Background: In the last decade, research has highlighted the importance of interprofessional approaches to education and practice. Collaboration between medical practice and engineering has been identified as particularly relevant to developing accountable models for sustainable healthcare and overcoming increased specialization leading to professional barriers. This study aims to analyze insights and understanding expressed by nursing students and biomedical engineering students following a joint learning activity regarding a medical device used in the hospital setting.

Method: A qualitative approach deriving from a phenomenological view examined an interprofessional learning activity where the focus was on active integration and knowledge exchange.

Conclusion: The activity was expressed as a positive opportunity for getting insights into perspectives from other professional groups as well as insights into the importance of a system perspective in patient safety. The learning and insights listed in the evaluations included ideas about how the two professional groups could collaborate in the future.

The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production. The results show that kinds of engagement are interlinked and contribute to clinical engagement behaviour in quality of care and patient safety. Increased work resources have importance for engagements in organizational improvements, especially in top-down implementations. An extended work engagement model during organizational improvements in health care was supported. The model contributes to knowledge about how and when clinicians are mobilized to engage in organizational changes.

BACKGROUND: Recent research has highlighted the risks involved in work intensification; i.e. the risk of human resources being consumed, incurring higher risks of emotional ill health such as burnout among employees. At the same time, there are some indications that individual employees are being left to themselves to manage work tasks in intensive work environments. OBJECTIVE: This article explores how strongly engaged people master intensive work through coping and job crafting in a salutogenic way. METHODS: The article is based on 34 in depth interviews of persons in various professions within research and development departments in three Swedish companies. RESULTS: The interviews indicated that employees generally experienced work as almost constantly intense. We identified two strategies for mastering intensive work; i.e. an active strategy and a cognitive strategy, involving elements of both coping and job crafting. The specific elements of these strategies determine whether salutogenic processes are present. CONCLUSIONS: The results suggest that it is the specific elements of the coping and job-crafting strategies that determine whether or not salutogenic processes occur, and that organisational support is an important supplement to the individual processes for mastering intensive work.

The aim of this article is to describe a theoretical framework, i.e., theoretical underpinnings and pedagogical principles, for leadership programs that support managers' evidence-based knowledge of health-promoting psychosocial work conditions, as well as their capability to apply, adapt, and craft sustainable managerial work practices. First, the theoretical framing is introduced, i.e., a system theory that integrates key work conditions with a practical perspective on managerial work and organization. Second, pedagogical principles and measures for leaders' training in integrated handling across system levels are described. Last, we present summarized results from an intervention study applying the theoretical framework and pedagogical principles. The complexity of interactions among different factors in a work system, and the variety in possible implementation approaches, presents challenges for the capability of managers to craft sustainable and health-promoting conditions, as well as the evaluation of the program components. Nevertheless, the evaluation reveals the strength of the program, in providing holistic and context-sensitive approaches for how to train and apply an integrative approach for improving the work environment.

Hälso- och sjukvårdens arbetsmiljö är viktig för både medarbetare och patienter. Syftet med denna artikel är att beskriva vad som karaktäriserar en hälsofrämjande arbetsmiljö, varför den är viktig inom hälso- och sjukvården och hur en hälsofrämjande arbetsmiljö kan utvecklas. Resultat från vår forskning och tidigare forskning, visar att medarbetares arbetsmiljö, hälsa och engagemang är viktigt för att ge bästa möjliga förutsättningar för att främja patienters hälsa. Viktiga arbetsmiljöfaktorer är i detta sammanhang ett starkt socialt kapital i form av erkännande, ömsesidighet och tillit mellan människor, ett verksamhetsnära ledarskap samt verksamhetsnära utveckling utifrån en systemteoretisk bas där man stödjer och förstår flera faktorer och förhållanden. Det sociala kapitalet kan liknas vid bränslet i ett kretslopp som skapar arbetstillfredsställelse, engagemang och nya arbetssätt. Det verksamhetsnära ledarskapet är viktigt för att skapa förutsättningar för hållbarhet i kretsloppet.

Work environment issues in health care have importance not only for employees but also for patients. The aim of this article is to describe important conditions for a health-promoting work environment, the significance of this for health care service, and how health-promoting work conditions can be developed. The results from our, as well as from others’, previous research show that employees’ work environment, health and engagement are critical for the improvements of quality of care and patient safety. Important factors are social capital (i.e. recognition, reciprocity and trust between humans), as well as practice-oriented approaches to developments based in system theory perspectives. The social capital can be compared to the fuel in a cycle creating work satisfaction, engagement and new ways of working and a practice-oriented and a servant leadership facilitates the development and the sustainability of this cycle.

Purpose - The purpose of this paper is to investigate the relation between leadership and social capital and what qualities of leadership are important for social capital among employees in hospital settings over time. Design/methodology/approach - A cohort of employees in hospitals answered a questionnaire at three occasions. Five small (approx. 100-bed) or mid-sized (approx. 500-bed) hospitals were included. The response rate was 54 percent at baseline (n = 865), 59 percent at one-year follow-up (n = 908) and 67 percent at two-year follow-up (n = 632). Findings - Repeated measures over time showed differences between groups in levels of social capital with respect to levels of leadership quality. Relation-oriented leadership had the strongest association with social capital. There was evidence that leadership was associated with social capital over time and that different kinds of leadership qualities were associated with social capital. Research limitations/implications - This study conducted and analyzed quantitative data, and therefore, there is no knowledge of managers' or employees' own perceptions in this study. However, it would be interesting to compare managers' decreased and increased leadership quality and how such differences affect social capital over time. Practical implications - The findings feature the possibility for healthcare leaders to build high quality leadership as an important resource for social capital, by using different leadership orientations under different circumstances. Originality/value - The paper showed that leadership was an important factor for building social capital and that different leadership qualities have different importance with respect to certain circumstances.

Whole-system approaches linking workplace health promotion to the development of a sustainable working life have been advocated. The aim of this scoping review was to map out if and how whole-system approaches to workplace health promotion with a focus on management, leadership, and economic efficiency have been used in Nordic health promotion research. In addition, we wanted to investigate, in depth, if and how management and/or leadership approaches related to sustainable workplaces are addressed. Eighty-three articles were included in an analysis of the studies' aims and content, research design, and country. For a further in-depth qualitative content analysis we excluded 63 articles in which management and/or leadership were only one of several factors studied. In the in-depth analysis of the 20 remaining studies, four main categories connected to sustainable workplaces emerged: studies including a whole system understanding; studies examining success factors for the implementation of workplace health promotion; studies using sustainability for framing the study; and studies highlighting health risks with an explicit economic focus. Aspects of sustainability were, in most articles, only included for framing the importance of the studies, and only few studies addressed aspects of sustainable workplaces from the perspective of a whole-system approach. Implications from this scoping review are that future Nordic workplace health promotion research needs to integrate health promotion and economic efficiency to a greater extent, in order to contribute to societal effectiveness and sustainability.

Many hospitals have recently implemented the management concept lean production. The aim of this study was to learn how and why three Swedish hospitals selected and developed their hospital-wide lean production strategies. Although previous research shows that the concept is implemented in various ways, there is limited research on how and why different hospitals choose different implementation strategies and if the chosen strategies contribute to sustainable participation in organizational development. A case study of three different Swedish hospitals implementing lean production was thus performed. We studied the content of the hospitals' selected implementation strategies, conditions and rationales behind their strategy selection, and how different organizational actors participated in the implementation. Qualitative interviews with 54 key actors at the studied hospitals were performed. In addition, a self-administered survey questionnaire to employees was answered at T1 (2012, n = 557), T2 (2013, n = 554), and T3 (2014, n = 366). The three studied hospitals chose different strategies for implementing lean production due to different contextual conditions and for different reasons. The hospital-wide implementation strategies were related to employees' interest and participation in lean production. The results show that many different actors at different organizational levels need to participate in lean production in order to sustain and diffuse change processes. Furthermore, broad motives including quality of care seem to be needed for engaging different professional groups.

Aim: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. Background: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. Method: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. Results: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Conclusion and implications for nursing management: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.