Nomie Eriksson

Standards for information security and processes in healthcare

Purpose – Regardless of who or where we are and when we get sick, we expect healthcare to make us well and to handle us and our information with care and respect. Today, most healthcare institutions work separately, making the flow of patient information sub‐optimal and the use of common standards practically unheard of. The purpose of this paper is to emphasise the use for standards to improve information security in process‐oriented distributed healthcare.Design/methodology/approach – The paper introduces a real‐life case which is analysed to highlight how and where standards can and should be used in order to improve information security in process‐oriented distributed healthcare.Findings – In total, 11 flaws or problems in information security and process‐orientation are identified. From these, six changes are suggested which address how information is handled, and how organizational routines should be standardized.Research limitations/implications – The case setting is Swedish healthcare, but problem...

Hospital management from a high reliability organizational change perspective: A Swedish case on Lean and Six Sigma

Purpose The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO). Design/methodology/approach Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n=17) nurses at two Swedish hospitals. Findings The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement. Practical implications Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned. Originality/value The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

Fiery Spirits in the context of institutional entrepreneurship in Swedish healthcare

PURPOSE Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery Spirits, as institutional entrepreneurs can, working in a team, implement sustained change in hospital clinical practice. DESIGN/METHODOLOGY/APPROACH This paper describes two case studies, conducted at two Swedish hospitals over a period of two years, in which changes in clinical practice were implemented. In both cases, key-actors, termed Fiery Spirits, played critical roles in these changes. The authors use a qualitative approach and take an intra-organizational perspective with semi-structured in-depth interviews and document analysis. FINDINGS The new clinical practices were successfully implemented with a considerable influence of the Fiery Spirits who played a pivotal role in the change efforts. The Fiery Spirits persuasively, based on their structural and normative legitimacy and the adoption of learning processes, advocated, and supported change. PRACTICAL IMPLICATIONS Fiery Spirits, given flexibility and opportunity, can be powerful forces for change outside the trajectory of management-inspired and management-directed change. Team members, when inspired and encouraged by Fiery Spirits, are less resistant to change and more willing to test new clinical practices. ORIGINALITY/VALUE The paper complements literature on how the Fiery Spirit concept aligns with concepts of clinical governance and leadership and how change can be achieved. Additionally, the findings show the effects of legitimacy and learning processes on change in clinical practice.

Followership for Organizational Resilience in Health care

The resilient organization has the important capability of creating high reliability. In health care, professionals deal with major challenges in terms of new working methods. The chapter describes the introduction of a standardized working method in hospitals, utilizing Lean-oriented work processes. That is different from nurses’ and physicians’ traditional and flexible way of working. These differences in approaches are the subject of the study. The question is: How can followership create and maintain high reliability and resilience in health care? A comparative case study was performed using interviews and steering documents. To maintain and create high reliability, social resources such as followership are important. Followers’ ability to improve, cooperate, and learn turned out to be important characteristics. Organizational resilience depends on these professionals’ ability to manage change.

Interprofessional Barriers: A Study of Quality Improvement Work Among Nurses and Physicians

This article studies interprofessional barriers between nurses and physicians in the context of quality improvement work. A total of 17 nurses and 10 physicians were interviewed at 2 hospitals in Sweden. The study uncovered a number of barriers relating to both the relative status of each group and their defined areas of responsibility.

Managing healthcare information: analyzing trust.

Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrixs usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.