| 1. |
- Carlström, Eric
(author)
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Middle managers on the slide
- 2012
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In: Leadership in Health Services. - : Emerald. - 1751-1879 .- 1751-1887 .- 0952-6862. ; 25:2, s. 90-105
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Journal article (peer-reviewed)abstract
- Purpose– This article aims to examine middle managers in health care and how their role has changed in times of fiscal constraints. It seeks to focus particularly on how cost savings influence the position of middle managers in the organisation between governance and advocacy pressure.Design/methodology/approach– A total of 25 Swedish middle managers from public health care organisations during fiscal constraints were interviewed about what contributes to their positioning in the organisation.Findings– The loyalty of middle managers is tested in the "in between" role. Excessive loyalty, in any direction, can distance a middle manager from their expected position. In times of a weakening economy, middle managers are expected to be a tool that is used by the management to communicate savings, personnel reductions, redundancies and closures. This contributes to middle managers sliding out of their role in between.Practical implications– Middle managers' skills are within care itself. In times of cost savings, demands are placed on their ability to handle advanced management tasks. They need to gain a clearer insight into management control, understanding conflict management and leadership.Originality/value– The article explains not only why middle managers slide up (take on governance roles) and down (take on advocacy roles) in the organisation, which has been described previously. It also explains why middle managers slide out (abdicate responsibility) of the role between governance and advocacy during times of fiscal limitations.
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| 2. |
- Cregård, Anna, 1971, et al.
(author)
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Perceptions of trust in physician-managers
- 2015
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887 .- 0952-6862. ; 28:4, s. 281-297
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. Design/methodology/approach – The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. Findings – The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians’ trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. Research limitations/implications – This paper’s findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. Practical implications – The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. Originality/value – The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.
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| 3. |
- Andersson, Thomas, 1970-
(author)
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The medical leadership challenge in healthcare is an identity challenge
- 2015
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 28:2, s. 83-99
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Journal article (peer-reviewed)abstract
- Purpose– The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face.Design/methodology/approach– Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action.Findings– This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians.Research limitations/implications– The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership.Practical implications– Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership.Originality/value– Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.
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| 4. |
- Bååthe, Fredrik, 1968, et al.
(author)
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How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study
- 2023
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In: Leadership in Health Services. - : Emerald. - 1751-1879 .- 1751-1887. ; 36:2, s. 261-274
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Journal article (peer-reviewed)abstract
- PurposeThis study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals' engagement. Design/methodology/approachQualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. FindingsThe top managers had the intention to balance between quality of patient care, economy and professionals' engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. Practical implicationsFor health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals' engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals' engagement. However, this study builds on a limited number of participants. More research is needed. Originality/valueSustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals' engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.
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| 5. |
- Ekholm, Bodil, 1946-
(author)
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Middle managers in elderly care under demands and espectations
- 2012
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 25:3, s. 203-215
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Journal article (peer-reviewed)abstract
- Purpose - The purpose of this project was to study how middle managers look on and shape their work and leadership with regard to the demands and expectations that exists from different participants within the home help service operation. The participants are politicians, officials at central level, nursing staff, persons receiving care and their relatives.Design/methodology/approach - The participants are eight managers in eight different home-help service units. The units are spread out in four district with high socioeconomic status and four districts with low. Four managers are at public units and four are at units with private executor. The majority of the managers had worked as leaders between three and eight years. The study is based on individual interviews and observations of the managers and of staff meetings. The data were subjected to content analysis. Two main categories and five subcategories were generated.Findings - There were large similarities in how the managers perceived the demands and expectations, but there were differences when it came to how they handled them. Three of the managers experienced that they could handle the demands and expectations through organizing and structuring the operation and prioritizing the assignments, while five of the managers experienced difficulties to handle them and they conveyed that they suffered from stress. The managers that could handle the demands combine a professional and an organizational perspective in their leadership.Originality/value - The knowledge from the study may be of great value in recruiting new managers in elderly care but also in creating programs of competence development for managers.
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| 6. |
- Ellström, Eva
(author)
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Managerial support for learning at work : a qualitative study of first-line managers in elder care
- 2012
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 25:4, s. 273-287
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Journal article (peer-reviewed)abstract
- Purpose – The aim of the present study is to explore the meaning of managerial support for learning and development in the workplace. The overall research question concerns how first-line managers in elder care perceive and understand their mission and tasks and how they in practice handle issues of co-workers' learning and development.Design/methodology/approach – The study was designed as a multiple-case study including eight first-line mangers in eight care units. Data were collected through interviews and observations.Findings – The study demonstrates the variation that exists concerning how first-line managers understand and enact their tasks. Specifically, it is possible to distinguish four qualitatively different patterns concerning how the managers acted and interacted with their co-workers.Research limitations/implications – The empirical generalisability of the results is limited by its character as a multiple-case study of eight managers in eight different work units. At the same time, the strength of a multiple-case study lies in its potential for making analytic generalisations, that is, for identifying theoretically meaningful examples and patterns across a number of cases.Practical implications – The paper suggests a need for management development programs that promote not only a broader understanding of the task as a manager of elder care, but also knowledge about and skills in leading and organising workplace learning and development.Originality/value – This study adds to the limited knowledge of how first-line managers in care work understand and deal with learning and developmental issues in the workplace.
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| 7. |
- Furåker, Carina, 1946, et al.
(author)
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Registered nurses' views on nursing competence at residential facilities
- 2013
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In: Leadership in Health Services. - : Emerald. - 1751-1879 .- 0952-6862. ; 26:2, s. 135-147
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Journal article (peer-reviewed)abstract
- Purpose: The aim of this paper is to describe registered nurses' (RNs') ways of working and their views on what competence they require, make use of and wish to develop when caring for older people at residential facilities. Design/methodology/approach: The participants comprised 23 RNs, trained after 1993 and working at seven residential facilities. The data collection consists of group interviews during spring 2009. The group interviews were subjected to content analysis. Findings: Three main categories and six sub-categories were identified. The findings show that the majority of RNs work in a consultative way although they are responsible for basic care as well as advanced nursing care. They must rely on the staff's competence. They compare the residential facilities to a "mini-hospital" and they are often frustrated by the staff's incompetence. Attitudes to research findings and to the use of evidence-based knowledge were limited. Research limitations/implications: RNs require extensive theoretical, technical and medical knowledge as well as knowledge related to persons with dementia conditions and psychiatric disorders and how to lead, teach and supervise. Practical implications: Social and professional isolation influences competence development and working situation and the differences in leadership influence the quality of nursing care. RNs do not critically reflect on what knowledge they require and make use of and how to search for scientific knowledge and this will have a negative influence on the attitude to the competence. Originality/value: There is a need of extensive and varied knowledge in evidence-based nursing as well as in leadership and teaching to be able to work independently. © Emerald Group Publishing Limited.
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| 8. |
- Höög, Elisabet, 1962-, et al.
(author)
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Challenges in managing a multi-sectoral health promotion program
- 2013
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 26:4, s. 368-386
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this paper is to investigate program management teams’ views on issuesand challenges in managing a large, multi-sectoral child health promotion program in Sweden.Design/methodology/approach: In total, 17 participants representing two autonomous programmanagement teams, one strategic and one operational, were interviewed. Analysis of interview datawas complemented with reviews of program documents.Findings: Program management teams identified important issues concerning the program’sformal structure, goals, role distribution, and change and dissemination processes, but lacked a sharedmental model of the situation. Inter and intra group communication, long- and short-term strategicplanning were further areas in need of improvement. While issues and challenges might seem to beagreed upon by the program’s change agents, closer inspection reveals variation in key characteristicsas well as in perspectives on solutions.Originality/value: Health promotion programs are challenging. Researchers trying tounderstand program success have focused on particular interventions, contextual factors andprogram recipients. Less research has focused on the internal processes of teams tasked withwide-ranging change mandates and the effects such processes can have on program outcomes. Thisstudy contributes to a deeper understanding on internal processes and mental models of changeagent teams.
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| 9. |
- Ingelsson, Pernilla, 1968-, et al.
(author)
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Strengthening quality culture in private sector and health care: What can we learn from applying soft measures?
- 2018
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In: Leadership in Health Services. - 1751-1879 .- 1751-1887. ; 31:3, s. 276-292
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this study is to present a comprehensive approach to studying organizational culture using “soft measures” to facilitate sustainable quality development in organizations. The purpose is also to present, discuss and compare the results from a survey designed to measure a company’s value base.Design/methodology/approach – A number of different methods were used to collect soft data to study and measure organizational culture and at the same time influence the culture and the leadership within three organizations. One method, the survey, was used on two different occasions to obtain an overview of the culture within an organization and to investigate if the activities had influenced the culture and the leadership.Findings – The application of soft measures used by leaders to study and develop organizational culture resulted in statistically significant positive changes in organizational work culture, according to a pre-post survey after a short period of one year.Practical implications – The approach can be used by leaders in different types of organizations as the challenge of changing the organizational culture through the leadership seems to be a common challenge regardless of line of business.Originality/value – The study shows the benefits of using a comprehensive approach to assess an organization’s culture based on qualitative measures and analysis.
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| 10. |
- James, Inger, et al.
(author)
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First-line managers struggling to lead home care based on the individual's needs and goals : conflict between ethical principles
- 2024
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In: Leadership in Health Services. - : Canadian Healthcare Association. - 1751-1879 .- 1751-1887. ; 37:5, s. 84-98
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual's needs and goals.DESIGN/METHODOLOGY/APPROACH: In this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.FINDINGS: The results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization's needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.ORIGINALITY/VALUE: The FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual's needs and goals.
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