| 1. |
- Kjellström, Sofia, 1970-, et al.
(author)
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Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden.
- 2017
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In: Journal of Health Organization and Management [1477-7266]. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:4, s. 487-502
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Journal article (peer-reviewed)abstract
- Abstract Purpose – The purpose of this paper is to explore work motivation among professionals at well-functioningprimary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach – Five primary healthcare centers in Sweden were purposively selectedfor being well-operated and representing public/private and small/large units. In total, 43 interviews werecompleted with different medical professions and qualitative deductive content analysis was conducted. Findings – Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematicquality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications – Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications – The design of the reforms and leadership are essential preconditions for work motivation. Originality/value – The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.
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| 2. |
- Nyström, Monica E., et al.
(author)
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Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
- 2018
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In: BMC Health Serv Res. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
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Journal article (peer-reviewed)abstract
- Background: Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention. Methods: The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge-all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. Results: The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. Conclusions: An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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| 3. |
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| 4. |
- Andersson Bäck, Monica, 1969, et al.
(author)
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Do middle managers have room for manoeuvre in Swedish human service organisations?
- 2015
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In: 33rd Annual International Labour Process Conference, Athens, Greece 13-15 April 2015.
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Conference paper (other academic/artistic)abstract
- Middle managers in Swedish human service organisations are responsible for implementing the many goals and visions of government as formulated in policy. Since the 1980’s there is a growing expectation that these goals should be materialized through HRM strategies. In the wake of New Public Management (NPM), HRM has become significant in human service organisations as expressed in proliferation in the numbers and specializations of managers, a development of management rhetoric and particularly investments in managerialism and managers as a way of achieving change. This paper reports on the contradictory positions that arise for middle managers, in human service organizations where HRM is integral part of managerial repertory. The aim is to examine how the role of middle manager is impacted as a result of this increasing organizational complexity and governance. As part of the middle-layer, middle managers must balance the various aspects of their work from a weak power base, and act as a buffer between their staff and their seniors. As a result, inconsistencies between the expectations of the organization and the individual employees they manage create tension, conflict and feelings of powerlessness that may result in increased inefficiency - the opposite of the organizational intention. This research is based on interviews and observations of 30 Swedish middle managers from human service organisations over a period of two years. We use qualitative text analyses to analyse our data. We expect to find that middle managers use different types of strategies to give meaning to the work they do and create room for manoeuvre in everyday practice.
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| 5. |
- Andersson Bäck, Monica, 1969, et al.
(author)
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Identity work of successful primary care managers and competing institutional logics
- 2017
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In: EGOS 2017, Copenhagen.
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Conference paper (other academic/artistic)abstract
- AbsThis paper rests on bourgeoning research that has awakened a strong interest among organizational scholars, considering self-reflexive identity work linked to the processes of revealing, effectuating, and reflecting change of institutional logic. We combine two strands of theories, the one related to institutional logics perspective with theory of identity work. Based on a qualitative case study and against the background of change in Swedish primary healthcare, we aimed to explore institutionalization processes related to micro-social interactions of five primary care managers, who were handling a multiplicity of institutional logics – competing, co-existing and complementing – while working their identity in relation to significant actors. The findings showed mechanisms of change, and as a result new constellations of logics. The constellations varied however from primary care center to center, and from manager to manager, visualizing individual variation in influencing institutional logics as well as being influenced. The findings demonstrated managers’ identity work as a process in which the managers strive to work managerial ideas, self-perceptions, and experiences, as well as expectations and views held by significant others.
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| 6. |
- Andersson Bäck, Monica, 1969, et al.
(author)
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Lofty ideals and lowly troubles among nursing home managers
- 2018
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In: The Management of Wicked Problems in Health and Social Care. - New York, NY : Routledge, 2019. | Series: Routledge studies in health management : Routledge. - 9781138103627 - 9781351592536 ; , s. 62-74
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Book chapter (peer-reviewed)
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| 7. |
- Andersson Bäck, Monica, 1969, et al.
(author)
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Mellan två stolar
- 2016
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In: Makt och inflytande i arbetslivet. - Stockholm : PremissFörlag. - 9789186743536 ; , s. 117-168
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Book chapter (peer-reviewed)abstract
- I det här kapitlet har vi fokuserat på hur mellanchefer vidtar olika typer av strategier för att hantera krav och förväntningar på dem och deras arbete. Vi har valt att tolka mellanchefarnas strategier i termer av makt respektive frånvaro av makt.
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| 8. |
- Andersson Bäck, Monica, 1969
(author)
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Motivation och finansiella incitament - En litteraturöversikt över de komplexa drivkrafterna inom vård och omsorg
- 2015
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Reports (other academic/artistic)abstract
- Rapporten syftar till att ge en sammanfattande översikt över aktuella studier och teorier på området och hur dessa omsätts i praktiken i hälso- och sjukvården samt omsorgen, både i Sverige och internationellt. Sammantaget utmanas vårdens och omsorgens ledning och styrning enligt de vårdprofessionellas egna logiker och värderingar av nya och utifrån kommande drivkrafter och tekniker för ledning och styrning. Komplexiteten i verksamheterna förutsätter att man möter utvecklingen genom kunskapsområde för drivkrafter och incitament, vilket säkerställs genom en flervetenskaplig ansats.
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| 9. |
- Andersson Bäck, Monica, 1969
(author)
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Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat. Comment on “Governance, Government, and the Search for New Provider Models”
- 2016
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In: International Journal of Health Policy and Management. - : Maad Rayan Publishing Company. - 2322-5939. ; 5:8, s. 511-513
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Journal article (peer-reviewed)abstract
- Recognizing the advantages of primary care as a means of improving the entire health system, this text comments on reforms of publicly funded primary health centers, and the rapid development of private for-profit providers in Sweden. Many goals and expectations are connected to such reforms, which equally require critical analyses of scarce resources, professional trust/motivation and business logic in the wake of freedom and control of ownership and management. In line with Saltman and Duran, this article calls for research and a methodologically developed approach to capture everyday practice in-depth and how regulation, market incentives and patient demands are met by professionals and primary care leaders.
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| 10. |
- Andersson Bäck, Monica, 1969, et al.
(author)
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The Norrtaelje model: a unique model for integrated health and social care in Sweden
- 2015
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In: International Journal of Integrated Care. - 1568-4156. ; 15:Special Issue: SI, s. 1-11
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Journal article (peer-reviewed)abstract
- Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This “top-down” approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.
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| 11. |
- Areskoug Josefsson, Kristina, 1973-, et al.
(author)
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Workers' experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study
- 2018
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:4, s. 406-414
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Journal article (peer-reviewed)abstract
- Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.
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| 12. |
- Avby, Gunilla, 1965-, et al.
(author)
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Tending to innovate in Swedish primary health care: a qualitative study
- 2019
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19
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Journal article (peer-reviewed)abstract
- BackgroundPolicymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jonkoping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.MethodsFive Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.ResultsThis study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.ConclusionsThis qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy push with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.
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| 13. |
- Russell, Bob, et al.
(author)
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System, society and dominance effects in the adoption of tele-health: A tri-country comparison
- 2017
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In: Economic and Industrial Democracy. - 0143-831X .- 1461-7099. ; 38:3, s. 425-447
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Journal article (peer-reviewed)abstract
- Although there have been many studies of low skilled call centre operators, research on professional workers in call centres is less common and cross-national research on such operations even rarer. This article compares the labour process experiences of tele-nurses – registered nurses in call centre settings – across three countries: the UK, Australia and Sweden. Using cross-national, comparative ethnographies, through a system, society and dominance (SSD) approach, the article explores the common problems tele-nurses face as well as distinctive societal differences in the ways in which this branch of e-health care is being established. The outcomes reveal both societal diversity and mounting pressures towards a globalizing conformity between the three countries with regard to the working practices of tele-nursing. The findings have important implications for whether or not a professional project can be developed around tele-health care.
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| 14. |
- Szücs, Stefan, 1964, et al.
(author)
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Ledarskap inom människobehandlande organisationer
- 2015
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In: Människobehandlande organisationer - Villkor för ledning, styrning och professionellt välfärdsarbete Redakröter: Staffan Johansson, Peter Dellgran & Staffan Höjer. - Stockholm : Natur & Kultur. - 9789127136311 ; , s. 232-251
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Book chapter (peer-reviewed)
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| 15. |
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