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Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
2003 (English)In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 16, no 7, 354-60 p.Article in journal (Refereed) Published
Abstract [en]

Abstract:

The objective was to elucidate hospital leaders’ understanding of the organisational structures and processes and their understanding of their leading role during an intensive period of reorganisation. From a qualitative exploratory study using semi-structured interviews and thematic analysis four themes were identified: understanding the function of leadership and management, understanding organisational structures and processes, their own role as leader, and the outside world. The results indicate that the organisation is characterised by disintegration and erratic structures. The leaders perceive that they lead a learning organisation but in practical care work the organisation functions more like an organisation streamlined for mass production. This discrepancy between their understanding and practical daily care work led to dissatisfaction and existential chaos among the leaders. Our findings show an example of “clashes with the individual attractor pattern”, an urgent, but not yet very clear problem in health-care organisations of today.

Place, publisher, year, edition, pages
2003. Vol. 16, no 7, 354-60 p.
Keyword [en]
Adaptive system theory, Downsizing, Health services, Leadership, Learning organizations
Identifiers
URN: urn:nbn:se:uu:diva-91083DOI: 10.1108/09526860310510860OAI: oai:DiVA.org:uu-91083DiVA: diva2:163677
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Continuous Quality Development by Means of New Understanding: A four year study on an Intensive Care Unit during times of hard work and demanding organisational changes
Open this publication in new window or tab >>Continuous Quality Development by Means of New Understanding: A four year study on an Intensive Care Unit during times of hard work and demanding organisational changes
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kvalitetsutveckling genom en ny förståelse av verksamheten : En fyra års studie på en Intensivvårdsavdelning, i tider av hårt arbete och utmanade organisatoriska förändringar
Abstract [en]

The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 65 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1306
Keyword
Health services research, Intensive Care Unit, Mechanical system, Complex Adaptive System, Diminishing resources, Workload, Sickness absenteeism, Sense of Coherence, Stress related symtoms, Organisational Climate, Longitudinal study, Hälso- och sjukvårdsforskning
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-3782 (URN)91-554-5808-4 (ISBN)
Public defence
2003-12-12, Pelsarsalen, Länssjukhuset Gävle, ing. 35, 801 87, Gävle, 13:00
Opponent
Supervisors
Available from: 2003-11-18 Created: 2003-11-18Bibliographically approved

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Lindberg, EvaRosenqvist, Urban

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