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Organizational preconditions and supportive resources for Swedish healthcare managers.: Factors that contribute to or counteract changes
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH).
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 [en]
Healthcare, Managers, Support, Organizational preconditions, Healthcare process quality
National Category
Work Sciences
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-238487ISBN: 978-91-7729-921-9 (print)OAI: oai:DiVA.org:kth-238487DiVA, id: diva2:1260468
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
List of papers
1. The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes
Open this publication in new window or tab >>The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes
2017 (English)In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 6, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.

Place, publisher, year, edition, pages
Sciedu Press, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:kth:diva-198938 (URN)10.5430/jha.v6n1p25 (DOI)
Note

QC 20170109

Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2018-11-02Bibliographically approved
2. Health care managers' views on and approaches to implementing models for improving care processes
Open this publication in new window or tab >>Health care managers' views on and approaches to implementing models for improving care processes
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.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:kth:diva-165969 (URN)10.1111/jonm.12303 (DOI)000372022600019 ()2-s2.0-84959465137 (Scopus ID)
Note

QC 20150505

Available from: 2015-04-30 Created: 2015-04-30 Last updated: 2018-11-02Bibliographically approved
3. Professional Bureaucracy and Health Care Managers’Planned Change Strategies: Governance in SwedishHealth Care
Open this publication in new window or tab >>Professional Bureaucracy and Health Care Managers’Planned Change Strategies: Governance in SwedishHealth Care
Show others...
2018 (English)In: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 8, no 1, p. 23-41Article in journal (Refereed) Published
Abstract [en]

To increase efficiency and quality, process development has been implemented in many Swedish

hospitals. These hospitals are usually organized as professional bureaucracies in which

health care managers have limited decision control. The new governance principles has been

implemented without removing bureaucratic elements. This study analyzes how managers implement

planned change in these professional bureaucracies, considering if managers coaching

style, organizational preconditions, implementation strategy, appraisal of change and clinic autonomy,

is associated with health care process quality (HPQ). The study is based on interviews

with health care managers and longitudinal assessments of HPQ. The results revealed significant

differences between coaching style, organizational preconditions, and HPQ over time. The

conclusion is that leadership and preconditions is of importance for the health care manager’s

ability to work with planned change, as that the health care managers understand how management

methods, governance principles, and professional bureaucracies work in practice.

Keywords
Bureaucracy / health care organizations / health care managers / implementation / lean management
National Category
Work Sciences
Research subject
Technology and Health
Identifiers
urn:nbn:se:kth:diva-238485 (URN)000432445300003 ()
Note

QC 20181217

Available from: 2018-11-02 Created: 2018-11-02 Last updated: 2018-12-17Bibliographically approved
4. How can support resources support sustainable leadership in healthcare?
Open this publication in new window or tab >>How can support resources support sustainable leadership in healthcare?
2018 (English)In: Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-238734 (URN)
Note

QC 20181109

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

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