Runo Axelsson

From territoriality to altruism in interprofessional collaboration and leadership.

Interprofessional collaboration has become more and more necessary in health and social care, mainly because of the increasing specialization of services and the increasing professionalization of different occupational groups. Most interprofessional collaboration is at the same time also interorganizational and it is taking place within a complicated structure, where collaborative teamwork is combined with hierarchical co-ordination and control in a sort of matrix organization. Based on the literature on organization, leadership and collaboration, this paper discusses territorial behaviour among professional groups and agencies as a difficult barrier to interprofessional collaboration. In order to overcome that barrier, the concept of altruism is explored as an alternative to territoriality. Professional altruism as well as altruistic leadership is discussed as a condition and a possibility for interprofessional collaboration. The discussion is illustrated with empirical data from a case study of collaboration in vocational rehabilitation.

Towards an evidence based health care management

Inspired by the development of Evidence Based Medicine, this article introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice. This will require some new managerial skills that should be included in the education and training of health care managers. It will also require a new orientation for research on health care management. There will be a demand for more applied research, and also for research with a more positivist orientation.

Development of health promoting leadership : Experiences of a training programme

Purpose – The purpose of this paper is to describe and analyse the experiences of an intervention programme for development of health promoting leadership in Gothenburg in Sweden. The more specific purpose is to identify critical aspects of such a programme as part of the development of a health promoting workplace.Design/methodology/approach – A programme supporting managers in health promoting leadership was studied. The study was performed as a holistic case study design. In total, 17 semi‐structured interviews were conducted, supplemented with data from a leadership survey. The material was coded according to the principles of content analysis, resulting in the three main categories: comprehensiveness, integration and participation.Findings – The results show the importance of regarding the development of health promoting leadership as a contribution to the building of organisational capacity for health promoting workplaces. This requires a comprehensive approach, including both individual and structu...

The impact of organisational settings on physician wellbeing

PURPOSE The purpose of this research is to show that the Swedish health care system has undergone major changes during the last decades, which have exerted strong influence on the operational freedom of physicians. DESIGN/METHODOLOGY/APPROACH This study consisted of 169 physicians in management positions, who answered a questionnaire assessing the relationship between their organizational settings and their perceived wellbeing. The organizational setting was defined as contact with top management, decision-making influence, well defined organization and whether the physician is acting as a leader. The perceived wellbeing was defined as social climate, work related exhaustion, work satisfaction, influence, development ability and supportive leadership. FINDINGS According to the results, organizational support improves work satisfaction and mental energy, and decreases work related exhaustion among physicians. This all leads to decreasing turnover rate among physicians. ORIGINALITY/VALUE These results point to the importance of maintaining a positive and supportive atmosphere for physicians in their work environment in order to encourage physicians to remain and take on management positions in the health care system. Furthermore enhancing physician influence over decision making processes is important to counteract work-related exhaustion and it might also contribute to a more efficient organization.

Organizational health in health organizations: towards a conceptualization

This article is introducing a new concept of organizational health and discussing its possible implications for health organizations and health management. The concept is developed against the background of New Public Management, which has coincided with increasing workplace health problems in health organizations. It is based on research mainly in health promotion and health management. Organizational health is defined in terms of how an organization is able to deal with the tensions of diverse and competing values. This requires a dialectical perspective, integration as well as disintegration, and a tricultural approach to value tensions. The concept of organizational health is pointing towards an inverse value pyramid and a hybrid- and value-based form of management in health organizations. An application of this concept may clarify competing values and help managers to deal with the value tensions underlying workplace health problems on an organizational as well as an individual and group level. More empirical research is required, however, to link more closely the different aspects of organizational health in health organizations.

Effects of performance-based reimbursement in healthcare

The aim of this study was to assess changes in attitudes and behaviour related to efficiency and quality of care after introduction of performance-based reimbursement. The study consisted of two parts. Part One was performed in 1992-94 as a repeated cross-sectional study of physicians in Stockholm County Council working with a newly introduced performance-based reimbursement system. Part Two was a similar study conducted in 1994 in 11 Swedish councils without performance-based reimbursement. The results show a significant difference between the two groups of physicians in attitudes concerning changes in quality of care and premature discharge from hospital. Despite concern about quality and premature discharge, physicians in Stockholm were found to have changed their behaviour in that the average length of stay in 1994 was about one day shorter in Stockholm than in the other 11 county councils. This indicates that the performance-based reimbursement system may strengthen the incentive to increase efficiency.

Health promoting leadership - different views of the concept

OBJECTIVE To describe and analyse different views of health promoting leadership among actors involved in workplace health promotion in eight Swedish municipalities. METHODS Twenty individuals were interviewed and their views were analysed according to the methodology of phenomenograpic research, exploring how health promoting leadership was described, what motives were expressed, and what critical conditions were perceived for developing such leadership. RESULTS The informants described health promoting leadership in three ways: organising health promoting activities, having a supportive leadership style, and developing a health promoting workplace. The motives mentioned for developing health promoting leadership were instrumental motives and improved health. The critical conditions for health promoting leadership were organisational conditions, characteristics of individual managers, and support to managers. CONCLUSIONS It seems that the concept of health promoting leadership was often used to link ideas about good leadership to the health of employees. Organisational goals and management trends may also have influenced the motives as well as the conditions for development of health promoting leadership.

Leadership, organization and health at work: a case study of a Swedish industrial company

The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.

Quality, efficiency and integrity: value squeezes in management of hospital wards

AIM The aim of this study was to explore and describe the value squeezes experienced by ward managers in connection with quality management in hospital wards. The study focused on integrity pressure and coping strategies to deal with such pressure. BACKGROUND Nurses in the role of ward managers have a key function in the field of quality improvement. These managers are also responsible for the efficient running of their wards and thus face tensions between demands for both quality and efficiency. METHOD Data were collected through interviews conducted with 10 ward managers from six Norwegian hospitals. The data were analysed using both content and template analysis. RESULTS Ward managers felt squeezed between conflicting values associated with demands for both quality and efficiency. These tensions resulted in pressure on integrity for the managers as well as their nursing colleagues. Three different management strategies were used to cope with such pressure: quality conscious, efficiency adjusting and hybrid. CONCLUSION A hybrid strategy appeared to be the best, both for the ward managers and the hospital organisations, despite the fragmentation associated with this strategy. IMPLICATIONS FOR NURSING MANAGEMENT Hybrid management may be beneficial for coping with pressure on integrity, although more empirical research is needed.

Modes of Interaction and Performance of Human Service Networks

Abstract Performance in health and human service networks requires mutual adjustment between participating organizations with different competencies. In this article the impact of group modes of interaction concerning administration and steering and direct service delivery upon different dimensions of network performance and client outcomes is tested in a sample of eighty-three local networks of refugee resettlement support in Sweden. The results show that networks with group modes of interaction concerning both issues generally perform best, but the effect varies across performance dimensions, is modified by availability of needed competence in the network and does not easily translate to client outcomes.