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Health care managers' views on and approaches to implementing models for improving care processes
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.ORCID iD: 0000-0002-1134-9895
KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
2016 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2016. Vol. 24, no 2
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:kth:diva-165969DOI: 10.1111/jonm.12303ISI: 000372022600019Scopus ID: 2-s2.0-84959465137OAI: oai:DiVA.org:kth-165969DiVA, id: diva2:809219
Note

QC 20150505

Available from: 2015-04-30 Created: 2015-04-30 Last updated: 2018-11-02Bibliographically approved
In thesis
1. Organizational preconditions and supportive resources for Swedish healthcare managers.: Factors that contribute to or counteract changes
Open this publication in new window or tab >>Organizational preconditions and supportive resources for Swedish healthcare managers.: Factors that contribute to or counteract changes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish Healthcare managers’ organizational preconditions and supportive resources are important for their ability to work with planned change in a sustainable way. This thesis further investigates these factors together with an output measure, healthcare process quality (HPQ).

The overall aim was to investigate how healthcare managers’ organizational preconditions and support contribute to or counteract managers’ work with planned change in order to implement process development in a sustainable way. Specific aims were: to improve knowledge of managers’ views of and approaches to increasing their employees’ influence on and engagement in models for improving care processes (study I); to investigate relationships among managers’ organizational preconditions, support, and work to improve quality of care and HPQ over time (study II); to investigate whether managers’ coaching style, preconditions, implementation strategy, appraisal of change, and clinical autonomy are associated with HPQ (study III ); and to assess the influence of support from superiors, colleagues, external sources, subordinates, and private life on managers’ own health (study IV ).

The data for Studies I – III came from five hospitals collected over a three-year period. The data were collected by means of interviews (Study I, qualitative analysis) and annual questionnaires (Studies II and III, quantitative and mixed-method analyses). The data for Study IV were based on questionnaires administered to first- and second-line managers in municipal care, twice during a two-year period.

The results revealed that the healthcare managers were key actors in implementing planned change, but were dependent on their employees’ engagement in order to succeed. Managers’ appraisal of work with planned change became more positive with strong support from other managers, employees, and the organization as well as with long managerial experience. Support from private life and networks, as well as the managers’ attitudes towards their managerial role, predicted their own health. For new managers or managers with many employees, organizational support predicted their health-related sustainability. Managers practising a more distanced style of coaching (e.g., clearly delegating responsibility for implementation work to employees) were associated with better HPQ outcomes than were managers who were more involved in implementation. In conclusion, implementation of planned change are facilitated by, engaged managers, employees with knowledge of implementation work and of the healthcare system, as well as organizational structures that support the managers. Strong support from various sources as well as managerial experience are important for managers’ appraisal of work with planned change. Strong managerial support and a more delegated leadership style are both important factors related to higher estimated HPQ.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2018. p. 62
Series
TRITA-CBH-FOU ; 2018:36
Keywords
Healthcare, Managers, Support, Organizational preconditions, Healthcare process quality
National Category
Work Sciences
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-238487 (URN)978-91-7729-921-9 (ISBN)
Public defence
2018-11-26, Sal T2, Hälsovägen 11, Huddinge, 16:16 (Swedish)
Opponent
Supervisors
Note

QC 20181102

Available from: 2018-11-02 Created: 2018-11-02 Last updated: 2018-11-09Bibliographically approved

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