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The flexible working time model: a successful adaptation to diminishing resources but also a threat to quality improvment and staff´s wellbeing
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: Scandinavian Journal of Management, ISSN 0956-5221Article in journal (Refereed) Submitted
Place, publisher, year, edition, pages
2003.
Identifiers
URN: urn:nbn:se:uu:diva-91084OAI: oai:DiVA.org:uu-91084DiVA: diva2:163678
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2010-06-09Bibliographically 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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