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  • 1. Bergman, David
    et al.
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sandahl, Christer
    Effects of dialogue groups on physicians' work environment2007In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 21, no 1, p. 27-38Article in journal (Refereed)
    Abstract [en]

    Abstract: Purpose – The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. Design/methodology/approach – The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n=68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. Findings – The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. Research limitations/implications – In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. Practical implications – The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. Originality/value – There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

  • 2.
    Feo, Rebecca
    et al.
    Univ Adelaide, Adelaide Nursing Sch, Adelaide, SA, Australia;Flinders Univ S Australia, Coll Nursing & Hlth Sci, Adelaide, SA, Australia.
    Donnelly, Frank
    Univ Adelaide, Adelaide Nursing Sch, Adelaide, SA, Australia.
    Muntlin Athlin, Åsa
    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 Medical Sciences, Clinical Epidemiology.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Providing high-quality fundamental care for patients with acute abdominal pain: A qualitative study of patients' experiences in acute care2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 1, p. 110-123Article in journal (Refereed)
    Abstract [en]

    Purpose Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences. Design/methodology/approach A qualitative descriptive study, using repeated reflective interviews, was analysed thematically (n=10 patients). Findings Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one's care. Patients reported that health professionals established genuine professional-patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional-patient relationships were seen as inexcusable.

  • 3.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Moberg, Linda
    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 Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Costs will rather increase Actions and arguments against decommissioning in local health services in Sweden2018In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 32, no 8, p. 943-961Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper was to study the unfolding of an urgent and extensive decommissioning program in Sweden, focusing on the public's reactions and their arguments when opposing the decommissioning activities.

    Design/methodology/approach

    The public's responses were studied through local media. Its content was surveyed and divided into actions and arguments. The arguments were further analyzed and categorized into inductively developed themes.

    Findings

    Protest activities, such as demonstrations, meetings and petitions, were not coordinated, but mostly carried out for withdrawals of unique services and services in remote areas. The public questioned the decision makers' information, calculations and competence, the adequacy of the consequence analyses and whether the decommissioning activities would lead to any real savings. Patient and public safety, the vulnerable in society, and effects on the local areas were important topics. Thus, it seems the decision makers did not fully succeed in communicating the demonstrable benefits or create clarity of the rationales for decommissioning the particular services. Furthermore, it seems the public has a more inclusive approach to health services and their value compared to decision makers that need to keep the budget.

    Originality/value Decommissioning is an emerging field of research, and this study of the unfolding of an urgent and extensive decommissioning program contributes with evidence that may improve decommissioning policy and practice. The study illustrates that it may be possible to implement a decommissioning program despite public protest, but that the longer-term effects on the health system's legitimacy need to be studied.

  • 4.
    Frykman, Mandus
    et al.
    Karolinska Institutet/LIME.
    von Thiele Schwarz, Ulrica
    Karolinska institutet.
    Muntlin Athlin, Åsa
    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 Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Hasson, Henna
    Karolinska Institutet/LIME.
    Mazzocato, Pamela
    Karolinska institutet.
    The work is never ending: uncovering teamwork sustainability using realistic evaluation2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 1, p. 64-81Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork.

    Design/methodology/approach

    Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used.

    Findings

    The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced.

    Practical implications

    The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period.

    Originality/value

    By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

  • 5.
    Jansson von Vultée, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    The impact of management programs on physicians’ work environment and health: A prospective, controlled study comparing different interventions2004In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 18, no 1, p. 25-37Article in journal (Refereed)
    Abstract [en]

    Female physicians have less influence over their daily work conditions and exhibit slower career advancement as compared to their male colleagues. The aim of this study is to assess the impact on individual and organizational well being from different kinds of management programs. Female physicians participating in management intervention programs were compared with a reference group of matched physicians and sickness absenteeism was significantly lower in the intervention group. No significant differences were found between the groups with regard to career advancement, individual, organizational and professional well being. Health care organizations spend a substantial amount of resources on management programs in order to improve leadership, autonomy and the work-environment of physicians in times of increasing discontent among this key group of health care employees. Our study indicates some beneficial health effects from structured management programs but there is a need to develop and assess the efficacy of these programs further.

  • 6.
    Kaltenbrunner, Monica
    et al.
    Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden.
    Mathiassen, Svend Erik
    Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden.
    Bengtsson, Lars
    Univ Gävle, Fac Engn & Sustainable Dev, Gävle, Sweden.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden; Lishui Univ, Med & Hlth Coll, Nursing Dept, Lishui, Peoples R China.
    Lean maturity and quality in primary care2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 2, p. 141-154Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

    Design/methodology/approach: Data were collected using a survey based on Liker’s four principles, divided into 16 items (n=298 staff in 45 units). Complementary observations (n=28 staff) were carried out at four units.

    Findings: Lean maturity varied both between and within units. The highest Lean maturity was found for “adhering to routines” and the lowest for “having a change agent at the unit.” Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.

    Practical implications: Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

    Originality/value: This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

  • 7.
    Sebrant, Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Educational Sciences, Department of Education.
    Emotion, Power and Identity: Emotional display of envy when taking on management roles in a professional hierarchy2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, ISSN 1477-7266, Vol. 28, no 4, p. 548-561Article in journal (Refereed)
    Abstract [en]

    Purpose

    Drawing on a previous study of organising processes and the construction of identity in a Swedish geriatric clinic, the impact of emotions is brought to the fore in the interpretation of power relations among professional groups. The purpose of this article is to find a way to interpret emotions as discursively constructed in organising processes.

     Design/methodology/approach

    A sequence of critical events is described where leading positions were negotiated at the clinic. Senior physicians and head nurses are highlighted as opposing forces in a struggle where envious emotions seemed to be a driving force in the political interplay. The empirical material in this article comes from the previous study. It is a set of participant observations and parts of interviews that took place before and after the implementation of a new organisational plan for the clinic.  

    Findings

    The envious and regressive undertone in the relationships between the actors made them act for egocentric reasons instead of creating new ways of collaborating and learning new leading roles. The power relations of the medical hierarchy were reproduced, which made new ways of relating threatening and difficult to achieve.

    Originality/value

    The results of the study confirm that people involved and perhaps in conflict with each other have to be able to, or get help to, make sense of their emotional experiences to employ them constructively. Otherwise they fall back into well-known patterns in order to feel secure. A vital part of learning in change processes is the support to individuals and groups in gaining emotional understanding of themselves and others. Leaders and managers who often are initiators of change ought to be aware of the importance of emotional support in change processes. If they are not, they are destined to be a part of the confusion.

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