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The double spiral of change--experiences of privatization in a Swedish hospital.
Nordic Council of Ministers, Nordic School of Public Health NHV.
Nordic Council of Ministers, Nordic School of Public Health NHV.
2010 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 25, no 2, 156-68 p.Article in journal (Refereed) Published
Abstract [en]

UNLABELLED: Privatization is a trend in countries with a public health system. It involves organizational change, a cultural transformation and changes for the employees as well as a more strictly controlled work. The objective of this study is to describe, analyse and interpret how privatization is perceived by the employees of a health care organization in Sweden.

METHODOLOGY: In-depth interviews have been performed with physicians, paramedics, secretaries, nurses, assistant nurses and local managers, in all 14 respondents, after a private entrepreneur had taken over the management of a hospital. The interviews were tape-recorded and have been analysed and interpreted following a grounded theory approach.

FINDINGS: The transcribed interviews show that trust is a core category and linked with emotions, commitment and security. The analysis shows that employees' experience of privatization within a health care organization differs and is full of nuances and complexities.

CONCLUSION: A simultaneous virtuous and a vicious circle of experiences and reactions may describe how employees experience privatization. It can also be concluded that leadership is an important factor in the success of organizational change.

Place, publisher, year, edition, pages
2010. Vol. 25, no 2, 156-68 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3671DOI: 10.1002/hpm.968PubMedID: 20540078OAI: oai:DiVA.org:norden-3671DiVA: diva2:785448
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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