Susanna Bihari 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.

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...

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.

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.

Interorganizational collaboration in transitional care – A study of a post-discharge programme for elderly patients

Introduction and aim: This article reports a study of a post-discharge programme for elderly patients in Norway. It took place in an intermediate ward for transitional care and was based on collaboration between a municipality and a hospital, which was part of a health enterprise. The aim of the study was to analyse the collaboration and its possible effects on the quality of patient care, and the economic efficiency of the project for the organizations involved. Methodology: A mixed-methods approach, consisting of interviews, questionnaires and analyses of official documents and statistics. Results: The collaboration was working well on the top level of the organizations, but was more problematic on the operative level. However, there were clear signs of improvement. The patients who received transitional care were more satisfied with their stay at the ward than their previous stay at the hospital. They were discharged to their homes more often and perceived to have a higher level of functioning than the hospital patients. Average costs per patient were also lower in the ward than in the hospital departments. Conclusion: The collaboration had mainly positive impacts on the quality of patient care and the economic efficiency of elderly care in the municipality. However, the board of the health enterprise decided to close down the intermediate ward.

Collaboration in workplace health promotion – a case study

Purpose - The aim of this article is to describe and analyze a case of interorganizational and intersectoral collaboration on workplace health promotion involving nine municipalities in a Swedish r ...

Actor or arena: contrasting translations of a law on interorganizational integration

PURPOSE A Swedish framework law has enabled integration between public agencies in vocational rehabilitation. With the support of this law, coordination associations can be formed to fund and organize joint activities. The purpose of this study is to describe and analyze how the law has been interpreted and translated into local coordination associations and how local institutional logics have developed to guide the organization of these associations. DESIGN/METHODOLOGY/APPROACH Data was collected through observations of meetings within two coordination associations and supplemented with documents. The material was analyzed by compilation and examination of data from field notes, whereupon the most important aspects were crystallized and framed with institutional organization theory. FINDINGS Two different translations of the law were seen in the associations studied: the association as an independent actor, and as an arena for its member organizations. Two subsequent institutional logics have developed, influencing decisions on autonomy, objectives and rationality for initiating and organizing in the two associations and their activities. The institutional logics are circular, further enhancing the different translations creating different forms of integration. RESEARCH IMPLICATIONS/LIMITATIONS Both forms of integration are legitimate, but the different translations have created integration with different degrees of autonomy in relation to the member organizations. Only a long-term analysis can show whether one form of integration is more functional than the other. ORIGINALITY/VALUE This article is based on an extensive material providing insights into a form of interorganizational integration which has been scarcely researched. The findings show how different translations can influence the integration of welfare services.

Great expectations - introduction of flow managers in a university hospital

A major reorganization of a university hospital included the clinical structure as well as the administrative structure of the hospital. The focus of the reorganization was to improve the coordination of patient flows through the hospital. An important part of the organizational change was the introduction of flow managers. The aim of the article is to describe and analyze the challenges of the flow managers in the implementation of the reorganization. The description is based on a number of individual and focus group interviews with professionals and managers on different organizational levels. The analysis is guided by a broad conceptual framework, focusing on the processes of change in a professional organization like a hospital. The results show that the flow managers started with a lot of uncertainty regarding their responsibilities. There was also a lot of resistance to the reorganization, which the flow managers came to personify. They proceeded by building relationships and shaping their role and tasks. They tried to balance proactive and reactive strategies of change. There were some positive results, but they felt that that the expectations placed on them had been unrealistic. The introduction of flow managers in a university hospital has touched upon many elements of the conceptual framework. There were a number of structural, cultural, financial and strategic barriers influencing the change process. The main conclusion of the analysis is that the flow managers need more power and legitimacy in the organization to deal with these barriers. Copyright

In the Eye of The Storm: When a new Horizontal Management Position meets hospital reality

Introduction : In 2013 the ‘Region of North-Jutland’ in Denmark started a major reorganization of their hospitals. In order to improve the quality of care for their patients, the reorganization was focusing on the coordination of patient flows through the hospitals and also between the hospitals and the primary sector. The new organization of the hospitals can be regarded as a sort of matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on team-work, meetings and information exchange is combined with elements of co-location and horizontal management. In short there are three main innovations. The first innovation is a new clinical structure with a creative combination of interdependent medical specialties in order to facilitate the patient flows. In each clinical department there is a management “troika” consisting of a clinical director (primarily physicians), a deputy clinical manager responsible for human resources (nurses) and a new horizontal management position accountable for patient flows (nurses and a few physicians). The second innovation is the appointment of this latter and third member of the “troika”: a new horizontal management position. They are accountable for horizontal integration strategies and development of patient flows within their own clinics, across the boundaries of the different clinics and across the boundaries of the hospital and the primary sector. The third innovation is the strong focus on teamwork to support the patient flows of the hospital. Among others the “troika” is working as a management team, where the new horizontal management position plays an important role. The aim of the article is to describe and analyze the role of the new horizontal management position in the reorganization of the hospital (in the following and to facilitate the written communication this role will be named the new managers). The paper maps these new managers’ efforts to shape their role in the management processes and to gain legitimacy. Theory and methods : The reorganization process which is still going on is followed by a group of organizational researchers. They are conducting a qualitative case study of Aalborg University Hospital, based on a number of individual and focus group interviews with professionals and managers on different organizational levels. The interview data are combined with data from observations of meetings and documentary materials including strategy and planning documents, annual reports, as well as five Master Theses about the reorganization. The analysis is guided by a broad theoretical framework, focusing on the development of horizontal processes in a professional organization. Results : The results show that the new managers started with a lot of uncertainty regarding their responsibilities. There was also a lot of resistance to the reorganization, which the new managers came to personify. Throughout the change process, the educational background of the new managers had been discussed a lot. The physicians had emphasized that, according to the law, they are responsible for the treatment of patients, and therefore the new managers with a nursing background could not be responsible for patient flows. Because of the critical views of the physicians, the new managers began their work with a positive, humble and cautious, exploratory approach. It seemed that they played the role of a facilitator or coordinator rather than being a negotiator or giving instructions. Another role that was not so prominent among the new managers was to monitor the coordination of the patient flows. It would require the involvement of many different actors, which was not possible during the first year. There were also some positive results, achieved by the new managers, but on the whole they felt that the expectations placed on them had been unrealistic. Discussion : Having followed the first two years of the change process the opportunities for the new managers to act as horizontal change agents and deal with key barriers to change will be discussed. The main barriers consisted of a number of structural, cultural, financial and strategic barriers influencing the change process. Conclusion : The study sheds new light on integrated care as a concept that can be used also in a hospital, since integrated patient flows through horizontal management was of major importance in the reorganization. The new managers have faced major challenges trying to implement top management visions concerning integrated patient flows through horizontal management. It seems obvious to characterize this new role as placed right in the eye of the storm.