskarteam från Karolinska institutet, Göteborgs universitet och Luleå tekniska universitet och pågår från november 2009 till och med december 2012. Syftet med projektet är att i regionen Sörmland utveckla och testa arbetssätt som kan stödja innovativ verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet involverar flera organisatoriska nivåer och huvudmän, inklusive landsting och kommuner. Den teoretiska basen bygger på lärdomar från kvalitets-utveckling, organisatoriskt lärande, innovationsforskning och organisatorisk kreativitet. Upplägget ger förutsättningar för lärande och snabb återkoppling över organisatoriska gränser. Resultaten kan bidra till kunskap om hur olika förutsättningar påverkar lärande, kreativitet och innovationsutveckling inom vård och omsorg, vilket i sin tur underlättar beslut kring strategiska satsningar och ökad kvalitet i vården. Projektet förväntas ge ny kunskap kring organisationers lärandeprocess som kan användas även för andra utvecklingssatsningar.
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| 5. |
- Andersson Bäck, Monica, 1969
(författare)
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Callcenter + omvårdnad = sjukvårdsrådgivning – det bästa av två världar?
- 2008
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Ingår i: Telefonrådgivning inom Hälso- och sjukvård/red Inger Holmström. - Lund : Studentlitteratur. - 9789144047768 ; , s. 163-186
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Telefonrådgivning inom hälso- och sjukvård ger en bred översikt över olika aspekter av telefonrådgivnings-verksamhet i Sverige. Innehållet fokuserar på samtal som arbetsverktyg snarare än på medicinska bedömningar och symtom. Några av kapitlen tar upp organisatoriska aspekter medan andra utgår från sjuksköterskans respektive uppringarens perspektiv. Med hjälp av illustrativa exempel visar författarna på såväl samtalets olika faser som etiska dilemman vid specifika samtal i t.ex. en akut situation. Boken vänder sig främst till dem som arbetar med eller vill börja arbeta med hälso- och sjukvårdsrådgivning per telefon samt till studerande i olika vårdutbildningar. Den lämpar sig även för andra yrkesgrupper som arbetar med rådgivning per telefon, t.ex. apotekspersonal, sjukgymnaster, barnmorskor, allmänläkare och kuratorer.
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| 6. |
- Andersson Bäck, Monica, 1969
(författare)
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Conceptions, conflicts and contradictions in the introduction of a Swedish Health Call Centre
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Call centres have been called the industrialisation of the service sector, characterised by mon¬o¬¬tonous, highly controlled work and standardised procedures performed in an old-fashion¬ed, Tayloristic spirit. Stress and work intensification are known implications of such work. Healthcare on the other hand, is based on bureaucracy, but has professional staff. Nurses describe their occupation in terms of caring, cherishing, educating the sick, being de¬dicat¬ed and genuinely concerned for the patient, while assessing and treating individual reactions to health problems. But what happens in a health call centre (HCC)? The call centre is aimed at mass-production, the monitoring of work, performance targets and control. The overall aim of the thesis regards how can this be combined with the nursing profession and the consciousness of taking care of people in vulnerable states of pain and anxiety? The thesis draws on a study of an HCC in western Sweden, covering the period from 2002 to 2006, based on more than 80 semi-structured interviews with key actors, 400 struc¬tur¬ed interviews with care-seekers, repeated observations, written documents and other sources. The results shows how HCC work and work organisation are concieved based on social relations, which are shaped and influenced by institutions and social actors. In a Swedish context, the organisation of HCCs have been introduced on a broad scale since the late 1990s, and it catches the characteristics of the Swedish healthcare system in the horns of a dilemma, i.e. the ambition to simultanously address (1) equality (2) high quality (3) effic¬¬iency and cost control and (4) freedom of choice. Designed to solve healthcare problems HCCs imply new ways to organis¬e work within healthcare, based on new techno¬logy, a kind of Swedish New Public Management practices and rethoric, control mechanisms and new work relations. Yet the HCC strongly emphasises the continuity of Swedish health¬care connected to overall institutional features in political, economic, regulatory and cultural terms. Accordlingly, the case-study also shows a process of tensions, conflicts and resistance. Visualised as operating in a battlefield, the actors expressed strong and divergent concep¬tions towards the HCC. The tensions consider focus on primary care versus resources to secon¬dary care, meeting demands for access and immediate care versus steering healthcare, adapting versus changing demands, the responsible care-seeker versus the exigent healthcare consumer, rationalising human service versus more calls on the phone, control versus coordi¬na¬tion. For the telenurses the contradictions are also to full¬fill both quantity and quality imperatives and to work in line with ethics and socialised convictions, while wanting care-seekers as well as physicians to be satisfied. The HCC confirms both a positive and negative picture of call centres embracing contradictions such as control versus autonomy, participation versus exclusion, professional responsibility versus professional vulnerability, upskilling versus deskilling, younger versus older nursing generations, work intensification versus less physical work, isolation versus freedom and different aspects of emotional labour. The concept of HCC might be interpreted as a movement in the direction of a more liberal, Anglo-Saxion model of economy, but with distinct tendency toward divergency characterised by Swedish industrial relations and work organisation for the healthcare sector and related to the continuous professionalisation project within nursing.
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| 9. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
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Do middle managers have room for manoeuvre in Swedish human service organisations?
- 2015
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Ingår i: 33rd Annual International Labour Process Conference, Athens, Greece 13-15 April 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Middle managers in Swedish human service organisations are responsible for implementing the many goals and visions of government as formulated in policy. Since the 1980’s there is a growing expectation that these goals should be materialized through HRM strategies. In the wake of New Public Management (NPM), HRM has become significant in human service organisations as expressed in proliferation in the numbers and specializations of managers, a development of management rhetoric and particularly investments in managerialism and managers as a way of achieving change. This paper reports on the contradictory positions that arise for middle managers, in human service organizations where HRM is integral part of managerial repertory. The aim is to examine how the role of middle manager is impacted as a result of this increasing organizational complexity and governance. As part of the middle-layer, middle managers must balance the various aspects of their work from a weak power base, and act as a buffer between their staff and their seniors. As a result, inconsistencies between the expectations of the organization and the individual employees they manage create tension, conflict and feelings of powerlessness that may result in increased inefficiency - the opposite of the organizational intention. This research is based on interviews and observations of 30 Swedish middle managers from human service organisations over a period of two years. We use qualitative text analyses to analyse our data. We expect to find that middle managers use different types of strategies to give meaning to the work they do and create room for manoeuvre in everyday practice.
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| 10. |
- Andersson Bäck, Monica, 1969, et al.
(författare)
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Identity work of successful primary care managers and competing institutional logics
- 2017
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Ingår i: EGOS 2017, Copenhagen.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- AbsThis paper rests on bourgeoning research that has awakened a strong interest among organizational scholars, considering self-reflexive identity work linked to the processes of revealing, effectuating, and reflecting change of institutional logic. We combine two strands of theories, the one related to institutional logics perspective with theory of identity work. Based on a qualitative case study and against the background of change in Swedish primary healthcare, we aimed to explore institutionalization processes related to micro-social interactions of five primary care managers, who were handling a multiplicity of institutional logics – competing, co-existing and complementing – while working their identity in relation to significant actors. The findings showed mechanisms of change, and as a result new constellations of logics. The constellations varied however from primary care center to center, and from manager to manager, visualizing individual variation in influencing institutional logics as well as being influenced. The findings demonstrated managers’ identity work as a process in which the managers strive to work managerial ideas, self-perceptions, and experiences, as well as expectations and views held by significant others.
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