Eric Carlström

Why is collaboration minimised at the accident scene?: A critical study of a hidden phenomenon

– The purpose of this paper is to study why collaboration among police, fire, and ambulance services is minimised at accident scenes., – Observations and semi‐structured interviews were carried out during 2007‐2008. The data material comprises a total of 248 hours of observations on 20 occasions and 57 interviews with 80 people., – The study identifies the difference between rhetoric and practice in connection with accident work. Collaboration is seen as a rhetorical ideal rather than something that is carried out in normal practice. Asymmetry, uncertainty and lack of incentives are important explanations as to why only limited forms of collaboration are actually implemented., – The paper shows a distinction between collaboration as rhetoric and practical collaboration at accident scenes., – The article proposes a multi‐faceted collaboration concept. In this way, collaboration can be developed and refined., – The results of the study show that police, fire, and ambulance services want to develop excellent forms of collaboration at the accident scene, but avoid this as it leads to uncertainty and asymmetries and because of a lack of incentives. However, simpler forms of collaboration may be realistic in the organisation of everyday work at accident scenes.

Organizational culture and the implementation of person centered care: Results from a change process in Swedish hospital care

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.

The 20-minute team : a critical case study from the emergency room

RATIONALE In this article, the difference between team and group is tested empirically. The research question posed is How are teams formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while parallel cooperation is a transition between group and team. METHODS To answer the question, a longitudinal case study has been made of a trauma team at a university hospital. Data have been collected through interviews and direct observations. Altogether the work of the trauma team has been studied for a period of 5 years (2002-2006). RESULTS The results indicate that two factors are of central importance for the creation of a team. The first is related to its management and the other to the forms of cooperation. To allow for a team to act rapidly and to reduce friction between different members, clear leadership is required. CONCLUSIONS The studied team developed cooperation with synchronous elements but never attained a level that corresponds to idealized conceptions of teams. This is used as a basis for challenging ideas that teams are harmonious and free from conflicts and that cooperation takes place without friction.

Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context

It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method - a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments - an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) - was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions.

Review article: Staff perception of the emergency department working environment: Integrative review of the literature

Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative‐descriptive studies, four mixed descriptive/comparative (non‐randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence‐based interventions to improve staff morale.

Managing boundaries at the accident scene – a qualitative study of collaboration exercises

Purpose The purpose of this study is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.Design/methodology/approach Interv ...

Middle managers on the slide

Purpose– This article aims to examine middle managers in health care and how their role has changed in times of fiscal constraints. It seeks to focus particularly on how cost savings influence the ...

The impact of organizational culture on the outcome of hospital care: After the implementation of person-centred care

Aims: To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. Methods: a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. Results: The regression analysis showed that; 16% (R2 = 0.02) of a decreased health status, 22% (R2 = 0.05) of pain/discomfort and 13% (R2 = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. Conclusions: The results from the present study tentatively indicated an association between an organizational culture and patients’ health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.

Models of teamwork: ideal or not? A critical study of theoretical team models

Purpose. There is a tendency in team research to employ concepts of stepwise models, reaching from the primitive to the excellent, to suggest that a higher level of evolution is better than the bas ...

Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review

BackgroundPerson-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care.MethodsTen databases were systematically searched in January 2014. Studies had to report an intervention offered to pregnant women with obesity and measure gestational weight gain to be included. All included studies were independently double coded to identify to what extent they included three defined aspects of person-centred care: 1) “initiate a partnership” including identifying the person’s circumstances and motivation; 2) “working the partnership” through sharing the decision-making regarding the planned action and 3) “safeguarding the partnership through documentation” of care preferences. Information on gestational weight gain, study quality and characteristics were also extracted.ResultsTen studies were included in the review, of which five were randomised controlled trials (RCT), and the remaining observational studies. Four interventions included aspects of person-centred care; two observational studies included both “initiating the partnership”, and “working the partnership”. One observational study included “initiating the partnership” and one RCT included “working the partnership”. No interventions included “safeguarding the partnership through documentation”. Whilst all studies with person-centred care aspects showed promising findings regarding limiting gestational weight gain, so did the interventions not including person-centred care aspects.ConclusionsThe use of an identified person-centred care approach is presently limited in interventions targeting gestational weight gain in pregnant women with obesity. Hence to what extent person-centred care may improve health outcomes and care satisfaction in this population is currently unknown and more research is needed. That said, our findings suggest that use of routines incorporating person-centredness are feasible to include within these interventions.