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Ledarskap och medarbetarskap vid strukturella förändringar i hälso- och sjukvården: Nyckelaktörers och medarbetares upplevelser
Nordic Council of Ministers, Nordic School of Public Health NHV.
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 [en]
health and medical care, efficiency, mergers, privatisation, grounded theory.
Keyword [sv]
hälso- och sjukvård, effektivitet, sammanslagningar, privatisering, grounded theory.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3672ISBN: 978-91-85721-66-5 (print)OAI: oai:DiVA.org:norden-3672DiVA: diva2:785464
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
List of papers
1. The concept of effectiveness —a  blind alley?: A study of different interpretations in a Swedish county council
Open this publication in new window or tab >>The concept of effectiveness —a  blind alley?: A study of different interpretations in a Swedish county council
2001 (English)In: The International Journal of Health Planning and Management, ISSN 1099-1751, Vol. 16, no 1, 61-71 p.Article in journal (Refereed) Published
Abstract [en]

Swedish health care organizations are experiencing pressure to make ever greater efforts to rationalize and to increase effectiveness in the way they plan and provide services. In order to gain a better understanding of the current practice of the three groups of key actors in Swedish health care—politicians, senior civil servants and operational managers—and their perception of effectiveness, a study was carried out in a Swedish county council using both qualitative and quantitative methods. While in general the concept of effectiveness is thought of as crucial, it is not clearly or uniformly defined within the organization. Each of the three groups defines the concept in a way that reflects their own function, which may lead efforts to achieve effectiveness into a blind alley. Copyright © 2001 John Wiley & Sons, Ltd

Keyword
business development; effectiveness; resource management; planning; rationalization; responsibility; qualitative methods
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3666 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-03Bibliographically approved
2. The double spiral of change--experiences of privatization in a Swedish hospital.
Open this publication in new window or tab >>The double spiral of change--experiences of privatization in a Swedish hospital.
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3671 (URN)10.1002/hpm.968 (DOI)20540078 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-03Bibliographically approved
3. Balancing involvement: employees' experiences of merging hospitals in Sweden.
Open this publication in new window or tab >>Balancing involvement: employees' experiences of merging hospitals in Sweden.
2002 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 1, 11-8 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process.

AIMS: The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden.

METHODS: This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care.

FINDINGS: Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement.

CONCLUSIONS: The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.

Keyword
change; health care personnel; involvement; mergers; qualitative method; management; politicians
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3669 (URN)11895526 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-03Bibliographically approved
4. The staff's experience of structural changes in the health and medical service in western Sweden.
Open this publication in new window or tab >>The staff's experience of structural changes in the health and medical service in western Sweden.
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3668 (URN)10786548 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-02-03Bibliographically approved

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