| 1. |
- Eklöf, Mats, 1953, et al.
(författare)
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Dialogträning på vårdarbetsplatser
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund, syfte och design Begreppet dialog har använts för att definiera välfungerande och utvecklingsinriktad kommunikation och inbegriper att uttrycka genuina uppfattningar, erfarenheter och känslor, att vänta in, lyssna på och respektera andra perspektiv än det egna samt att vara beredd att låta sig påverkas. Studien var en klusterrandomiserad kontrollerad studie av en dialogträningsmetods effekter på dialogklimat och psykosocial arbetsmiljö bland personal vid enheter inom svensk sjukvård. Träningseffekter och träningsprocessen studerades även i en kvalitativ intervjustudie bland tränade. Träningen genomfördes på fem enheter inom svensk sjukvård och fem enheter utgjorde kontrollgrupp. Kontrollbetingelsen bestod av en konventionell föreläsning om dialog på arbetsplatsen. Metod Inklusionskriterier för enheter var chefens motivation och intresse, frånvaro av allvarliga samarbetssvårigheter samt att organisationsförändringar inte planerades under studieperioden. Träningen genomfördes i mindre grupper och följde en fast struktur men där utrymme fanns för situationsanpassade processinterventioner och kunskapsförmedling av tränarna. Tre legitimerade psykoterapeuter med erfarenhet av att leda gruppsamtal var tränare. Data insamlades med enkäter före träning samt 3 och 6 månader efter träning. 277 personer deltog, varav 158 tränades. Intervjuer med 21 deltagare genomfördes efter träningsperioden. Resultat Den kvantitativa effektstudien indikerade positiv träningseffekt på dialogklimat och psykosocial arbetsmiljö, dock med varierande grad av säkerhet. Resultaten pekade på att effekter kunde öka mellan tre- och sexmånadersuppföljningarna, vilket var oväntat. Den kvalitativa studien fann att deltagare kunde berätta om a) omedelbara träningseffekter i termer av Dialogöppningar (öppet klimat under träningen, utrymme för lyssnande och tal, tid för reflektion och perspektivbyte, vägledning i att formulera egna ståndpunkter, medvetenhet om styrkan i normer och värderingar) samt b) Förändrade kommunikationsmönster i arbetet (undvikande av förolämpningar och ironi, att våga säga sin mening och begära, att vara hänsynsfull och balanserad samt att konstruktivt konfrontera). De kvalitativa resultaten visade också förhållanden som möjliggör respektive försvårar dialog på vårdarbetsplatser, samt att motstånd mot träningen förekommit. Slutsatser Vi drog slutsatsen att dialogträning enligt den beskrivna metodiken var effektiv som medel att påverka kommunikationen bland deltagarna i dialogisk riktning och att öka deras inflytande i arbetet. Keywords Dialog, Feedback, Inflytande, Intervention, Kommunikation, Mixed method, Mixed models, Psykosocial, Teamklimat, Vård.
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| 3. |
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| 4. |
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| 5. |
- Adolfsson, Petra, 1970, et al.
(författare)
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After Quantification: Quality Dialogue and Performance in a Swedish Municipality
- 2007
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Ingår i: Financial Accountability & Management. - 0267-4424. ; 23:1, s. 73-89
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Tidskriftsartikel (refereegranskat)abstract
- The article discusses the performance management and quality systems as widely accepted reform processes in the New Public Management (NPM). These reforms are said to be built on a rational model of decision making by gathering information from various accounting, auditing and accountability systems. The chief characteristic of this system is customer focus, which motivates the management and evaluation of an operation. The article further discusses how the model of quality dialogue was implemented by different administrations including the city administrative office, the upper secondary school, and the four districts of the City of Gothenburg.
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| 6. |
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| 7. |
- 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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| 8. |
- Arman, Rebecka, 1976, et al.
(författare)
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Fragmentation in managerial work - A study of first- and second-line managers in health care.
- 2011
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Ingår i: 27th EGOS Colloquium, Gothenburg, 7-9 July. Sub-theme 48: Leadership and managerial work: identity, fairness and work behavior..
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Konferensbidrag (refereegranskat)abstract
- This is a study on health care managers’ work. Ten first- and second-line managers from different types of health care settings were shadowed and interviewed for four days each. Three additional managers were interviewed and observed during meetings. The study contributes to both the managerial work activities and health care management research traditions with its analysis of how fragmentation and processes of power mutually and dynamicly constitute each other in everyday work, a relationship that has previously been unexplored. Scheduled and unscheduled meetings, communication activities, and deskwork consume the majority of managers’ work time. Many short activities, with rapid changes between tasks, characterize their workdays, which can be seen as evidence of work fragmentation. In taking a pragmatist and non-idealist perspective on the processes of power, this study also shows that even when the managers gave accounts of fragmentation, they typically took part in collective negotiations to choose and legitimize their activities. The managers used a narrative of fragmentation to negotiate in order to gain and/or maintain control over selected activities and to legitimately reduce their accountability for those activities. Thus, the managers’ narrative of fragmentation was related dynamically to disciplinary power processes. The qualitative method of interpretation used in the study generated results which are generalizable with respect to the development of useful concepts and a new vocabulary for the study of managerial work.
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| 9. |
- Arman, Rebecka, 1976, et al.
(författare)
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Images of the life metaphor in organizational studies
- 2024
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Ingår i: Handbook of Metaphor in Organization Studies. - Oxford : Oxford University Press. - 9780192895707 ; , s. 137-150
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Metaphors for organization and management have been a subject of strong interest in the area of organizational studies since the 1980s. Metaphors enhance the understanding of organizations and provide a mechanism for critiquing current practices, increasing effectiveness, and improving communication. The Oxford Handbook of Metaphor in Organization Studies provides a comprehensive reference for researchers, educators, and managers. The book comprises twenty-nine chapters, which are authored by over forty contributors, many of whom have played major roles in the development of the field over the years. The theoretical underpinnings of organizational metaphors are explored. An array of metaphorical contexts for understanding management and organizations is presented. The various uses of metaphor as a tool in research, education, and management are addressed, as are the limitations of metaphors. Finally, future research directions related to metaphors in organizational studies and management are proposed.
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| 10. |
- Arman, Rebecka, 1976, et al.
(författare)
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Managerial communication practices - Health care managers’ everyday structuration
- 2012
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Ingår i: Scandinavian Journal of Public Administration. - 2001-7405 .- 2001-7413. ; 16:2, s. 143-163
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to describe and analyse observed managerial communication. The research questions concerned: What characterizes managerial communication practices and the organizational consequences? We make use of structuration theory and view communication as a social interaction process in which temporary structures are negotiated. Ten first- and second-line managers were shadowed. The managers used a combination of structuration of caring, interdependency and accountability typical of health care organizations. The communication practices were related to how new norms of reputation management were institutionalized through structuration. The types of structuration were sometimes contradictory and productive communication was rare or non-existent. The managerial communication practices had consequences for the power and domination and for which issues were signified as part of the agenda. The conclusions can be generalizable to other professional organizations.
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| 11. |
- Arman, Rebecka, 1976, et al.
(författare)
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Managerial communication through legitimation practices
- 2008
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Ingår i: 3rd Nordic Workshop on Health Management and Organization, Uppsala University, December 4-5.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose – This article examines managerial communication in health care organizations based on in-depth empirical observations of leaders’ everyday activities. Design/methodology/approach – A semi-structured observation study in combination with a qualitative interview study is used to investigate what leaders do and what is characterizing managerial communication. Data was collected shadowing ten leaders for approximately four days each at different hospitals in Sweden. Findings – This study concludes that managerial communication was characterized by three different types of legitimacy practices: a) professional legitimacy building processes, b) administrative legitimacy building processes, and c) organizational legitimacy building processes. Managerial communication through professional legitimacy, administrative legitimacy and organizational legitimacy ordered signification of issues and constructed domination systems in the organizations. Research limitations – This research was designed to describe the local leaders’ activities and experiences in the studied setting. Therefore the data provides access to ten leaders’ everyday activities at different hospitals but not to statistical data based on a larger group of leaders. Practical implications – The research contributes to the knowledge of the relevance of practitioners involved in leadership and managerial communication aimed at improving health care practices. Originality/value – The research focuses on managerial communication in health care organizations based on in-depth empirical observations of leaders’ everyday activities and thus up-dates the knowledge and concepts about what leaders do. Article Type: Research paper. Keywords: leadership, managerial communication, legitimacy practices, health care organization.
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| 12. |
- Arman, Rebecka, 1976, et al.
(författare)
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Should we retire later? A study of society and organizational level narratives
- 2018
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Ingår i: 7th International Conference on Rhetoric and Narratives in Management Research (RNMR), March 2018, Barcelona.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Large parts of the world, including all OECD countries, face population ageing (OECD 2017). It has been termed one of the most significant socio-economic challenges currently facing the EU. As part of this challenge, the institution of retirement and the timing of this life event is coming into question (Barouch, Syce & Gregoriou 2014; Fischer, Chafee & Sonnega 2016; Sargent, Lee, Martin & Zikic, 2013). This institution is important for all types of organizations who have employees. The timing of retirement is traditionally mainly depicted as “the earlier the better”, because it gives freedom to the individual (Bengtsson & Flisbäck 2017) and the employer gains resources to employ the new and more up-to-date generation (Pritchard & Whiting 2014). At the same time, there is a competing meta-narrative depicting a need to delay retirement, “for the good of the welfare system” as well as to keep valuable and experienced employees in the workforce and prevent a lack of labor. There is political agreement within the EU that an alarming increase in the “demographic dependency ratio” should be addressed: as EU citizens, we are encouraged to work more years in order to help sustain the welfare systems. However, the choice when to retire is by no means entirely up to the individual. In Sweden, collective agreements between social partners largely set the work life exit-frameworks. An employer may well apply a policy to encourage employees to exit prematurely, by providing attractive employment pension benefits already at age 60. From an employer’s perspective, motives for keeping older workers beyond retirement are often a current - or predicted future - lack of younger skilled labor and thus employers see a prolonged work life as a way to keep and develop competence within the workplace as well as taking social responsibility (Brooke & Taylor 2005). Thus, a pure business or organizational efficiency perspective can be taken, or this can be complemented and most likely mixed with issues of legitimacy and normative values of what is socially responsible for an organization to do (Cedefop 2010; Midtsundstad 2011; Wallin and Hussi 2011; Baldauf and Lindley 2013; Larsen and Pedersen 2017). Thus, there is not one way to make sense of and narrativize the need for prolonging work life and delaying retirement. It is against this background that this study will show how and why the society wide actors as well as organizational actors are taking part in (re-)creating retirement timing norms and practices. We propose that a narrative analysis can uncover the dynamics of the translation between meanings at within different arenas in society. This has implications for our understanding of the changes and maintenance in patterns of actions, in this case the institution of retirement timing. In our efforts, we join a stream of recent studies showing a renewed interest in specific so-called “cultural” aspects of institutionalization: particularly the meaning that actors bring to and associate with the actions that constitute recurring organizational practices (Zilber, 2008). We take the starting point of several other authors who argue that there is a need to turn back attention to the creation of the very taken-for-grantedness that is the hallmark of institutionalization (Zilber, 2008). Several studies make use of narrative analysis and concepts in order to explore the meaning structures used in organizational settings (e.g. Haack, Shoeneborn & Wickert 2012; Landau, Drori & Terjesen 2014; Zilber 2002 & 2009). The aim of the current study is to find out how the society-level narratives intended to influence practices concerning work life exits has had an influence over workplace-level narratives regarding attitudes towards older employees and retirement timing’. We also develop the narrative conceptual tools for studying organizational change further. The study was carried out using two main sources of data, documents and a qualitative case study of two large Swedish employers, one public and one private. In the document study, we mapped how stakeholders at two societal levels (the EU and Swedish national arena) narrativized their views with respect to the issue of retirement and work life exits. The case study involved interviews with all relevant actors in the two organizations, which included top-managers, line managers, HR-specialists, trade union representatives and employees – both older and their younger colleagues. At the societal level we found two competing institutional meta-narratives: 1) retirement plotted as an issue of economic efficiency where older workers have gone from being a burden to becoming a resource, and 2) retirement plotted as a human values and rights issue with retirement going from being coerced at a specific age to being the choice of the individual. In the efficiency narrative, the sustainability of the welfare system is at stake, the dependency ratio and inefficient use of labor causes strains. Policy makers are important and incentives, regulations and demography are explanatory devices. In Sweden, social partners are the villains, since they make agreements that cause significant numbers of early retirements, and individuals are also depicted as responsible to work as long as they are able. In the rights and values narrative, healthy and “employable” individuals who want to work longer should not be forced to exit for regulatory or discriminatory reasons while unhealthy and non-employable individuals who are forced to continue working should be supported in order to reach equality. The individuals’ opportunities and choice is important: employers, poor work environments and regulation should be adjusted accordingly. In the two organizations that we studied, the society level efficiency narrative translated into a dominant story of the wish to select the sufficiently efficient older workers to continue to develop, employ them longer, as well as make use of their knowledge beyond the statutory or traditional early retirement age. However, the story of equality, the individuals’ freedom of choice and equal opportunities was submerged into the story of efficiency. Age diversity and taking responsibility for older workers was only mentioned as instrumental in order to keep selected valuable labor and increase “employer attractiveness/branding” in order to decrease the cost of recruitment in a tight labor market. The notion of competence and workability overrides other values, even in the stories of the employed and the union representatives. These findings as well as the implications for theory and practice will be developed further in the extended abstract. References Baldauf, B. Lindley, R. (2013). Active ageing and age management – European case studies focusing on the caring sectors and local government. Research, Policy and Planning 30(1):37-50 Baruch, Yehuda, Susan Sayce, Andros Gregoriou, (2014) "Retirement in a global labour market: a call for abolishing the fixed retirement age", Personnel Review, Vol. 43 Issue: 3, pp.464-482, https://doi.org/10.1108/PR-04-2013-0059 Bengtsson, M., & Flisbäck, M. (2017). On leaving work as a calling: retirement as an existential imperative. International Journal of Ageing and Later Life, 11(1), 37-67. Brooke, L. Taylor, P. (2005). Older workers and employment: managing age relations. Ageing and Society, 25, pp 415-429 doi:10.1017/S0144686X05003466 Cedefop (2010). Socially responsible restructuring – Effective strategies for supporting redundant workers. (Working paper No 7). Luxembourg: Publications Office of the European Union Fisher, G. G., Chaffee, D. S., & Sonnega, A. (2016). Retirement timing: A review and recommendations for future research. Work, Aging and Retirement, 2(2), 230-261. Haack, P., Schoeneborn, D., & Wickert, C. (2012). Talking the talk, moral entrapment, creeping commitment? Exploring narrative dynamics in corporate responsibility standardization. Organization Studies, 33(5-6), 815-845. Landau, D., Drori, I., & Terjesen, S. (2014). Multiple legitimacy narratives and planned organizational change. Human Relations, 67(11), 1321-1345. Larsen, M. & Pedersen, P.J. J Labour Market Res (2017). Labour force activity after 65: what explain recent trends in Denmark, Germany and Sweden? 50(1):15–27 https://doi.org/10.1007/s12651-017-0223-7 Pritchard, K., & Whiting, R. (2014). Baby boomers and the lost generation: On the discursive construction of generations at work. Organization Studies, 35(11), 1605-1626. Sargent, L. D., Lee, M. D., Martin, B., & Zikic, J. (2013). Reinventing retirement: New pathways, new arrangements, new meanings. Human Relations, 66(1), 3-21. OECD (2017), Pensions at a Glance 2017: OECD and G20 Indicators, OECD Publishing, Paris. Wallin, M. Hussi, T. (2011). Best practices in Age management- evaluation of organisation cases. Helsinki: National Institute of Occupational Health. Zilber, T. B. (2002). Institutionalization as an interplay between actions, meanings, and actors: The case of a rape crisis center in Israel. Academy of management journal, 45(1), 234-254. Zilber, T. B. (2008). The work of meanings in institutional processes. The SAGE handbook of organizational institutionalism, 151-168.
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| 13. |
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| 14. |
- Arman, Rebecka, 1976, et al.
(författare)
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The hierarchization of competing logics in psychiatric care in Sweden
- 2014
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Ingår i: Scandinavian Journal of Management. - : Elsevier BV. - 0956-5221. ; 30:3, s. 282-291
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Tidskriftsartikel (refereegranskat)abstract
- In many healthcare organizations, the managerial institutional logic co-exists and competes with the professional institutional logic in the day-to-day work of managers and professionals. In its examination of the relationship between these two institutional logics at three psychiatric care units for children and adolescents, this study contributes to our understanding of the theoretical concepts and their practical implications for the actor-to-actor approaches to competing institutional healthcare logics. Many earlier studies use theoretical concepts to describe this co-existence as a relatively equal relationship between the competing logics. This study, using data from interviews, observations and shadowing, reveals the existence of a process we label “hierarchization”. In this process, the managerial logic dominates the professional logic although the latter logic still co-exists and competes, albeit in a subordinate role. The study also reveals that quantification of primarily patient throughput is used to legitimize the dominant managerial logic. Such use of quantification supports the meta-trend of placing trust in numbers.
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| 15. |
- Arman, Rebecka, 1976, et al.
(författare)
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‘We don't talk about age’: A study of human resources retirement narratives
- 2022
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Ingår i: Ageing & Society. - 0144-686X .- 1469-1779. ; 42, s. 2588-2614
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Tidskriftsartikel (refereegranskat)abstract
- At the societal and policy level, delaying retirement is generally agreed upon to solve the problem of the increasing proportion of older workers in Sweden, as in many other countries. At the same time, two co-existing narratives that create legitimacy for early versus delayed retirement were found in our study, among both societal- and organisational-level actors. Older workers are viewed as either representatives of productive ageing and a solution to labour shortage problems, or as a barrier to recruiting younger, more promising employees with new skills. Through inductive qualitative analysis, this study shows in what way human resources departments are taking part in the institutional work of maintaining retirement-timing narratives in Swedish workplaces. The existing general organisational narrative of ‘the business case’ is used to mute discussion about delaying the retirement age, except for a select few. Their maintenance of this narrative is supported by the way in which the societal-level narratives target the individual, often backgrounding the role of employers.
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| 16. |
- Arman, Rebecka, 1976, et al.
(författare)
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What health care managers do : Applying Mintzberg’s structured observation method
- 2009
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 17:6, s. 718-729
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of the present study was to explore and describe what characterizes first-and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first-and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.
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| 17. |
- Arman, Rebecka, 1976, et al.
(författare)
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Work activities and stress among managers in health care
- 2012
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Ingår i: The Work of Managers - Towards a Practice Theory of Management.. - Oxford, U.K. : Oxford University Press. - 9780199639724
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 18. |
- Dellenborg, Liselott (Lisen), 1966, et al.
(författare)
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Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden
- 2019
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Ingår i: Advances in Health Sciences Education. - : Springer Science and Business Media LLC. - 1382-4996 .- 1573-1677. ; 24:2, s. 353-381
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Tidskriftsartikel (refereegranskat)abstract
- While person-centred care has gained increasing prominence in recent decades as a goal for healthcare systems, mainstream implementation remains tentative and there is a lack of knowledge about how to develop person-centred care in practice. This study therefore aimed to explore what may be required in order for person-centred care programmes to be successful. The study used an ethnographic method of data collection. This consisted of closely following an implementation programme on a medical emergency ward in a Swedish hospital. Data consisted of participant observation and informal interviews with healthcare providers and their management leaders while they were in the process of training to use person-centred care. These interlocutors were using action learning methods under the guidance of facilitators. Our findings revealed that although the programme resulted in some of the processes that are central for person-centred care being developed, organisational factors and a lack of attention to ethics in the programme counteracted these positive effects. The study highlights the importance of facilitating mechanisms to produce desired results. These include management leaders’ learning about the dynamic and collective nature of learning processes and change. They also include allowing for inter-professional dialogue to enable managers and professionals to reflect deeply on professional boundaries, disciplinary knowledge and power relations in their teams. Teamwork is essential for the development of person-centred care and documentation, in accordance with this specific implementation programme, is also indispensable. The space for inter-professional dialogue should also accommodate their various perspectives on the aims of care and organizational reality.
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| 19. |
- Dellve, Lotta, 1965, et al.
(författare)
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A stepwise qualitative approach to support a balanced time-use among health care leaders
- 2008
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Ingår i: The 5th Nordic Interdisciplinary Conference on Qualitative Methods in the Service of Health, Stavanger.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Stress among health care leaders may have impact of quality of care, leaders' turnover and employee stress. The need for leader support is well recognized, but there are few empirical studies about qualities, implementation and effect. Aim To develop leadership support, to handle central challenges, defined by leaders themselves. This presentation focus on methodological challenges in the stepwise development and implementing of a support program. Method (a) Qualitative in-depth interviews, and focus-groups of challenges and needed support, analysed by constructivist grounded theory. A central challenge was their time-use, i.e. working hours and time-allocation between strategic, employeeship and administrative tasks. (b) A model for observation and intervention of time-use and leadership practice was developed: each leader was shadowed during four days incl daily interviews and "calender interview" of self-reported activities. The intervention involved mirroring the leaders' everyday activities and encouraging reflective communication of their experienced challenges in a group setting. Follow-up of observation after three months. Results Two leadership strategies were used to meet different logics and demands; (a) leadership by separating the logics and fragmenting them into different spaces of time. Here, leaders strived to define, structure, divide and allocate tasks. (b) leadership by integrating different logics by the currentness of solutions and a proactive leadership style that shaped the basis for participative employeeship. Additionally, compound identities, loyalty commitments and interests shape conditions for increased or maintained influence. Strategies to achieve legitimacy were either to retaining clinical skills and a strong occupational identity or taking a full leadership role.
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| 21. |
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| 22. |
- Dellve, Lotta, 1965, et al.
(författare)
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Health care leaders’ stress, fragmentation of work and time-use strategies
- 2008
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Ingår i: International Symposium Activity 2008, May 12-14, 2008, Helsinki, Finland.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The complex nature of the psychosocial work environment with its trend of increasing occupational stress creates challenges for today’s health care leaders (HCL). Health, work ability and performance among health care workers have been related to leadership qualities and strategies. While, leaders own stress has been qualitatively related to fragmentation of work, compound identities and loyalty commitments. However, most of earlier studies are based on interviews or questionnaires, and few on observations. This study was conducted within a research program with the purpose to understand and support sustainable leadership in health care organizations. Adopting the Mintzberg structured observational method of leaders’ activities and behavior in combination with interviews and stress-indicators, we investigated what HCL really do at work and what kind of leadership activities that were related to stress. The further aim was to develop a method for support in sustainable time-use, sustainable from the perspective of leadership practice (quality and performance) and individual health among leaders. Method: Strategically selected HCL (n=10) were observed during one week each. Stress was measured by continuous heart-rate and the stress-energy scale (4 times a day). The HCL were also interviewed at the end of the days as well as in-depth after the observation period. Results: The result from the observations show that stress was observed in relation to frequently being interrupted (causing a fragmentation in their work). While, low stress was observed during uninterrupted times of administrative work (24% of their working time). In comparison with studies of other leaders, HCL had more and shorter activities. In total, 2 473 activities was observed during a week (3-14 activities/h). Most, 59% of their working time comprised of meetings (scheduled and unscheduled), especially with their subordinates (73%) and <1% with their own superior. Little time was used for preparation and reflection (1-9%) and there was almost no time between the activities. The method for support in sustainable time-use comprise a shorter observation, mirroring and own reflection and, group-wise mirroring to increase insight of alternative strategies.
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| 23. |
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| 24. |
- Dellve, Lotta, 1965, et al.
(författare)
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Managerial work at top- and lower-levels to handle values of quality of care, efficiency and work environment
- 2016
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Ingår i: The 10 NOVO symposium. Sustainable healthcare through professional collaboration across boundaries, 10-11 november 2016.. - Reykjavik : Administration for Occupational Health and Safety. - 9789935926555
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Konferensbidrag (refereegranskat)abstract
- Introduction: The critique of NPM of health care service is vast especially regarding consequences for work environment and professional autonomy. However, implications of new concepts and management trends, e.g. value-based leadership and open management, for lower-level managerial work practice and the outcomes of their work are less known. This study focuses top and lower level managers’ work and communication of values of quality of care, efficiency and work environment through Key Performance Indicators (KPI). Material and methods: A qualitative driven mixed method study-design was used with statistical analysis (mixed models repeated measures) of the generated hypothesis. Data from 5 Swedish public hospitals (2012-2015) was used: interviews with managers at top- and lower levels (n=198), the yearly questionnaire to managers (n=429) and employees’ (n=1361) and observations at the work units. Results: Top managerial approaches in managing and communicating KPI was observed related to how logics of control vs. trust, vision and visualization formed the interaction between managers at top- and lower levels: (a) Intervening governance to create clarity of prioritized KPI, (b) Practice-serving prioritizing of KPI to create trust and enthusiasm at lower levels as well as meta-learning, (c) Store front strategies showing success and “best practice” to stimulate internal interest and support external accountability. The top management approaches had impact on the lower level managers’ work with improvements and KPI: what KPI that was prioritized, their work situation, stress and job satisfaction. The two-year follow-up showed different patterns of outcomes regarding efficiency, quality of care and work environment conditions, as well as workers stress and engagement, related to the top-level managerial approaches. Conclusions: Value-based leadership and open management have various grounds, logics and practice. Top management approaches have substantial impact on lower-level managers’ work with improvements of values and prioritizing of key performance indicators as well as on the outcomes and working conditions.
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| 25. |
- Dellve, Lotta, 1965, et al.
(författare)
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Managing complex workplace stress in health care organisations: Leaders' perceived legitimacy conflicts
- 2009
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Ingår i: International Journal of Nursing Management. - : Wiley-Blackwell Publishing Ltd.. - 0966-0429 .- 1365-2834. ; 17:8, s. 931-941
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Tidskriftsartikel (refereegranskat)abstract
- Aim To conceptualize how health care leaders’ strategies to increase their influence in their psychosocial work environment are experienced and handled, and may be supported. Background The complex nature of the psychosocial work environment with increased stress creates significant challenges for leaders in today’s health care organizations. Method Interviews with health care leaders (n = 39) were analysed in accordance with constructivist grounded theory. Results Compound identities, loyalty commitments and professional interests shape conditions for leaders’ influence. Strategies to achieve legitimacy were either to retain clinical skills and a strong occupational identity or to take a full leadership role. Ethical stress was experienced when organizational procedural or consequential legitimacy norms were in conflict with the leaders’ own values. Leadership support through socializing processes and strategic support structures may be complementary or counteractive. Conclusions Support programmes need to have a clear message related to decision-making processes and should facilitate communication between top management, human resource departments and subordinate leaders. Ethical stress from conflicting legitimacy principles may be moderated by clear policies for decision-making processes, strengthened sound networks and improved communication. Implications for nursing management Supportive programmes should include: (1) sequential and strategic systems for introducing new leaders and mentoring; (2) reflective dialogue and feedback; (3) team development; and (4) decision-making policies and processes.
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