Managerial work at top- and lower-levels to handle values of quality of care, efficiency and work environment

• Introduction: The critique of NPM of health care service is vast especially regarding consequences for work environment and professional autonomy. However, implications of new concepts and management trends, e.g. value-based leadership and open management, for lower-level managerial work practice and the outcomes of their work are less known. This study focuses top and lower level managers’ work and communication of values of quality of care, efficiency and work environment through Key Performance Indicators (KPI). Material and methods: A qualitative driven mixed method study-design was used with statistical analysis (mixed models repeated measures) of the generated hypothesis. Data from 5 Swedish public hospitals (2012-2015) was used: interviews with managers at top- and lower levels (n=198), the yearly questionnaire to managers (n=429) and employees’ (n=1361) and observations at the work units. Results: Top managerial approaches in managing and communicating KPI was observed related to how logics of control vs. trust, vision and visualization formed the interaction between managers at top- and lower levels: (a) Intervening governance to create clarity of prioritized KPI, (b) Practice-serving prioritizing of KPI to create trust and enthusiasm at lower levels as well as meta-learning, (c) Store front strategies showing success and “best practice” to stimulate internal interest and support external accountability. The top management approaches had impact on the lower level managers’ work with improvements and KPI: what KPI that was prioritized, their work situation, stress and job satisfaction. The two-year follow-up showed different patterns of outcomes regarding efficiency, quality of care and work environment conditions, as well as workers stress and engagement, related to the top-level managerial approaches. Conclusions: Value-based leadership and open management have various grounds, logics and practice. Top management approaches have substantial impact on lower-level managers’ work with improvements of values and prioritizing of key performance indicators as well as on the outcomes and working conditions.

Ämnesord

SAMHÄLLSVETENSKAP  -- Annan samhällsvetenskap -- Arbetslivsstudier (hsv//swe)

SOCIAL SCIENCES  -- Other Social Sciences -- Work Sciences (hsv//eng)

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