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Professional Bureaucracy and Health Care Managers’Planned Change Strategies: Governance in SwedishHealth Care
KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH).
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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.

Place, publisher, year, edition, pages
2018. Vol. 8, no 1, p. 23-41
Keywords [en]
Bureaucracy / health care organizations / health care managers / implementation / lean management
National Category
Work Sciences
Research subject
Technology and Health
Identifiers
URN: urn:nbn:se:kth:diva-238485ISI: 000432445300003OAI: oai:DiVA.org:kth-238485DiVA, id: diva2:1260366
Note

QC 20181217

Available from: 2018-11-02 Created: 2018-11-02 Last updated: 2018-12-17Bibliographically 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: 2020-01-30Bibliographically approved

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