| 1. |
- Olsson, Jesper, et al.
(författare)
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System characteristics of healthcare organizations conducting successful improvements
- 2007
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 21:3, s. 283-296
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - In a previous study, based on a survey to all clinical department and primary care center managers in Sweden, it was concluded that the prevailing general improvement strategy is characterized by: drivers for improvement are staff needs, patients and data are not as important, improvements mainly focus on administrative routines and stress management, improvements are mainly reached, by writing guidelines, and conducting meetings, the majority of managers perceive outcomes from this strategy as successful. The purpose of current research in this paper is to investigate whether there is any other improvement strategy at play in Swedish health care. Design/methodology/approach - Data from the study of all Swedish managers were stratified into two populations based on an instrument predicting successful improvement. One population represented organizations with exceptionally high probability of successful imrpovement and remaining organizations represented the general improvement strategy. Findings - The paper finds that organizations with high probability for successful change differed from the comparison population at the p=0.05 level in many of the surveyed characteristics. They put emphasis on patient focus, measuring outcomes, feedback of data, interorganizational collaboration, learning and knowledge, communication/ information, culture, and development of administration and management. Thus these organizations center their attention towards behavioral changes supported by data. Practical implications - Organizations predicted to conduct successful improvement apply comprehensive improvement strategies as suggested in the literature. Such actions are part of the Patient Centered Task Alignment strategy and it is suggested that this concept has managerial implications as well, as it might be useful in further studies on improvement work in health care. Originality/value - This paper provides empirically based findings on a successful improvement strategy that can aid research-informed policy decisions on organizational improvement strategies. © Emerald Group Publishing Limited.
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| 2. |
- Böling, Susanna, et al.
(författare)
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No ordinary consultation : a qualitative inquiry of hospital palliative care consultation services
- 2020
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Ingår i: Journal of Health Organization and Management. - : Emerald Group Publishing Limited. - 1477-7266. ; 34:6, s. 621-638
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Considering the great need for palliative care in hospitals, it is essential for hospital staff to havepalliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care.However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need forfurther knowledge about the process of palliative consultations. The purpose of this study therefore was toexamine how palliative consultations in hospitals are practised, as perceived by consultants and health careprofessionals on receiving wards.Design/methodology/approach – Focus groups with palliative care consultation services, health carepersonnel from receiving wards and managers of consultation services. Interpretive description and constantcomparative method guided the analysis.No ordinaryconsultationThe authors would like to thank participating colleagues for sharing their knowledge and experiencesabout palliative consultations.Ethics approval and consent to participate: The project received ethical approval from the SwedishEthical Review Authority, No. 809–16. Informed consent preceded participation for all of the participants.Consent for publication: Not applicable.Availability of data and material: The datasets generated and analysed during the current study are notpublicly available due to the inclusion of potentially sensitive individual data about health status. Theethical approval includes a statement that the data will be kept in a private repository but are availablefromthe corresponding author on reasonable request.Funding: Sahlgrenska Academy at the University of Gothenburg.Authors' contributions: JO, HB and JB planned the study. All authors conducted focus group €interviews. Analysis and interpretation of focus group data was performed by SB with support from JO, €HB and JB. SB wrote the first draft of the manuscript, JO, HB and JB commented on the manuscript and €contributed to the final version. The final manuscript was read and approved by all authors.Competing interests: The authors declare that they have no competing interests.The current issue and full text archive of this journal is available on Emerald Insight at:https://www.emerald.com/insight/1477-7266.htmReceived 14 April 2020Revised 24 June 2020Accepted 2 July 2020Journal of Health Organization andManagement© Emerald Publishing Limited1477-7266DOI 10.1108/JHOM-04-2020-0130Findings – Variations were seen in several aspects of practice, including approach to practice and representedprofessions. The palliative consultants were perceived to contribute by creating space for palliative care,adding palliative knowledge and approach, enhancing cooperation and creating opportunity to amelioratetransition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultationservices utilised proactive practices that took the initiative in relation to the receiving wards.Originality/value – A lack of policy and divergent views on how to conceptualise palliative care appeared tobe associated with variations in consultation practices, tentative approaches and a bottom-up drivendevelopment. This study adds knowledge, implying theoretical transferability as to how palliative careconsultations can be practised, which is useful when designing and starting new consultation services.
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| 3. |
- Andersson, Johanna, et al.
(författare)
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Actor or arena : Contrasting translations of a law on interorganizational integration
- 2012
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 26:6, s. 778-793
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – A Swedish framework law has enabled integration between public agencies in vocational rehabilitation. With the support of this law, coordination associations can be formed to fund and organize joint activities. The purpose of this study is to describe and analyze how the law has been interpreted and translated into local coordination associations and how local institutional logics have developed to guide the organization of these associations. Design/methodology/approach – Data was collected through observations of meetings within two coordination associations and supplemented with documents. The material was analyzed by compilation and examination of data from field notes, whereupon the most important aspects were crystallized and framed with institutional organization theory. Findings – Two different translations of the law were seen in the associations studied: the association as an independent actor, and as an arena for its member organizations. Two subsequent institutional logics have developed, influencing decisions on autonomy, objectives and rationality for initiating and organizing in the two associations and their activities. The institutional logics are circular, further enhancing the different translations creating different forms of integration. Research implications/limitations – Both forms of integration are legitimate, but the different translations have created integration with different degrees of autonomy in relation to the member organizations. Only a long-term analysis can show whether one form of integration is more functional than the other. Originality/value – This article is based on an extensive material providing insights into a form of interorganizational integration which has been scarcely researched. The findings show how different translations can influence the integration of welfare services.
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| 4. |
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| 5. |
- Andersson, Johanna, 1981, et al.
(författare)
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Constructing accountability in inter-organisational collaboration: the implications of a narrow performance-based focus
- 2014
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Ingår i: Journal of Health Organization and Management. - 1477-7266. ; 28:5, s. 619-634
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose – The purpose of this paper is to analyse how accounts of collaboration practice were made and used to construct accountability in the empirical context of coordination associations, a Swedish form of collaboration between four authorities in health and social care. They feature pooled budgets, joint leadership and joint reporting systems, intended to facilitate both collaboration and (shared) accountability. Design/methodology/approach – Empirical data were collected in field observations in local, regional and national settings. In addition, the study is based on analysis of local association documents such as evaluations and annual reports, and analysis of national agency reports. Findings – Accountability is constructed hierarchically with a narrow focus on performance, and horizontal (shared) accountability as well as outcomes are de-emphasised. Through this narrow construction of accountability the coordination associations are re-created as hierarchical and accountability is delegated rather than shared. Research limitations/implications – Features such as pooled budgets, joint leadership and joint reporting systems can support collaboration but do not necessarily translate into shared accountability if accountability is interpreted and constructed hierarchically. Practical implications – When practice conforms to what is counted and accounted for, using the hierarchical and narrow construction of acco untability, the result may be that the associations become an additional authority. That would increase rather than decrease fragmentation in the field. Originality/value – This research derives from first-hand observations of actor-to-actor episodes complemented with the analysis of documents and reports. It provides critical analysis of the construction and evaluation of accounts and accountability related to practice and performance in collaboration. The main contribution is the finding that despite the conditions intended to facilitate inter-organisational collaboration and horizontal accountability, the hierarchical accountability persisted.
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| 6. |
- 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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| 7. |
- Andersson, Thomas, 1970-, et al.
(författare)
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Nurturing innovative culture in a healthcare organisation : Lessons from a Swedish case study
- 2022
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Ingår i: Journal of Health Organization & Management. - : Emerald Publishing. - 1477-7266 .- 1758-7247. ; 37:9, s. 17-33
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation. Design/methodology/approach: Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps. Findings: The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important. Practical implications: This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process. Originality/value: The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations.
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| 8. |
- 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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| 9. |
- Anell, Anders
(författare)
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Reconsidering performance management to support innovative changes in health care services
- 2024
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Ingår i: Journal of Health Organization and Management. - 1477-7266. ; 38:9, s. 125-142
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Tidskriftsartikel (refereegranskat)abstract
- PurposeA large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.Design/methodology/approachThe article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.FindingsAn enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.Originality/valueThe article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.
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| 10. |
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| 11. |
- Bergin, E, et al.
(författare)
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Different timetables for change: understanding processes in reorganizations--a qualitative study in a psychiatric sector in Sweden
- 2005
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Ingår i: Journal of health organization and management. - : Emerald. - 1477-7266. ; 19:4-5, s. 355-77
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Tidskriftsartikel (refereegranskat)abstract
- It is well‐known that a decrease in economic resources in health care results in increased workload, stress and pressure on personnel. The main aim of this study was to explore and understand how personnel in health care were influenced by multiple obligations in the context of a changing surrounding.Design/methodology/approachPersonnel within psychiatry were interviewed in an open‐ended, interactive mode. The transcribed interviews were analysed using grounded theory as the method of study.FindingsThese professionals working within a turbulent work situation experienced a struggle between external demands and internal obligations of an ethical or ideological character. For many of them earlier psychological contracts were broken, earlier organizational culture was overthrown and their professional authority was threatened. They were required to change or abandon well‐established professional identities. Fundamental changes such as the transition of theoretical framework or revision of internal obligations have quite a different timetable from a technical change of method or organizational structure.Practical implicationsThe findings of two timetables for change should be addressed when considering reorganizations. If these findings are applied to personnel in health care, seeing them also as patients in the system may be avoided.Originality/valueThe different timetables for external change and internal reorganization, with support from findings in in‐depth interviews, have not been described until now.
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| 12. |
- Bergin, E, et al.
(författare)
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Surviving multiple obligations through stimulation, autonomy, and variation
- 2011
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Ingår i: Journal of health organization and management. - : Emerald. - 1477-7266. ; 25:4, s. 455-68
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Tidskriftsartikel (refereegranskat)abstract
- Professionals in academic health centers (AMCs) face multiple obligations, such as those from research, teaching and clinical care. The purpose of this study is to explore and develop an understanding about how well findings generated from two previous studies about the influence of multiple obligations on health care personnel fit those within health care associated with academic institutions.Design/methodology/approachA total of 11 professionals engaged in teaching, research, and clinical work were interviewed. Data from the open‐ended interactive interviews were transcribed and compared with findings from the two previous studies, using modified analytic induction.FindingsWork at an AMC can entail balancing three tasks: research, education, and clinical care. These tasks as well as the different employers associated with them can be a source of conflict. For a group of committed professionals, these conflicts were accepted and balanced as long as they experienced stimulus, autonomy, and variation.Research limitations/implicationsModified analytic induction, an uncommon analysis method, is useful for comparing findings from previous studies in another context and with different subjects.Practical implicationsStimulation, autonomy, and variation could play a vital role as driving factors in coping and dealing with the unavoidable presence of multiple obligations in today's health care systems.Originality/valueAlthough AMCs combine clinical care, research, and teaching, the intersection of all three has in contrast not been investigated so thoroughly at the individual level.
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| 13. |
- Berglund, Helene, 1957, et al.
(författare)
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Organizing integrated care for older persons: Strategies in Sweden during the past decade
- 2015
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Ingår i: Journal of Health Organisation & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 29:1, s. 128-151
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach – The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings – Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. Research limitations/implications – Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. Practical implications – Guiding clinical practice to be aware of importance of setting follow-up goals.
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| 14. |
- Bergman, David, et al.
(författare)
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Effects of dialogue groups on physicians' work environment
- 2007
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 21:1, s. 27-38
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Purpose – The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. Design/methodology/approach – The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n=68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. Findings – The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. Research limitations/implications – In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. Practical implications – The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. Originality/value – There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.
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| 15. |
- Bergman, D, et al.
(författare)
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Learning from dialogue groups--physicians' perceptions of role
- 2009
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Ingår i: Journal of health organization and management. - : Emerald. - 1477-7266. ; 23:2, s. 225-39
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to examine the aspects of being a physician that such medical professionals mention in dialogue groups when given the opportunity to choose their own topics of discussion.Design/methodology/approachOver a period of two years, 60 physicians participated in eight dialogue groups at one of the main hospitals in Stockholm, Sweden. Five focus group interviews were performed after the final dialogue group session.FindingsQualitative content analysis showed that three themes dominated in the physicians' perceptions of their role: hierarchy and subgroups; understanding of learning and knowledge; clinical work. Very little time in the dialogue groups was spent discussing the third theme, i.e. problems or issues related to patients or their families. The hierarchy among doctors seemed to influence many aspects of the role of these individuals, their healthcare organisation and their work environment. The methodology in the dialogue groups challenged the prevailing hierarchical structures and seemed to improve the relations between different groups of doctors in the hierarchy. For some of the physicians, this also resulted in a new way of perceiving and acting in their professional role.Research limitations/implicationsThe results of this study represent only one hospital.Practical implicationsThe findings may help healthcare managers understand physicians' conceptions of their role.Originality/valueFew intervention studies have considered management programmes directed towards physicians. The present investigation is the first qualitative analysis of the use of dialogue groups within a healthcare setting.
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| 16. |
- Berlin, Johan, 1975-, et al.
(författare)
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From artefact to effect : the organising effects of artefacts on teams
- 2010
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 24:4, s. 412-427
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Earlier studies have identified artefacts, but have only to a lesser degree looked at theireffects. The purpose of this paper is to investigate how artefacts contribute to organisation. Design/methodology/approach – A trauma team at a university hospital has been observed andits members interviewed. Findings – The trauma team showed itself to be rich on artefacts since it had strong internal drivingforces, high legitimacy, and tried to live up to high expectations from the outside. Its members were motivated to be in the forefront of trauma care. Through renewal, the team succeeded in maintaining demarcation. It also succeeded in systemising internal work tasks and made for itself a position in relation to the outside. The team's capacity, however, came to be limited by internal conflicts and battles for prestige. Practical implications – The study shows that informal logic has a strong influence on teams.Teamwork contributed to the development of organisational structure and motivation for the personnel. Originality/value – Earlier studies advocate the important role of artefacts in order to communicate, collaborate, negotiate or coordinate activities. The conclusion is that artefacts also have an organising and developing effect on teams in a fragmented and differentiated healthcare.
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| 17. |
- Blomberg, Helena, 1970-, et al.
(författare)
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A narrative study of newly graduated registered Swedish nurses' establishment in the profession and the portrayal of a healthcare organisation
- 2019
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Ingår i: Journal of Health Organization and Management. - : Emerald Insight. - 1477-7266. ; 33:4, s. 413-425
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this paper is to investigate how the participants talk about their experiences as newly graduated nurses, managers and nursing colleagues in the context of "newcomers' establishment in the profession" and to identify how they portray the healthcare organisation in their narratives. Design/methodology/approach A narrative approach is used to reveal and illustrate three perspectives on the topic "new-comers' establishment". In total, 14 interviews are conducted with 4 managers, 4 nursing colleagues and 6 newly graduated registered nurses. The focus of this study is how a healthcare organisation embraces and retains newly graduated registered nurses and how this is perceived. Findings The newcomers' establishment is facilitated by an orientation programme and an orientation period, individual support provided by managers and colleagues, and the creation of trust to boost confidence in nursing situations. The organisation is portrayed as struggling with high workloads, nursing shortages, high levels of responsibility and showing concern and an interest in the newcomer. The parties criticise the university for not teaching the most basic knowledge, thereby revealing the existence of a theory-practice gap. Originality/value The research shows how building trust amongst the organisation's members is essential for creating a satisfying workplace and the retention of newly graduated registered nurses. Empirical descriptions of newly graduated nurses, managers and nursing colleagues experiences of "newcomers establishment" are rare, which is why the description of such "establishment" in this research increases the value of the paper.
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| 18. |
- Brännström, Inger A
(författare)
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Gender stratification in management. The World Health Organization 2000
- 2004
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 18:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- The World Health Organization (WHO) is a global organization that nowadays has integrated gender issues into its policy, programmes and budget. How then is the state of affairs in the area of gender equity at the ultimate governing bodies of the modern WHO? This study aims to assess the representation of women and men and their promotion within the supreme decision-making bodies of the WHO during the year 2000. Information sources used are the official and confirmed protocols of the 53rd World Health Assembly (WHA) in 2000 and of the two Executive Board (EB) meetings of the corresponding year. A descriptive quantitative content analysis approach is used exclusively. The present study demonstrates strikingly skewed gender distribution, with men substantially at an advantage numerically in the prominent positions at the WHA 2000. Additionally, men also hold an advantage in terms of being promoted to leading positions within the bodies examined, notably all upgraded chairs of the EB during 2000. However, the formerly male-dominated supervisory positions of the WHO are, these days, challenged by women having been elected at the very top of the WHO. The present study stresses the need to elaborate a qualitative research design to advance the understanding of the social construction of gender in supreme governing positions of the modern WHO.
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| 19. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Engaging physicians in organisational improvement work.
- 2013
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Ingår i: Journal of health organization and management. - 1477-7266. ; 27:4, s. 479-97
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Tidskriftsartikel (refereegranskat)abstract
- To improve health-care delivery from within, managers need to engage physicians in organisational development work. Physicians and managers have different mindsets/professional identities which hinder effective communication. The aim of this paper is to explore how managers can transform this situation.
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| 20. |
- Carlström, Eric, 1957, et al.
(författare)
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Organisational Culture and Change - Implementing person-centered care
- 2012
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Ingår i: Journal of Health Organisation & Management. - : Emerald. - 1477-7266. ; 26:2, s. 175-191
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person-centred care (PCC) for patients with chronic heart failure. Design/methodology/approach – Surveys were sent out to 170 nurses. The survey included two instruments – the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC). Findings – The results indicate that a culture with a dominating focus on social competence decreases “routine seeking behaviour”, i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well-defined framework. Practical implications – An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes. Originality/value – Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units – i.e. the health workers in different hospital wards – was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.
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| 21. |
- Carlström, Eric, 1957, et al.
(författare)
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The association between subcultures and resistance to change – in a Swedish hospital clinic
- 2014
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Ingår i: Journal of Health Organisation & Management. - 1477-7266. ; 28:4, s. 458-476
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Tidskriftsartikel (refereegranskat)abstract
- Summary: Purpose: The purpose of this paper was to explore the different subcultures and the employees’ preparedness for change at an orthopaedic clinic in a university hospital in Sweden. The idea was to describe how different working groups might react to the change, in order to discover the possible impact of the model prior to implementation. This approach was based on the fact that costly implementation processes have had disappointing results and limited impacts on some organisations. Design: Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire (OVQ) and Resistance to Change Scale (RTC). Findings: The results suggest a dominance of a human relations culture i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease resistance to change. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. Practical implications: By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. Originality/value: The rational goal/internal processes dimension exerted a stronger association with resistance to change than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low resistance to change. The results are contrary to the accepted understanding of public organisations known to be slow to change. Keywords: Change, Organisational culture, Healthcare, Working groups, Person-centred care, Sweden. Paper type: Research paper
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| 22. |
- Choi, S, et al.
(författare)
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Logics of pre-merger decision-making processes: the case of Karolinska University Hospital
- 2009
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Ingår i: Journal of health organization and management. - : Emerald. - 1477-7266. ; 23:2, s. 240-54
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in‐depth case study of the pre‐merger process of Karolinska University Hospital.Design/methodology/approachBased on extensive document analysis and 35 key informant interviews the paper reconstructed the pre‐merger process, searched for empirical patterns, and interpreted those by applying neo‐institutional theory.FindingsSpanning nearly a decade, the pre‐merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo‐institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only.Practical implicationsThis paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context.Originality/valueThis is the first systematic in‐depth study of a university hospital merger employing a decision‐making perspective.
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| 23. |
- Choi, Soki, et al.
(författare)
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Managing clinical integration : a comparative study in a merged university hospital
- 2012
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Ingår i: Journal of Health Organization & Management. - : Emerald. - 1477-7266 .- 1758-7247. ; 26:4, s. 486-507
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - This paper explores critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase our understanding of why clinical integration succeeds or fails.Design/methodology/approach - We compare two cases of integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged departments of the same specialty from each hospital site. We conducted 53 interviews with individuals representing various staff categories and collected documents to check data consistency.Findings - The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts – clinical management’s 1) interpretation of the mandate, 2) design of the management constellation and 3) approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top-down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom-up management approach within planned boundaries. These findings are basically consistent with the literature’s prescriptions for managing professional organisations.Practical implications - Managers need to understand that public healthcare organisations are based on multiple logics that need to be handled in a balanced way if clinical integration is to be achieved – especially the tension between managerialism and professionalism.Originality/value - By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.
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| 24. |
- Colldén, Christian, 1983, et al.
(författare)
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A value-based taxonomy of improvement approaches in healthcare
- 2017
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Ingår i: Journal of Health, Organisation and Management. - 1477-7266. ; 31:4, s. 445-458
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach: Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs – lean, value-based healthcare, and patient-centered care – are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings: Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as “health outcomes” is widespread, but healthcare professionals are less likely than managers to also view value as a process. Originality/value: The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging “value era”. It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models.
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| 25. |
- Cregård, Anna, 1971-
(författare)
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Inter-occupational cooperation and boundary work in the hospital setting
- 2018
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Ingår i: Journal of Health Organization & Management. - Bingley : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 32:5, s. 658-673
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to add a little piece to the research on boundary work and inter-occupational cooperation by addressing two questions: how do actors perform boundary work in an inter-occupational cooperation project that seeks to improve the personnel health work in a hospital setting? What impact does the boundary work have on such cooperation in the personnel health project?Design/methodology/approach: The study is based on individual, in-depth interviews and participative observations of focus group discussions conducted at a regional municipal organization in Sweden. Respondents are hospital line managers, experts and strategists in the HR departments, and experts from the internal occupational health service.Findings: The concepts on boundary work, which include closing/opening boundary strategies, provide the framework for the empirical illustrations. The cooperation runs smoothly in the rehabilitation work because of an agreed upon process in which the professionals’ jurisdictions are preserved through closing strategies. Illness prevention and health promotion are not areas of inter-occupational cooperation because the stronger actors use closing strategies. While the weaker actors, who try to cooperate, use opening boundary strategies in these areas, they are excluded or marginalized.Research limitations/implications: The empirical investigation concerns one cooperation project and was completed at one data collection point.Originality/value: No similar study of boundary work and inter-occupational cooperation in a hospital setting is available despite the frequency of this professional group configuration in practice. A more inclusive concept of professionalism may facilitate the study of boundary work and inter-occupational cooperation among actors with different professional authority. © Emerald Publishing Limited 2018
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