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- Andersson, Thomas, 1970-, et al.
(author)
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Easier to trust managers than management? : The case of improvement work in healthcare
- 2011
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Conference paper (peer-reviewed)abstract
- Previously, improvement work in healthcare has mainly been medically related and driven by medical research, but NPM implies that management-initiated improvement work targeting organizing, productivity, efficiency, work flow etc. has become more and more common. Management-initiated improvement work has a high failure rate, and in general it seems difficult to motivate co-workers to actively participate. In all processes of organizational change, trust in the initiator of a change project is an important prerequisite to enable change take place. In this article, our purpose is to investigate how trust in management influences management-initiated improvement work. In a qualitative study we investigate improvement work at three Swedish hospitals. Our theoretical framework is based on a view of management as being both the people who manage and the system of management. This distinction is important since we can trust people and we can have confidence in a system, but these processes are different. Consequently, it is possible to trust individual managers, but as long as we do not trust management as a system, management-initiated improvement work will face considerable problems. To analyze trust we use a model that identifies three important antecedents for one person (the trustor) to consider another person (the trustee) as trustworthy: ability, benevolence and integrity. Using social system theory, we extend this model to on the one hand describe trust in specific persons (specific managers), and on the other hand describe confidence in a system (management in general, which the system-specific managers are parts of). The results indicate that there in general is a lack of trust between healthcare personnel and healthcare management. We were able to find certain managers who were found trustworthy by the personnel, but despite these trust-relations the personnel did still not have confidence in management as a system. To the contrary, these managers were perceived as exceptions, and did not change the perception of management in general. The consequences for management-initiated improvement work were that most personnel at best were ignorant to it, and at worst resisted it openly. However, there were examples when trusted enthusiastic managers succeeded in initiating improvement work, but then the continuation and success was directly connected to this person, and if s/he left, the improvement work stopped. Furthermore, some work groups seemed to very clearly separate “real” improvement work, which they initiated themselves, from “phony” improvement work initiated by management, which only stole time from more important tasks.
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- Andersson, Thomas, 1970-, et al.
(author)
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Institutional Work Through Interaction in Healthcare
- 2017
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In: Academy of Management Proceedings. - : Academy of Management.
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Conference paper (peer-reviewed)abstract
- This study examines how interactions between individual actors can form institutional work in a highly institutionalized setting. Recent progress within the institutional logics perspective has directed focus to the roles of individual actors, their strategic actions, and how institutional logics may be interpreted and rebalanced. However, these contributions are founded on individual actors’ identity processes, but not on how institutional work can be performed through interactions among individual actors adhering to different institutional logics. We performed a qualitative case study, based on observations and interviews, with a focus on quality-improvement work performed in a hospital. The study affirmed that institutional work primarily maintains and upholds the rigidity of healthcare organizations, by interactions that either preserve the distance between different institutional logics or prevent their mutual influence on each other. However, when institutional work transcends maintaining – towards creating or disrupting – the interaction is characterized both by acts of claiming influence and acts of granting influence between actors adhering to different institutional logics. Nonetheless, these interactions are dependent upon the approaches of the physicians; such interactions start with the physicians either being granted influence or granting influence – influence that can later be claimed by the other actor. As such, although the coexistence of different institutional logics is currently an established phenomenon in healthcare, we illustrate how institutional work is contingent upon the dominating professional logic of physicians.
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- Andersson, Thomas, 1970-, et al.
(author)
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Organisering av förbättringsarbete inom vården med inspiration från industrin
- 2011
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Conference paper (peer-reviewed)abstract
- I denna artikel fokuserar vi på användandet av industriellt baserade produktionssynsätt (IBP) inom vården i avsikt att arbeta systematiskt med förbättringsarbete. Tidigare forskning har visat att det är svårt att få nya arbetsmetoder att få genomslag i den dagliga praktiken. I denna artikel fokuserar vi på om det går att se indirekta effekter såsom hur förbättringsarbetet organiseras beroende på vilka IBP olika sjukhus väljer att arbeta med. Undersökning är genomförd genom fallstudier på tre sjukhus som har valt att arbeta med tre olika metoder: six sigma, processorientering och mikrosystem.Studien visar att de olika logikerna bakom de olika metoderna ger fundamentalt olika sätt att organisera förbättringsarbetet vid de tre sjukhusen. Six sigma-sjukhuset valde ett centraliserat förbättringsarbete i hög grad drivet av experter på förbättringsmetoder, processsjukhusethade en expertavdelning som var mer av bollplank och utbildare för verksamhetens förbättringsarbete och mikrosystem-sjukhuset valde ett decentraliserat förbättringsarbete där förbättringsarbetet var både lokalt initierat och drivet.
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