First-line Managers Research Articles

Challenges for staff encountering older people's existential concerns: Swedish first-line managers' views. A cross-sectional study.

To describe first-line managers' (FLMs) views of the challenges faced by staff when encountering older people's existential concerns in home and residential care. This cross-sectional study uses a combination of qualitative and quantitative methods. The study was approved by the Swedish Ethical Review Authority (ref. number 2014/652 ) and followed the guidelines of the Helsinki Declaration. FLMs in home and residential care were randomly selected and invited to participate. A self-administered questionnaire was distributed online to 467 managers, 136 (29%) of whom completed it. About 80% of the FLMs reported that their staff members sometimes or frequently had conversations with the older people in their care about existential concerns, including the following topics: thoughts and feelings about meaning in life; losses and longing for meaningful relations; death, fears and uncertainty and supporting meaningful everyday life. About 75% of the managers also reported that their staff sometimes or often had conversations about existential concerns with one another. Major hindrances to existential conversations were reportedly cognitive impairment and aphasia among the older people and insecurity and unwillingness among the staff. Most managers (73%) reported that their staff received support when encountering existential concerns, mostly as individual support from managers or registered nurses. The main limitation of this study is its low response rate, which is common for digital surveys. Nevertheless, the sample is considered to be representative; therefore, the study holds exploratory value. Regular conversations among staff, improved conversational skills and the ability to listen reflect on and perceive older people's perspective and life world are needed when encountering older people's existential concerns. FLMs play a crucial role in emphasising and planning staff support on a regular basis.

Women’s health and psychological well-being in the return-to-work process after long-term sick leave for common mental disorders: women’s and first-line managers’ perspectives

Background and aimCommon mental disorders are common reasons for long-term sick leave, especially among women. Return to work is often complex and unsuccessful, why more knowledge is needed regarding women’s health and psychological well-being in the return-to-work process. Therefore, the aim was to describe women’s health and psychological well-being in the return-to-work process, from women’s and first-line managers’ perspectives.MethodsIndividual interviews were conducted with 17 women and 16 first-line managers. Qualitative content analysis was performed based on the content areas “Women’s health (i.e. overall well-being, both physical and psychological) throughout the whole RTW process” and “Women’s psychological well-being (happiness, meaning and a sense of being significant) at work after work resumption” Themes and categories were created.ResultsWomen and managers had similar descriptions, i.e. that women’s health and psychological well-being depend on the individual characteristics of women themselves, their private life, work and other stakeholders. However, women described relational work tasks (e.g. meeting patients) as beneficial for health, and highlighted small stressors in the work environment, which the managers did not. Having work that was compatible with private life, being in good health, having stimulating work tasks and strengthening relationships at work were important for the women’s psychological well-being.ConclusionsBased on women’s and first-line managers experiences, promotion of women’s health and psychological well-being during the return-to-work process requires individually adapted assessments and actions involving women’s entire life situation. First-line managers should know that relational work tasks (e.g., meeting patients) can be beneficial for women’s health as well as that minor stressor in the work environment can put their health at risk.

Fall Risk Management by Nurses in the Inpatient Wards of Aceh Government Regional General Hospital, Indonesia

A patient fall is an incident that commonly occurs with or without injury. Not only does it potentially cause injury, but these incidents can also prolong the length of stay and increase the treatment cost. Nurses play an essential role in assessing and preventing the risk of falls in patients through appropriate education and preventive measures by Standard Operating Procedures (SOP). Effective implementation of SOPs can reduce the frequency and impact of fall incidents and improve the safety and quality of patient care. This case study aimed to expound on fall risk management in the Aceh Government Regional General Hospital wards. A quantitative case study type with a cross-sectional study was designed. The sample consisted of 28 nurses, and the data collection tool used an observation sheet to examine the implementation of fall risk management following the hospital SOP. Data analysis used descriptive statistical tests; the data was then presented as a frequency distribution table. The results show that 67.9% of nurses implemented fall risk management, and 32.1% did not implement it. It was essential to increase nurses’ compliance with the SOP for managing fall risk by monitoring and evaluating periodically and in stages by the first-line manager in the Aceh Government Regional General Hospital wards. It is also recommended that nurses routinely assess the risk of falling in patients, educate patients and their families about it, and participate in ongoing training to improve patient safety in hospitals to achieve better quality healthcare.

First-line managers´ perceptions of missed nursing care in community health care for older people-A phenomenographic study.

First-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers´ perceptions of missed nursing care in community health care for older people. A qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566). The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'. It is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.

First-line managers’ experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study

BackgroundFirst-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context.PurposeTo investigate first-line managers’ experience of clinical practice guideline implementation in orthopaedic care.MethodsThis qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed.ResultsTo the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation.ConclusionsAlthough first-line managers know how to effectively implement CPGs, an organization’s terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.

The Mediating Role of Perceived Investment in Employee Development in the Relationship between Transformational Leadership and Task Performance among First-Line Managers in the Banking Sector

The Mediating Role of Perceived Investment in Employee Development in the Relationship between Transformational Leadership and Task Performance among First-Line Managers in the Banking Sector

Enabling street-level work: minimal structures for customized social services

ABSTRACT This study asks how customization (the provision of non-standardized services) in street-level practice can be enabled. Based on 300h of ethnographic fieldwork, this study demonstrates that practitioners not only need discretionary room, but also social structures, professional knowledge, ‘customization templates’, and – somewhat contradictory – boundaries that limit the endless possibilities of customization. These structures or ‘enablements’ not only enable practitioners to develop novel solutions, but also create predictability, commonality, and consistency. The analysis also explains the role of first-line managers in this practice, which can be both legitimizing and obstructing. When structures lack, customization comes with serious risks for beneficiaries and street-level practitioners.

Co-Design Smart Disaster Management Systems with Indigenous Communities

Tribal governments bear an uneven burden in the face of escalating disaster risks, climate change, and environmental degradation, primarily due to their deeply entrenched ties to the environment and its resources. Regrettably, accessing vital information and evidence to secure adequate funding or support poses difficulties for enrolled tribal members and their lands. In response to these challenges, this paper collaborates with tribal nations to co-design intelligent disaster management systems using AI chatbots and drone technologies. The primary objective is to explore how tribal governments perceive and experience these emerging technologies in the realm of disaster reporting practices. This paper presents participatory design studies. First, we interviewed seasoned first-line emergency managers and hosted an in-person design workshop to introduce the Emergency Reporter chatbot. Second, we organized a follow-up design workshop on tribal land to deliberate the utilization of drones within their community. Through qualitative analysis, we unveiled key themes surrounding integrating these emergency technologies within the jurisdiction of tribal governments. The findings disclosed substantial backing from tribal governments and their tribal members for the proposed technologies. Moreover, we delved into the potential of chatbots and drones to empower tribal governments in disaster management, safeguard their sovereignty, and facilitate collaboration with other agencies.

First-line managers' experience of guideline implementation during the COVID-19 pandemic.

To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. A descriptive, qualitative study. Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

Measuring Trust in Public Sector Organizations – Research Note

The study aims to develop and psychometrically test an instrument to assess trust in public sector organizations. Although trust-based management is of interest in many municipalities in the Nordic countries, an instrument to assess trust adapted for this context is lacking. The present study complies with Luhmann’s system theory and commonly used instruments in this tradition. Data from 240 first-line managers (RR 75%) and 1,871 employees (RR 47%) from all departments in one Swedish municipality were analyzed with a multi-level approach. Out of 16 initial items presented to first-line managers and employees, 8 were retained after the psychometrical testing in both samples. Factor loadings at both within and between levels, and the multilevel homology when exploring convergent and criterion-related validity, showed a similar pattern of two distinct factors. Similar to other previously developed instruments, Supervisory Trust was one dimension. The second construct Organizational Trust included items on trust in politicians and administrative specialists, in addition to trust in top-level managers. The Public Sector Organizational Trust Inventory can be recommended for use in future research on trust at individual as well as group levels.

Impact of Structural Employee Empowerment on Hospital Ratings: Mediating Role of Social Climate and First-Line Managers' Resilience.

The purpose of this article is to investigate the relationship between the structural empowerment of first-line health managers and health facility performance, examining the mediating roles of resilience and social climate in shaping the ratings of Slovak hospitals. Additionally, we aim to investigate the deeper mechanisms of this relationship, particularly the impact of resilience and the social climate, which can positively influence it. The data collection was conducted through a questionnaire survey in February 2022. Respondents included 540 healthcare managers at the first level of management from 44 Slovak hospitals, all of which were part of the evaluation by the Institute for Economic and Social Reforms (INEKO). The analysis involved the use of the PLS-SEM method to examine the relationships between variables and assess direct and indirect effects, utilizing SmartPLS 3.3 software. The findings reveal a positive association between the structural empowerment of first-level managers and the ranking of health facilities. The hypotheses regarding the mediation of both variables - First-Level Managers' (FLMs) resilience and social climate - are supported, whether considered separately or jointly. In the case of joint mediation, a significant portion of the indirect effect is conveyed through FLMs' resilience, suggesting a potential avenue of support from hospital management to enhance health facility ratings. Structural empowerment of first-line managers establishes the conditions for improving the ratings of health facilities. The total effect is significantly more pronounced in promoting their resilience and fostering a supportive social climate.

Identify Patients Correctly in the Inpatient Ward of Aceh Government Hospital: Case Study

The impact of patient care errors has become a global concern. Hospitals must have a safety program to minimize the risk of unexpected events and improve patient safety. Unexpected events can occur due to errors in implementing patient safety objectives, including correct patient identification. Not confirming the patient's ID bracelet, not explaining the purpose of the service, and not using active communication are problems in unsafe patient responses. This case study aims to determine the implementation of correct patient identification in the Aceh Government Hospital inpatient ward. This case study is a quantitative study with a cross-sectional design. The sample was determined using a total sampling technique of 21 nurses. The data collection tool uses observation sheets to identify patients correctly based on standard operational procedures, and data analysis uses descriptive statistical tests. The results of this case study show that 66.7% of respondents have optimally identified patients by ensuring the ID bracelet is installed correctly, 57.2% of respondents have not optimally identified patients by introducing themselves to the patient, 95.2% of respondents have not optimally identified patients by using active communication, 81.0% of respondents had optimally identified patients by providing informed consent before nursing actions, and 85.7% of respondents had not optimally identified patients before nursing actions. The results of this case study show that respondents generally have not implemented patient identification correctly. As a result, it is hoped that first-line managers, as direct superiors of respondents, can carry out routine supervision and guidance and that the Hospital Patient Safety Committee can provide ongoing training regarding patient safety goals to improve patient safety in hospitals.

Assessment and Management of Fall Risk in the Inpatient Ward of the Aceh Government Hospital: Case Study

One of the goals of patient safety is to prevent patient falls. Patient falls are an incident in hospitals that result in injury and even death of patients and are the second most common adverse event in health services after medication errors. Nurses can prevent falls by implementing fall prevention guidelines such as closely monitoring patients at high risk of falling and involving the patient's family to avoid falls. Nurses have a role in assessing and managing falls in patients by providing education to patients and taking fall prevention measures based on applicable Standard Operating Procedures. This case study aims to determine the assessment and management of fall risk in the Aceh Government Hospital inpatient ward. The sampling technique used total sampling with a total of 23 nurses. Data was collected in September 2023 after obtaining institutional permission and filling out informed consent to become a research respondent. The data collection tool uses an observation sheet to assess and manage fall risk, developed based on Standard Operational Procedures. Data analysis uses descriptive statistical tests. This case study shows that 78.2% of nurses did not carry out fall risk assessments, and 74.00% did not manage fall risks. As direct superiors of nurses, first-line managers can carry out supervision, guidance, and regular discussions to assess and manage fall risk. Hospital Patient Safety Committees must provide ongoing training regarding patient safety goals to improve patient safety.

Trust chains in public sector organizations and their significance for work unit performance and employee turnover intention

In this study, we propose that the concept of trust chains can be used to combine two influential traditions in organizational theory – Luhmann´s work on vertical trust and Putnam´s ideas on horizontal trust as a collective asset. Trust chains are then studied empirically by exploring how trust is assessed in the relationships between the employees in work units, the immediate managers, and the top management, including politicians and expert functions in a municipal organization. Aggregated data from questionnaires completed by 1,579 employees and their first-line managers in a Swedish municipality resulted in 126 work units. Cluster analysis identified five different configurations of trust chains with convergent and criterion validity. A solid trust chain with reciprocal links between employees in work units via layers of managers to the top management is clearly the most beneficial situation, while other configurations represent a variety of breaches, with less beneficial outcomes in terms of performance and turnover intentions.

Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators

ABSTRACT Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. Results A main theme was identified “the workplace and healthcare hold different organizational value logics” and four sub-themes: “the PSI-WPI challenged the organizational goals and values of the workplace and healthcare”, “the PSI-WPI challenged organizational values on fairness”, “the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators” and “the PSI-WPI introduced a need for the employee to juggle the employee and patient roles”. Conclusion Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders’ roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

The Role of First-Line Managers in a Pandemic in Reducing the Spread of Infections and Promoting the Health and Well-Being of Rohingya Refugees

ABSTRACT Humanitarian organizations in Bangladesh introduced emergency services to protect Rohingya refugees from COVID-19. This article aims to explore the roles front-line leaders from those organizations played in reducing the spread of the infection and protecting the refugees. By using in-depth interviews with 42 first-line managers (FLMs), it explores the innovative actions and strategies adopted by these managers to implement COVID-19-related programs and services. Initiatives such as training and engaging Rohingya volunteers and developing services promptly in order to raise awareness and manage testing, treatment, and psychosocial interventions contributed significantly to pandemic management in Rohingya refugee camps.

First-Line Nurse Managers' Perception Regarding Self Management Knowledge and Skills

First-Line Nurse Managers' Perception Regarding Self Management Knowledge and Skills

First-line managers struggling to lead home care based on the individual’s needs and goals – conflict between ethical principles

PurposeThe purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.Design/methodology/approachIn this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.FindingsThe results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.Originality/valueThe FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.

How Do Child Welfare Social Workers Assess the Leadership of Their First-line Managers? A 15-Year Perspective

Abstract The study aimed to investigate how child welfare social workers assessed the leadership of their first-line managers over a period of fifteen years and to examine whether the assessments have changed over time. More specifically, the analysis focused on the extent to which social workers perceive the leadership of their first-line managers to be empowering, supportive and fair. Data were collected in the years 2003 (n = 293), 2014 (n = 300) and 2018 (n = 309) using the same questionnaire, mainly based on QPS Nordic, which was distributed to social workers working with investigations of children and youth. The results show that the social workers assessed all measured aspects of their first-line managers’ leadership as better in 2014 compared to 2003 and significantly better in 2018 compared to 2003. In light of previous studies showing that child welfare managers experience less optimal conditions for their leadership, the results are surprising. How is it possible that the first-line managers, despite their own descriptions of a more difficult leadership situation, are seen as more supportive, empowering and fair in their leadership from the social workers’ perspective? Possible explanations for the social workers’ better assessments over the years, such as specialisation, are discussed.

Génériques et/ou spécifiques ? Quels sont les facteurs de risque permettant d’expliquer la détresse psychologique des cadres de premier niveau ?

La littérature scientifique visant à identifier les déterminants de la détresse psychologique au travail se concentre essentiellement sur des facteurs de risque psychosociaux largement répandus dans divers types d’emplois, comme les caractéristiques des tâches (Karasek, 1979). Il s’agit de facteurs pouvant être associés à bon nombre d’occupations puisque leur conceptualisation est générique (p. ex. la charge de travail quantitative). Or les études qui s’intéressent aux facteurs spécifiques à la nature même des emplois étudiés sont encore minoritaires dans la littérature portant sur la détresse psychologique. Dans notre étude, nous investiguons les facteurs de stress associés au rôle des cadres de premier niveau, lequel est reconnu pour sa nature dite « paradoxale » (Hales, 2005). Notre objectif de recherche consiste à identifier les facteurs de stress associés à leur rôle, puis à vérifier l’influence de ceux-ci sur leur niveau de détresse psychologique. Nous optons pour une méthodologie mixte en déployant un devis de type séquentiel exploratoire (Creswell, 2009). Ce type de devis débute par une approche inductive qui permet la collecte de données qualitatives (N=14) propices à la découverte de facteurs de stress spécifiques. Le volet quantitatif subséquent permet de vérifier l’effet de ces facteurs de stress sur le niveau de détresse psychologique à l’aide de données collectées auprès d’un plus vaste échantillon (N= 243). Notre recherche mixte permet d’abord de mettre en lumière les facteurs de risque spécifiques au rôle des cadres de premier niveau, soit le conflit imputabilité/contrôle ainsi que le conflit de rôle associé à la position paradoxale qu’ils occupent. Ensuite, l’étude hypothético-déductive montre que ces facteurs spécifiques contribuent à influencer leur niveau de détresse psychologique, tout comme les facteurs de risque génériques (c.-à-d. la charge de travail quantitative). Nos résultats permettent de mieux comprendre comment les tâches et les responsabilités contribuent à engendrer de la détresse psychologique en plus de positionner les facteurs de risque spécifiques au rôle des cadres de premier niveau comme une avenue de recherche pertinente pour mieux comprendre le phénomène de la détresse psychologique au travail.