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- Andersson, Thomas, et al.
(författare)
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Does patient-centred care mean risk aversion and risk ignoring? : Unintended consequences of NPM reforms
- 2012
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Ingår i: International Journal of Public Sector Management. - : Emerald Group Publishing Limited. - 0951-3558 .- 1758-6666. ; 25:4, s. 260-271
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – This article aims to describe and analyze the results of efforts to improve patient-centered care (PCC) in psychiatric healthcare.Design/methodology/approach – Using the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient-centered actions are performed. They conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days.Findings – The article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient’s medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.Practical implications – The article shows that accountability pressure to reduce patient risk may create new risks for patients.Originality/value – The study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.
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| 3. |
- Andersson, Thomas, et al.
(författare)
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Medarbetarskap, professioner och samarbeten
- 2012
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Ingår i: I Dellve, L. (red) Studiematerial: Hållbart chefskap i hälso- och sjukvården med vinjetter om engagemang, stress, tidsanvändning, medarbetarskap och vårdpraktik, Göteborg: Västra Götalandsregionen och Göteborgs universitet..
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Andersson, Thomas, et al.
(författare)
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Multiprofessional cooperation and accountability pressures. Consequences of a post-new public management concept in a new public management context
- 2012
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Ingår i: Public Management Review. - : Informa UK Limited. - 1471-9037 .- 1471-9045. ; 14:6, s. 835-855
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Tidskriftsartikel (refereegranskat)abstract
- This article examines how multiprofessional healthcare teams, working as a post-New Public Management (post-NPM) reform, respond to accountability pressure resulting from the implementation of NPM reforms. The team members use three strategies to respond to this pressure: responsibility avoiding that results in conflict; responsibility ignoring that results in parallel work and responsibility sharing that results in cooperation. Depending on how the professionals respond to different contextual factors, the choice of strategies can either foster or inhibit cooperation in multiprofessional teams. Achieving holistic patient care is threatened when accountability pressure increases for teams that have not yet developed their internal routines of cooperation.
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| 7. |
- Arman, Rebecka, 1976, et al.
(författare)
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The hierarchization of competing logics in psychiatric care in Sweden
- 2014
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Ingår i: Scandinavian Journal of Management. - : Elsevier BV. - 0956-5221. ; 30:3, s. 282-291
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Tidskriftsartikel (refereegranskat)abstract
- In many healthcare organizations, the managerial institutional logic co-exists and competes with the professional institutional logic in the day-to-day work of managers and professionals. In its examination of the relationship between these two institutional logics at three psychiatric care units for children and adolescents, this study contributes to our understanding of the theoretical concepts and their practical implications for the actor-to-actor approaches to competing institutional healthcare logics. Many earlier studies use theoretical concepts to describe this co-existence as a relatively equal relationship between the competing logics. This study, using data from interviews, observations and shadowing, reveals the existence of a process we label “hierarchization”. In this process, the managerial logic dominates the professional logic although the latter logic still co-exists and competes, albeit in a subordinate role. The study also reveals that quantification of primarily patient throughput is used to legitimize the dominant managerial logic. Such use of quantification supports the meta-trend of placing trust in numbers.
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