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- Falkenström, Erica, 1966-, et al.
(författare)
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Developing ethical competence in healthcare management
- 2016
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Ingår i: Journal of Workplace Learning. - 1366-5626 .- 1758-7859. ; 28:1, s. 17-32
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper was to explore what kind of ethical competence healthcare managers need in handling conflicts of interest (COI). The aim is also to highlight essential learning processes to develop healthcare managers’ ethical competence.Design/methodology/approach – A qualitative study was performed. Semi-structured interviews with ten Swedish healthcare managers from different care providers were carried out twice and analysed through step-wise categorisation.Findings – Four categories of COI were revealed and two ways (passive and active) in which COI were handled. Ethical guidelines did not help the healthcare managers to handle the COI, and none of the managers made use of any sort of systematic ethical analysis. However, certain ethical competence was of great importance to identify and handle COI, consisting of contextual understanding, rational emotions, some theoretical knowledge and a suitable language. Organising work so that ethical analysis can be carried out is of great importance, and top management needs to clearly express the importance of ethical competence and allocate resources to allow adequate learning processes.Originality/value – This paper highlights the management level and focuses on how work-integrated learning-processes can enable ethical competence. Ethical competence at the management level is essential both to comply with the constitution and legal requirements regarding healthcare, and so that managers are able to analyse COI and justify their decisions.
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| 2. |
- Falkenström, Erica, 1966-, et al.
(författare)
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På spaning efter etik : Etisk kompetens och ansvarstagande för ledning och styrning av hälso- och sjukvården
- 2018
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Kraven på vårdens professioner och chefer är höga. De förväntas ge en god och säker vård på lika villkor till hela befolkningen, administrera, prioritera och arbeta kostnadseffektivt. Men hälso- och sjukvården fungerar inte som den ska. Arbetsmiljön är osund, sjuksköterskor lämnar yrket, vården är ojämlik och svårt sjuka patienter får vänta i långa köer. Detta gör att människors liv, hälsa och värdighet står på spel.På spaning efter etik uppmärksammar tre nyckelgrupper av aktörer som genom sina beslut har ett stort inflytande över vårdens villkor: politiker, opolitiska chefstjänstemän och vårdgivarnas högsta chefer i landstingets ledningsorganisation. Hur ser de på sitt etiska ansvar för hälso- och sjukvården? Vilka etiska bedömningar och konsekvensanalyser gör de? Och vilken etisk kompetens fordras för att de ska kunna ta ett etiskt ansvar för vårdens villkor genom ledning, styrning och organisation på den regionala nivån – och därmed för att samhällsmedborgarna ska kunna känna tillit till att vården fungerar som den ska?Boken är ett resultat av ett tvärvetenskapligt empirisk forskningsprojekt, finansierat av AFA Försäkring, som har bedrivits på Stockholms centrum för forskning om offentlig sektor, Score.
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| 3. |
- Falkenström, Erica, 1966-
(författare)
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Svensk pandemiberedskap i organisationsetisk belysning : Empirisk analys och åtgärdsförslag för framtida pandemier
- 2021
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Rapport (refereegranskat)abstract
- The purpose of this report is to contribute knowledge about organizational ethical aspects of the Swedish pandemic preparedness. More specifically, 12 key policy documents aimed at guiding health care practice – before a pandemic and during the Covid-19 pandemic – has been analyzed regarding the purpose of the policy documents, their ethical content, and the attention given to value conflicts and the recipient organizations' ability to comply with fundamental ethical requirements. Based on the results, concrete proposals are given to strengthen the health care system’s preparedness and capacity for ethical responsibility in relation to the goal of the Swedish pandemic preparedness – and thus reduced vulnerability – for future pandemics.The analysis shows that purposes and essential ethical values prescribed by law, such as the principle of human dignity, tended to be reduced and even drained of their ethical content in the policy documents. Fundamental aspects of organizational ethics in health care (including an ethics of care) were also missing. For instance, overall, the purpose of health care has not been properly indicated in the policy documents, and no attention was given to the receivers’ prerequisites to take ethical responsibility for conflicts of interest that occur and to apply the policy documents during the pandemic. Moreover, by presenting new national principles for priorities during the ongoing pandemic, which in addition deviated from the Health Care Act, The National Board of Health and Welfare may have misled priority decisions and increased the moral stress among healthcare staff rather than reduced it. Thus, during the Covid-19 pandemic health care providers may have had insufficient organizational conditions, political guidance, and administrative support to act ethically in relation to the goal of the Swedish preparedness for crisis and pandemics.In order to maintain the ethical value system that the Swedish constitution and the Health Care Act are ultimately based on – and to promote social trust and a long-term sustainable and robust welfare system – ethics needs to be taken more seriously and given legitimacy by being organized into the every-day practices in the healthcare system.
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| 4. |
- Falkenström, Erica, 1966-, et al.
(författare)
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The knowledge–management complex : From quality registries to national knowledge-driven management in Swedish health care governance
- 2022
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Ingår i: Politics and Policy. - : John Wiley & Sons. - 1555-5623 .- 1747-1346. ; 50:5, s. 1053-1066
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Tidskriftsartikel (refereegranskat)abstract
- This article analyzes the emergence of the Swedish “national system for knowledge-driven management.” We argue that the system is best understood as a meta-instrument that is underpinned by an “instrument constituency,” a coalition held together by a joint interest in a particular policy solution. Based on interviews and documentary analyses, we show the conflicting interests that are included in the constituency and how the functional effectiveness of the meta-instrument is exposed to a number of risks that follow from its specific implementation and from the heterogeneity among its constituency. In particular, we point to the threats against professional learning, responsibility, and integrity.Related Articles: Selling, Niels, and Stefan Svallfors. 2019. “The Lure of Power: Career Paths and Considerations among Policy Professionals in Sweden.” Politics & Policy 47(5): 984–1012. https://doi.org/10.1111/polp.12325. Shen, Yongdong, Meng U. Ieong, and Zihang Zhu. 2022. “The Function of Expert Involvement in China's Local Policy Making.” Politics & Policy 50(1): 59–76. https://doi.org/10.1111/polp.12450. Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.
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| 6. |
- Falkenström, Erica, 1966-
(författare)
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Verksamhetschefens etiska kompetens : Om identifiering och hantering av intressekonflikter i hälso- och sjukvården
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- While research concerning ethical competence in medical practice is frequent, ethical competence in health care management is less often studied. This thesis focuses ethical competence and its preconditions, particularly with regard to health care managers’ identification and handling conflicts of interest. Based on the empirical analysis it also discusses what kind of ethical competence health care managers need, and how this competence can be developed in the organization. The study is based in action theory and takes an organizational pedagogical point of departure. Qualitative, semi-structured interviews were carried out twice with ten health care managers in the Stockholm region. Data were analysed using a thematic, step-wise method. The analysis revealed several examples of conflicts of interest and different ways in which they were managed. The all-embracing conflict involved weighing and prioritizing patients’ needs, patient safety, and work environment against political and economical goals. In most cases the informants did not manage to strike a balance between professional ethics and business management. The dominance of purposive/instrumental rationality tended to inhibit the managers’ ethical competence. At the same time, as shown by the analysis, some of the managers were able to use ethical competence to pursue value/belief-oriented rationality in achieving such a balance. Of great importance for success are having rational emotions and an adequate ethical language, and organizing for the task of handling conflict of interests in order to support action and provide qualifying experiences to learn from in the work processes. But the political and administrative control system also needs to clearly articulate the ethical dimensions of the managers’ task, allocate resources, and ensure that support systems and evaluation focus not only on finances but also on the value-rational aspects.
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| 8. |
- Falkenström, Erica, 1966-
(författare)
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Värdet av chefers etiska kompetens
- 2013
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X .- 2000-4192. ; 90:6, s. 857-865
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Tidskriftsartikel (refereegranskat)abstract
- While research concerning ethical competence in medical practice is frequent, ethical competence in health care management is less often studied. This article focuses ethical competence and its preconditions with regard to health care managers’ identification and handling of conflicts of interest. The article is based on empirical research. The aim is to highlight the importance of managers’ ethical competence and what such competence need to contain in order to promote ethical responsibility and a healthy working environment. Of great importance for success are having rational emotions, an adequate ethical language and communicative skills in order to promote dialogue. But the political and administrative control system also needs to clearly articulate the ethical dimensions of the managers’ task, allocate resources for training in ethics, and ensure that support systems and evaluation focus not only on finances but also on the value-rational aspects with regard to what the health care organization is aimed for.
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| 9. |
- Höglund, Anna T, 1960-, et al.
(författare)
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Commissioned reports in Swedish healthcare governance – descriptive mapping and a content analysis
- 2022
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In order to support decisions regarding governance, organization and control models of the healthcare system, the Swedish government, as well as regional-level agencies, regularly commissions expert reports that are supposed to form the basis for decisions on new steering forms in healthcare. Aim: The aim of this study was a) to perform a descriptive mapping of commissioned reports on Swedish healthcare governance and b) to pursue an in-depth content analysis of a strategic sample of such reports. Method: Initially, 106 reports from both national and regional levels were gathered and analysed. A matrix was constructed, consisting of questions on who had commissioned the report, who had produced it, what problems the report set out to solve and what solutions were suggested. Further, questions were posed on whether the report was research-based and whether ethical assumptions and arguments were presented. Thereafter, a strategic sample of 36 reports was selected for an in-depth analysis, using inductive content analysis. Results: The descriptive mapping showed that the aim of the analysed reports differed in form and content, and that they varied from giving an overview and investigating effects and consequences of new control models to more concrete goals, such as suggesting improvement measures. Academic experts involved in creating the reports often represented economics or business studies. The content analysis revealed examples of standardization in care, characterized by requirements to follow national guidelines, but also examples of requests for increased respect for professionals' competence and experience. Further, the analysis showed how the definition of equity in care had changed, from a focus on equity in access to care in the reports produced in the 1990s to an emphasis of arguments for geographical sameness and equity in quality of care in the later reports. Discussion: Two dominant trends were identified in the material, namely increased standardization and arguments for trust in the system. The great number of reports implies that the system risks requesting more information than it can handle and result in documents where the same message is recurrently repeated or create conflicts of interest and value tensions between different suggestions. Conclusion: Commissioned reports can have substantial consequences for new reforms of management practices in healthcare. It is therefore important to investigate them critically. The results of our investigation may contribute to a more comprehensive and adequate model for acquiring and using expert reports regarding healthcare governance, both in Sweden and in similar healthcare systems.
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