| 1. |
- Norén Bretzer, Ylva, 1969, et al.
(författare)
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Tillit kommer inte på beställning
- 2018
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Ingår i: Dagens Samhälle.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Vår rekommendation till Finansdepartementet är att inte blanda ihop tillit och förtroende och att inte göra tillit till både ingrediens och resultat, skriver flera forskare med anledning av Tillitsutredningens remissrunda.
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| 2. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Clinicians' psychological empowerment to engage in management as part of their daily work
- 2022
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 36:9, s. 272-287
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work. Design/methodology/approach: The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis. Findings: The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work. Practical implications: For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment. Originality/value: The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work.
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| 3. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Easier to trust managers than management? : The case of improvement work in healthcare
- 2011
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Konferensbidrag (refereegranskat)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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| 4. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Organisering av förbättringsarbete inom vården med inspiration från industrin
- 2011
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Konferensbidrag (refereegranskat)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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| 5. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Patients' perceptions of quality in Swedish primary care - a study of differences between private and public ownership
- 2021
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 35:9, s. 85-100
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.DESIGN/METHODOLOGY/APPROACH: The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.FINDINGS: The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.RESEARCH LIMITATIONS/IMPLICATIONS: The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.SOCIAL IMPLICATIONS: The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.ORIGINALITY/VALUE: The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.
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| 6. |
- Brorström, Björn, 1953-, et al.
(författare)
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Hållbar kommun : Att balansera konkurrerande värden
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Frågan ”Vad är en hållbar kommun?” är utgångspunkt i den studie som presenteras. Studien syftar till att belysa vad en hållbar kommun kan vara och behandlar frågan både ur ett teoretiskt och empiriskt perspektiv. Begreppet hållbarhet används flitigt i samhällsdebatten om hur vi ska ta oss an allehanda utmaningar på såväl global som lokal nivå. Hållbarhetsbegreppet används inte bara som ett attraktivt värdeomdöme och en retorisk tankefigur i samhällsdebatten, utan även som en strukturerande idé som håller på att finna sina organisatoriska uttrycksformer på såväl nationell som lokal nivå. Hållbarhetsbegreppet adresserar både ett tillstånd och ideal (hållbarhet) och en process och dynamik (hållbar utveckling).Vad händer då i ett redan komplext system när nya ideal adderas? Blir det ”lager på lager” och allt ska göras samtidigt? Blir det särkoppling, transformeras kommunen eller förändrar man där det är möjligt och ger det nya namn, men gör man det man alltid gjort? Inom forskning finns alla alternativ dokumenterade det tenderar nämligen att ske flera saker samtidigt när nya struktureringsidéer anammas.I den teoretiska referensramen identifierades tre konfliktytor; de kring ägande, resurser och utveckling. En förutsättning för all konfliktlösning är institutionella arrangemang för att hantera makt, intressen och möjligheter. Makt i form av vem som ingår överenskommelser, intressen i form av vad man är beredd att gå med på och möjligheter kring vad som kan åstadkommas. Det är således inte ”antingen eller”, utan snarare ”både och”, där flera avvägningar och bedömningar måste göras. Det kommunala självstyret är en god grund att vidareutveckla detta institutionella arrangemang för en hållbar kommun. Forskningsprojektet fortsätter där föreliggande rapport ger en god grund för fördjupade studier med mer precisa frågeställningar och intervjuer av fler aktörer. Kommunerna behöver organiseras, styras och ledas för att få fokus på hållbarhet. Hur det sker är en viktig fråga för fortsatt forskning.
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| 7. |
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| 8. |
- Cregård, Anna, et al.
(författare)
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A critique on physicians as managers in the healthcare sector : coping with contradictions in managerial and medical logics
- 2012
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Konferensbidrag (refereegranskat)abstract
- In the healthcare sector the physicians more and more often become managers, in Sweden as well as in many other countries. This is a global trend, which is motivated by better quality, higher efficiency and an increased possibility to control professional actors in the organization. Managing professions are perceived as difficult for many reasons and the appointment of physicians as managers is supposed to solve this problem. Our aim is to critically discuss the appointment of physicians on traditional management positions in healthcare sector and what it might result in. We recognize that there are positive effects, but they do not align with the rhetoric concerning these appointments. We also discuss an alternative way of organizing the management of professionals in healthcare organizations. We use two theoretical concepts to discuss this phenomenon: principles of control and shift in trust. The concepts are used to categorize and analyze our empirical data, which consist of deep interviews with 15 physicians and nurses, five focus groups consisting of physicians (managers) and five texts on the relationship between politics, administration and professions, written by physicians (managers) in management training. We also develop the concepts of medical and managerial logics. Our respondents recognize the principles of control as rational, and they perceive them as important. But there are contradictions between medical and managerial logics. The management discourse alter the care and raises questions they themselves cannot answer, for example “Is it right to treat people who themselves are responsible for their sickness”? They also discuss medical concepts as being altered, for example the course of treatment being completed. Nowadays the concepts concern strictly medical issues, which is not necessarily good in a health perspective. The shift in trust concerns four levels: the trust between individuals, between professional groups, between organizational levels and between the whole society and the healthcare system. For example the respondents mean that the staff sometimes are questioning if the physician as a manager have enough medical day-to-day practice, and there are examples where the staff try to steer away complicated surgery from their superior. The staff also question if he or she is competent enough in management. Another example is that there is a risk of a decrease in trust in the healthcare system as a whole. Gains and losses are described in monetary terms, and the business language is not recognised as appropriate in this kind of organization. In our conclusions we discuss that there are a chance that appointing physicians on administrative assignments might bring the ears of the colleagues, increased transparency in the everyday care and perhaps a better understanding of overall decisions. But there are also some negative effects and risks – which we discuss using the concepts of medical and managerial logics. Appointing physicians as managers result in two contradicting logics pressed into one individual, who are supposed to handle the contradictions on an individual basis. For example, this means that the principles of ethics will collide with a different rhetoric – from the rationality of medical logics (with equivalence principle and loyalty to the patient) to the rationality of business logics (with cost minimization, production maximization and loyalty to the organization). We summarize the risks below. —Risk 1: When the physician loses skill, or perceived as less competent than earlier, there will be consequences for both the physician and the patient.—Risk 2: When trust in the physician manager decreases, he/she will not gain support by other physicians.—Risk 3: When the trust between different levels, groups and individuals in the organization decreases, it will also decrease for care in general.—Risk 4: When important values in the service domain are pushed aside, this will favour the values in the administrative domain (efficiency over quality). Finally we discuss other ways of handling uncontrollable professional organizations, for example by refining administrative and medical roles, by establishing medical management as a speciality within medical education, and by re-strengthen the medical logic. Most important is to alter and nuance the discourse around physicians as managers.
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| 9. |
- Cregård, Anna, 1971, et al.
(författare)
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A critique on physicians as managers in the healthcare sector: coping with contradictions in managerial and medical logics
- 2012
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Ingår i: IRSPM 2012 Rome.
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Konferensbidrag (refereegranskat)abstract
- In the healthcare sector more and more physicians are becoming managers. Our purpose is to critically discuss the effects when physicians take managerial positions. The results indicate four risks: that the physician-managers’ medical competencies will diminish; the physicianmanagers will lack managerial competencies; the managerial logic will be prioritized over the medical logic; and if trust between different levels, groups and individuals in the organisation decreases, it will decrease in the healthcare system in general. We also discuss alternative ways to handle the contradictions between medical and managerial logics.
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| 10. |
- Cregård, Anna, 1971-, et al.
(författare)
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Chefskap i professionella organisationer : läkare som chefer
- 2018. - 1
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Ingår i: Att leda i en komplex organisation. - Stockholm : Natur och kultur. - 9789127822542 - 9789127824294 ; , s. 71-82
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Komplexa organisationer är vanligen svåra att styra – och det gäller särskilt organisationer med starkt professionaliserade aktörer. Det beror på flera faktorer: att det är svårt att överblicka handlingars konsekvenser i sådana organisationer, att det inte är självklart att styrimpulser efterföljs eller att verksamhetens viktigaste procedurer ens går att följa upp. Dessutom kan det som sker på en hierarkisk nivå sakna koppling till det som händer på en annan – och det gäller särskilt for kärnverksamhet i relation till ledning.
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