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- Ahlström, Karin
(författare)
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Managing broad responsibility together in a municipal company : Communication as prophylaxis
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Municipal companies are important actors in the pursuit of the goals of Agenda 2030 and are often formally obliged by their owners to work towards achieving these goals, but without jeopardizing ongoing production and the delivery of vital public services. This has, however, shown to be challenging, and managers are often unsure how to develop new ways of organizing to meet such complex challenges and take on broad responsibility. What has been recognized is the importance of collaboration, which is a beneficial and distinct organizational form of its own that creates value greater than what individual organizations can do separately. Such ways of working are, however, hardly straightforward endeavours, since they usually involve members with contrasting goals and approaches, are inclined to fragmentation, and can sometimes even add to the challenges they set out to resolve. The aim of this thesis is to understand the practical challenges associated with collaborative efforts to manage broad responsibility in a municipal company. In response to this aim, responsible managing is studied both empirically and through a research literature review. The purpose of the literature review is to better understand the challenges of managing broad responsibility and what is currently being done to achieve the goals of Agenda 2030 at the municipal level. To understand how responsible managing is accomplished in practice, the enactment of responsible manging is empirically studied in a municipal company over a total of four years. Particularly, two cases have been studied using a participatory research approach: first, the case of a top management team managing responsibly together and second, the case of responsible managing in interorganizational collaboration in a municipal company. For both cases, a theoretical lens is used, resting on a social constructionist and processual-relational ontology, supported by practice-based studies in the communicative stream. This means that attention is focused on communication (both talk and text) in an approach that views responsible managing as a communicative practice, a form of emergent, relational, and situated practice and the means by which responsible managing emerges, is sustained, and transformed. The overall results show how situated communicative practices are influential for preventing the limitation of broad responsibility, fragmentation of the share responsibility, and the deprioritization of obligations over time. Based on this, a metaphor of dental prophylaxis is proposed. By conceptualizing responsible managing as a situated communicative practice and showing how responsible managing may be enacted, this thesis contributes theoretically to the field of organization and management.
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| 2. |
- Ahlström, Karin, 1964-, et al.
(författare)
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Negotiating shared Responsibility for sustainable urban Development: Pronouns and In-here-ness as rhetorical Resources
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This article explores how issues of shared responsibility are negotiated in the realm of managing collaborative efforts between organizational actors for sustainable urban development abiding to the Agenda 2023 – with a particular focus on the rhetorical resources used in such negotiations. Through empirical material from recorded meetings in a one-year project at a municipal company, the article contributes to previous literature on collaborative ways of organizing and managing complex public challenges. With a focus on the discursive construction of shared responsibility, the concept of in-here-ness is introduced to denote accepted and assumed responsibility, which may shift through the use of pronouns: from a narrow ‘I’ or ‘we’ of stakeholders to a wider ‘we’ of collaborating parties. The article further contributes to the empirical field of sustainable development at the municipal level.
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| 4. |
- Bjärehed, Jonas, et al.
(författare)
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A thematic analysis of care provider experiences of using self-harm abstinence agreements in psychiatric inpatient care
- 2021
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 8:4, s. 1660-1667
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Traditional methods used when managing self-harm in a psychiatric inpatient setting tend to infringe on the autonomy of the individuals receiving treatment and are often experienced as practically and emotionally challenging by care providers. Therefore, we examined care providers' experiences of an alternative method negotiating self-harm abstinence agreements, which can be viewed as a form of positive risk taking.DESIGN: A qualitative approach using semi-structured interviews with twelve mental health professionals.METHODS: Thematic analysis of the interviews.RESULTS: Five themes emerged; "No-harm agreements versus constant observation and coercion," "No-harm agreements to promote independence and collaboration," "No-harm agreements' effect on ward safety," "Ambiguity surrounding the no-harm agreements" and "Ethical complexities of the no-harm agreements." These indicated perceived positive effects on the therapeutic relationship, the individuals' autonomous functioning and the ward environment, but also practical and ethical difficulties.
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| 5. |
- Blind, Per-Jonas, et al.
(författare)
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Fast-Track Program for Liver Resection - Factors Prolonging Length of Stay
- 2014
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 61:136, s. 2340-2344
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Fast-track programs involving multi-modal measures to enhance recovery after surgery, reduce morbidity and decrease hospital length of stay (LOS) are used for different major surgical procedures. For liver resections, factors influencing LOS within a fast-track program have been studied only to a limited extent, which was the aim of the present study. Methodology: The present study comprises the first 64 patients included in a fast-track program for liver resections introduced in March 2012. Patient outcomes were compared to a historical cohort of patients (n=62) operated in 2009. Factors prolonging LOS was analyzed by uni- and multivariate analysis. Results: Median LOS was 6 days (range 3-42 days) within the fast-track program as compared with 8 days (range 5-47 days) in the historical cohort (P=0.004). On multivariate analysis, factors increasing LOS in the fast-track group were found to be the presence of complication (P=0.018), extent of resection (major as compared to minor) (P=0.001) and inability to drink > 1250 ml on the day after surgery (P=0.002). Conclusion: Patients who can only drink limited amounts of fluid the day after-liver resection represent a subset of patients that should be given special attention within a fast-track program.
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| 6. |
- Brodin, Daniel, et al.
(författare)
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Inhaled ciclesonide in adults hospitalised with COVID-19 : a randomised controlled open-label trial (HALT COVID-19)
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the efficacy of inhaled ciclesonide in reducing the duration of oxygen therapy (an indicator of time to clinical improvement) among adults hospitalised with COVID-19.DESIGN: Multicentre, randomised, controlled, open-label trial.SETTING: 9 hospitals (3 academic hospitals and 6 non-academic hospitals) in Sweden between 1 June 2020 and 17 May 2021.PARTICIPANTS: Adults hospitalised with COVID-19 and receiving oxygen therapy.INTERVENTION: Inhaled ciclesonide 320 µg two times a day for 14 days versus standard care.MAIN OUTCOME MEASURES: Primary outcome was duration of oxygen therapy, an indicator of time to clinical improvement. Key secondary outcome was a composite of invasive mechanical ventilation/death.RESULTS: Data from 98 participants were analysed (48 receiving ciclesonide and 50 receiving standard care; median (IQR) age, 59.5 (49-67) years; 67 (68%) men). Median (IQR) duration of oxygen therapy was 5.5 (3-9) days in the ciclesonide group and 4 (2-7) days in the standard care group (HR for termination of oxygen therapy 0.73 (95% CI 0.47 to 1.11), with the upper 95% CI being compatible with a 10% relative reduction in oxygen therapy duration, corresponding to a <1 day absolute reduction in a post-hoc calculation). Three participants in each group died/received invasive mechanical ventilation (HR 0.90 (95% CI 0.15 to 5.32)). The trial was discontinued early due to slow enrolment.CONCLUSIONS: In patients hospitalised with COVID-19 receiving oxygen therapy, this trial ruled out, with 0.95 confidence, a treatment effect of ciclesonide corresponding to more than a 1 day reduction in duration of oxygen therapy. Ciclesonide is unlikely to improve this outcome meaningfully.TRIAL REGISTRATION NUMBER: NCT04381364.
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| 8. |
- Kullman, Eric, et al.
(författare)
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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- 2010
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Ingår i: GASTROINTESTINAL ENDOSCOPY. - : Elsevier Science B. V., Amsterdam. - 0016-5107 .- 1097-6779. ; 72:5, s. 915-923
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Tidskriftsartikel (refereegranskat)abstract
- Background: Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients. Objective: To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction. Design: Randomized, multicenter trial conducted between January 2006 and October 2008. Setting: Ten sites serving a total catchment area of approximately 2.8 million inhabitants. Patients: A total of 400 patients with unresectable distal malignant biliary obstruction. Interventions: ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction. Main Outcome Measurements: Time to stent failure, survival time, and complication rate. Results: The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030). Limitations: Randomization was not blinded. Conclusions: There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.
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| 9. |
- Larsson, Johanna, et al.
(författare)
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Säkerhetskultur och självkörande fordon och maskiner
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Självkörande fordon inom transportsektorn befinner sig ännu i utvecklingsstadiet. Att införa självkörande fordon och maskiner i befintliga verksamheter innebär ofta förändringar både i organisationen och den fysiska miljön och kan även innebära nya risker. I detta sammanhang kan säkerhetskulturen, både hos utvecklare och hos användare, spela viktig roll för att självkörande fordon och maskiner ska fungera säkert och effektivt i olika verksamheter. Projektets mål har varit att utveckla metoder för att förbättra säkerhetskultur där människor och automatiserad teknik samverkar som agenter i ett gemensamt system, samt att utveckla mätverktyg där hållbarhet, jämställdhet och säkerhet utvärderas för införande av självkörande fordon och maskiner. Projektet har utgått ifrån fallstudier från två olika domäner – självkörande bussar och självkörande industritruckar. Intervjuer har genomförts med utvecklare, kunder och slutanvändare. En enkät har tagits fram att mäta säkerhetskultur, jämställdhetskultur och hållbarhetskultur i organisationer som utvecklar självkörande fordon. Utöver detta har data från incidentrapporter analyserats. Lärdomarna från resultaten och projektdeltagarnas tidigare erfarenheter har resulterat i ett första utkast av en processmodell där säkerhetskultur integreras i utvecklingen av självkörande fordon och maskiner. Intervjuerna med utvecklare och kunder av självkörande fordon visade att säkerhetskultur inte var ett etablerat begrepp vare sig hos utvecklarna eller hos kunderna och att det därför inte var en faktor som man medvetet beaktade. Lärdomar från enkäten var att det finns skillnader mellan produktföretag och som markant påverkar formuleringar av frågeställningar. Det gick inte att fastställa om det föreligger kopplingar mellan hållbarhets-, jämställdhets- och säkerhetskultur. Fallstudien med bussarna visade bland annat att kund och leverantör pratar om olika typer av säkerhet samt att säkerheten ofta, men inte alltid, är prioriterad över effektiviteten. Utifrån analyserna av incidentdata från självkörande bussar samt förarlösa industritruckar har en lista med förslag på nyckeltal för att kunna analysera incidenter med självkörande fordon tagits fram inom projektet.
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