| 1. |
- Cregård, Anna, 1971, et al.
(författare)
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Perceptions of trust in physician-managers
- 2015
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887 .- 0952-6862. ; 28:4, s. 281-297
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. Design/methodology/approach – The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. Findings – The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians’ trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. Research limitations/implications – This paper’s findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. Practical implications – The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. Originality/value – The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.
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| 2. |
- Andersson, Thomas, 1970-
(författare)
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The medical leadership challenge in healthcare is an identity challenge
- 2015
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 28:2, s. 83-99
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Tidskriftsartikel (refereegranskat)abstract
- Purpose– The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face.Design/methodology/approach– Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action.Findings– This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians.Research limitations/implications– The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership.Practical implications– Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership.Originality/value– Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.
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| 3. |
- Ingelsson, Pernilla, 1968-, et al.
(författare)
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Strengthening quality culture in private sector and health care: What can we learn from applying soft measures?
- 2018
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Ingår i: Leadership in Health Services. - 1751-1879 .- 1751-1887. ; 31:3, s. 276-292
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this study is to present a comprehensive approach to studying organizational culture using “soft measures” to facilitate sustainable quality development in organizations. The purpose is also to present, discuss and compare the results from a survey designed to measure a company’s value base.Design/methodology/approach – A number of different methods were used to collect soft data to study and measure organizational culture and at the same time influence the culture and the leadership within three organizations. One method, the survey, was used on two different occasions to obtain an overview of the culture within an organization and to investigate if the activities had influenced the culture and the leadership.Findings – The application of soft measures used by leaders to study and develop organizational culture resulted in statistically significant positive changes in organizational work culture, according to a pre-post survey after a short period of one year.Practical implications – The approach can be used by leaders in different types of organizations as the challenge of changing the organizational culture through the leadership seems to be a common challenge regardless of line of business.Originality/value – The study shows the benefits of using a comprehensive approach to assess an organization’s culture based on qualitative measures and analysis.
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| 4. |
- Kajonius, Petri, et al.
(författare)
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Organizing Principles and Management Climate in High-Performing Municipal Elderly Care
- 2016
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 29:1, s. 82-94
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Previous research has shown that user-oriented care predicts older persons’ satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The present study set out to investigate the organizing principles and management climate characterizing successful elderly care organizations.Design – The care organization in one highly ranked municipality was selected and compared with a more average municipality. On-site semi-structured in-depth interviews with managers as well as participatory observations at managers’ meetings were conducted in both municipalities.Findings – The results revealed three key principles for successful elderly care: 1) organizing care from the viewpoint of the older service user, 2) recruiting and training competent and autonomous employees, 3) instilling a vision for the mission which guides operations at all levels in the organization. Furthermore, using climate theory to interpret the material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing things right characterizing the more average municipality.Value – We suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the upper management, i.e., the views of the older persons, the co-workers, and the mission. The results can guide future care quality developments and increase the understanding of the importance of organizational climate at the senior management level.
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| 5. |
- Lornudd, C., et al.
(författare)
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A randomised study of leadership interventions for healthcare managers
- 2016
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Ltd.. - 1751-1879 .- 1751-1887. ; 29:4, s. 358-376
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper was to assess two different leader development interventions by comparing their effects on leadership behaviour and evaluating their combined impact after two years, from the viewpoints of both the participating managers and external raters. Design/methodology/approach: The study was a longitudinal randomised controlled trial with a cross-over design. Health care managers (n = 177) were first randomised to either of two 10-month interventions and a year later were switched to the other intervention. Leadership behaviour was rated at pre-test and 12 and 24 months by participating managers and their superiors, colleagues and subordinates using a 360-degree instrument. Analysis of variance and multilevel regression analysis was performed. Findings: No difference in effect on leadership behaviour was found between the two interventions. The evaluation of the combined effect of the interventions on leadership behaviour showed inconsistent (i.e. both increased and decreased) ratings by the various rater sources. Practical implications: This study provides some evidence that participation in leadership development programmes can improve managers’ leadership behaviours, but the results also highlight the interpretive challenges connected with using a 360-degree instrument to evaluate such development. Originality/value: The longitudinal randomised controlled design and the large sample comprising both managers and external raters make this study unusually rigorous in the field of leadership development evaluations.
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| 6. |
- Lornudd, C., et al.
(författare)
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Healthcare managers’ leadership profiles in relation to perceptions of work stressors and stress
- 2016
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Ltd.. - 1751-1879 .- 1751-1887. ; 29:2, s. 185-200
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this study is to investigate the relationship between leadership profiles and differences in managers’ own levels of work stress symptoms and perceptions of work stressors causing stress. Design/methodology/approachCross-sectional data were used. Healthcare managers (n = 188) rated three dimensions of their leadership behavior and levels of work stressors and stress. Hierarchical cluster analysis was performed to identify leadership profiles based on leadership behaviors. Differences in stress-related outcomes between profiles were assessed using one-way analysis of variance. FindingsFour distinct clusters of leadership profiles were found. They discriminated in perception of work stressors and stress: the profile distinguished by the lowest mean in all behavior dimensions, exhibited a pattern with significantly more negative ratings compared to the other profiles. Practical implicationsThis paper proposes that leadership profile is an individual factor involved in the stress process, including work stressors and stress, which may inform targeted health promoting interventions for healthcare managers. Originality/valueThis is the first study to investigate the relationship between leadership profiles and work stressors and stress in healthcare managers.
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| 7. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Leading Processes of Patient Care and Treatment in Hierarchical Healthcare Organizations in Sweden – Process Managers’ Experiences
- 2015
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Ingår i: Leadership in Health Services. - 1751-1879 .- 0952-6862. ; 28:2, s. 135-148
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers' experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization. Design/methodology/approach - This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style. Findings - The process managers' experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager's responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager. Research limitations/implications - Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings. Originality/value - This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers' experiences, a subject that has not been investigated earlier.
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| 8. |
- Nordin, Annika, et al.
(författare)
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Behavioural and operational outcomes of a Master’s programme on improvement knowledge and leadership : A survey study
- 2019
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 32:4, s. 525-542
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to evaluate behavioural changes and operational outcomes resulting from a Master’s programme on improvement knowledge and leadership in the Swedish welfare sector. The welfare sector is the collective term for tax-funded services the state, county councils and municipalities are responsible to provide.Design/methodology/approach: A survey combined open-ended and closed questions using a five-point Likert scale. The questions were based on the learning objectives of the Master’s programme. The survey was sent to 139 graduates and achieved a response rate of 41 per cent (57 respondents). Responses were entered into a survey programme to enable the descriptive presentation of data; open-ended responses were analysed using conventional content analysis.Findings: Respondents reported their increased knowledge and changed behaviours had impacted operational outcomes, e.g. processes efficiency, compliance with guidelines and quality. They said the programme was of value to themselves and society but requested more leadership knowledge. All respondents recommended the programme to others.Originality/value: By operationalizing the Kirkpatrick framework, the paper describes outcomes on levels three and four, and the use of numerous best practice techniques for adult learning. This is valuable knowledge for organisers of improvement knowledge educations.
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| 9. |
- Nordin, Annika, et al.
(författare)
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Prospective sensemaking of a national quality register in health care and elderly care
- 2018
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 31:4, s. 398-408
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.Design/methodology/approachThis is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.FindingsWell-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.Originality/valueThe number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory.
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| 10. |
- Nordin, Annika, et al.
(författare)
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Sensemaking and cognitive shifts – learning from dissemination of a National Quality Register in health care and elderly care
- 2018
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Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 31:4, s. 371-383
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.Design/methodology/approachThe data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.FindingsThe ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.Originality/valueThe study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops.
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