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The staff's experience of structural changes in the health and medical service in western Sweden.
University of Borås, Sweden.
Nordic Council of Ministers, Nordic School of Public Health NHV.
Nordic Council of Ministers, Nordic School of Public Health NHV.
1999 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 7, no 5, 289-98 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The structure and contents of the health and medical service have changed in recent years. The merger of Norra Alvsborgs and Uddevalla hospitals into one local district under one leadership (the NU medical service) is a Swedish example of a structural change.

AIMS: This study intends to describe and analyse the staff's experience of a recently accomplished structural change in the local district NU medical service in the western part of Sweden.

METHODS: This study has been carried out from a qualitative point of view inspired by grounded theory. From a theme guide with specific questions, 31 interviews were carried out with staff working in the NU medical service.

FINDINGS: Four categories emerged from the body of interviews: 'participation', 'doubts', 'anxiety' and 'faith'. 'Participation' was defined as an overall core category, and was related to the other categories. The categories 'doubts', 'anxiety' and 'faith' were related to sub-categories and affected by the overall category 'participation'.

CONCLUSIONS: The overall results point to the importance of participation of staff members concerned. The role of the leadership when undergoing structural changes is considered as a major factor to make other staff members participate.

Place, publisher, year, edition, pages
1999. Vol. 7, no 5, 289-98 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3668PubMedID: 10786548OAI: oai:DiVA.org:norden-3668DiVA: diva2:785438
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-03Bibliographically approved
In thesis
1. Ledarskap och medarbetarskap vid strukturella förändringar i hälso- och sjukvården: Nyckelaktörers och medarbetares upplevelser
Open this publication in new window or tab >>Ledarskap och medarbetarskap vid strukturella förändringar i hälso- och sjukvården: Nyckelaktörers och medarbetares upplevelser
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund och syfte Inom hälso- och sjukvården har krav på ökad effektivitet, tillgänglighet och höjd kvalitet, samt en minskad ekonomisk ram, krävt förändringar i hälso- och sjukvårdssystemet. Ett syfte med denna avhandling är att utifrån professionellas upplevelser och erfarenheter belysa den praktiska innebörden av begreppet effektivitet i hälso- och sjukvården. Ett annat syfte är att utifrån olika perspektiv belysa ledarskap och medarbetarskap i samband med strukturella förändringar inom hälso- och sjukvården.

Metod Avhandlingen bygger på fyra delstudier (I – IV) genomförda med hjälp av en kvalitativ forskningsansats. Delstudie I bygger på intervjuer kring begreppet effektivitet med strategiskt utvalda representanter för en organisations tre beslutsnivåer. Delstudie II och III bygger på intervjuer med medarbetare från olika professioner som deltagit i två olika sjukhussammanslagningar. I delstudie IV intervjuades medarbetare om sina upplevelser i anslutning till privatisering av en hälso- och sjukvårdsorganisation.

Resultat Då en gemensam definition av begreppet effektivitet saknas i en Rorganisation ges olika aktörer utrymme att göra sin egen tolkning, vilket kan påverka måluppfyllelsen på ett negativt sätt. Vid strukturförändringar är det viktigt att medarbetare ges möjlighet till såväl delaktighet som att kunna balansera sina åtagande i processen. Det är även av vikt att medarbetare i en förändringsprocess har tillit till ledningen och organisationen. Strukturförändringar kan samtidigt innebära spännande utmaningar och nya möjligheter till utveckling.

Slutsatser Strukturella förändringar inom hälso- och sjukvården, i syfte att effektivisera, är komplexa och mångfacetterade. Samtidigt är begreppet effektivitet mångtydigt och svårutvärderat. Det påverkas av såväl struktur och ledarskap som medarbetarskap. En förändringsprocess påverkar både ledarskap och medarbetarskap. Framgångsfaktorer är medarbetarnas möjlighet till delaktighet och balans, samt deras tillit till såväl struktur som ledarskap

Abstract [en]

Background and purpose Within health and medical care, demands on increased efficiency, availability and increased quality, as well as a reduced financial framework, have required changes in the health and medical care system. One aim of this thesis is to illustrate the practical significance of the concept of efficiency in health and medical care on the basis of the experience of professionals. Another aim, on the basis of different perspectives, is to illustrate leadership and employeeship in connection with structural changes within health and medical care.

Method The thesis builds on four studies (I – IV) carried out with the help of a qualitative research approach. Study I builds upon interviews on the concept of efficiency with strategically selected representatives for an organisation’s three decision levels. Studies II and III builds upon interviews with employees from different professions who have participated in two different hospital mergers. In study IV employees were interviewed about their experiences in connection with the privatisation of a health and medical care organisation.

Outcome When there is no definition of the concept of efficiency in an organisation, different players are allowed scope to make their own interpretation, which can negatively affect fulfilment of objectives. During structural changes it is important that employees are given the opportunity to participate and to be able to balance their commitments in the process. It is also important that employees, in a process of change, have trust in the management and organisation. At the same time, structural changes can involve exciting challenges and new possibilities for development.

Conclusions Structural changes within health and medical care, with the purpose of streamlining, are complex and multifaceted. At the same time the concept of efficiency is ambiguous and difficult to evaluate. It is influenced by structure and leadership as well as employeeship. A process of change affects both leadership and employeeship. Success factors are the employees’ prospects for participation and balance, and their trust in both structure and leadership.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden, 2009. 70 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2009:6
Keyword
health and medical care, efficiency, mergers, privatisation, grounded theory., hälso- och sjukvård, effektivitet, sammanslagningar, privatisering, grounded theory.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3672 (URN)978-91-85721-66-5 (ISBN)
Public defence
2009-10-16, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-03Bibliographically approved

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