First-line Managers Research Articles

Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed‐methods study

To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission. Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients. A mixed-methods convergent design. Data were collected during 104h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research. Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients. These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety. The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION\u2014a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers\u2019 implementation strategy

BackgroundThe Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications.Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging.MethodsTwenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support.Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care.During the implementation intervention, all events are recorded, and the facilitators keep diaries.Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation.Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes.DiscussionThe OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

Conditions for reflexive practices in leadership learning: The regulating role of a socio-moral order of peer interactions

Peer interaction is a standard aspect of most leadership development programmes and is seen to be conducive to learning. Realising deeper and critical reflexivity in peer interaction is, however, challenging. This study employs conversation analysis to empirically explore peer interactions in a leadership development programme for first-line managers in the public sector in Denmark. The analysis shows that a socio-moral order, that is normative expectations inherent in interactions, guide peer discussions and shape the conditions for reflection and deeper reflexivity. The socio-moral order was based on a central principle of treating each other as experts on one’s own practice. This principle allowed for reflection but turned attention away from critical reflexive practices. As a result, peer discussions took a more conservative rather than a transformational orientation. The study extends the theoretical understanding of the conditions for critical reflexivity as it demonstrates how the socio-moral order of interaction regulates engagement in critically reflexive practices.

A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study

ObjectivesAcute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation...

Studying Resilient Action Strategies of First Line Managers

Background: One important key to an organization’s long-term competitiveness is the ability of first line managers (FLMs) to handle their role as a leader in daily work. FLMs main task is to contribute to a high and stable production output according to customer demands from an input that is characterized by instability and variability. To do so, FLMs must develop resilient action strategies – ways of working and daily problem solving that systematically facilitate to cope with instability. In this study protocol we present a methodological approach developed to evaluate and improve these.
 Methods/Design: The research approach is collaborative and developmental and performed together with two companies. The approach integrates and extends the theory and application of a model on interactive research and a framework on activity analysis. It will be applied using data collection techniques like interviews, diaries, observations, document analysis, and questionnaires. The analysis and development stages will be performed both separate and in collaboration in workshops and the result is planned to end up in the joint writing of a generic handbook on advantageous action strategies for FLMs’.
 Discussion: This study contributes with a new integration of two methodological approaches which provides a novel way to understand and develop dynamic on-the-job behaviour in work settings.

Implementing New Working Practices Through a Structured Support Model for Systematic Work Environment Management: A Qualitative Study From Swedish Municipalities.

To describe factors that facilitate and hinder implementation of a structured support model focusing on psychosocial work environment in Swedish municipalities. This qualitative study was conducted in six Swedish municipalities. In total, 63 semi-structured interviews and focus groups were conducted with key stakeholders in the municipalities during a 2-year period. The consolidated framework for implementation research (CFIR) was used for data analysis. Findings suggest that the support model needs to have an easy enough structure to understand and use, and it must be immediately applicable for work groups and employees. An important factor for facilitating implementation was the support from first-line managers and upper management. Upper management need to be committed to the model and communicate clearly to lower levels of the implementing organization on the purpose and objectives of the model.

Conditions for Workplace Learning as a New First-Line Manager in Elderly Care

The purpose of this article is to explore first-line managers’ experiences of workplace learning in elderly care, with a particular focus on the conditions for learning when entering a new workplace as the new manager. Qualitative interviews were conducted with 35 first-line managers from three organisations in Sweden. Four learning conditions emerged as being particularly significant for first-line managers: the managers’ previous professional experience, job-specific training, social support, and the joint repertoire of organisational arrangements. These conditions shifted in importance during the process of entering the workplace, and the way in which the conditions gave access to learning for different managers varied. The managers’ professional experience and others’ recognition of them had a considerable impact on their admittance to the new workplace. After the initial entry phase, the other three learning conditions became more significant and played a role in enabling or constraining the managers’ learning and becoming the new manager. One conclusion is that contextual and work experiences from elderly care were significant for learning during the initial phase and in order to gain access to workplace learning. Another conclusion is that high expectations and great responsibility were placed on the managers to satisfy their own learning needs. This implies that professional, social and emotional support that is received informally is just as significant for learning as formalised training for entering a new workplace as a new manager.

Innovation capability of women and men managers: evidence from Kazakhstan

The relationship between gender and managers’ innovation capability is not thoroughly investigated, and the innovator’s contribution and men and women’s impact on innovation management is not clearly stated in the research literature. Although recent studies have shown a positive impact of gender on organizational innovations, women managers are still considered less innovative compared to their male counterparts. The paper examines an under-researched role of innovators and their genders in managing innovations in organizations and aims at identifying women and men managers’ innovation capability in the context of newly emerging economy of Central Asia. The quantitative research method (a multivariate closed questionnaire) was utilized among 224 respondents from Kazakhstani private organizations functioning in extraction, construction, production, energy, service, trade, and education industries. Subordinates assessed their supervisors’ (first-line, middle-level, and top managers) innovation capability: stance on innovations, support of subordinates for innovative ideas and activity, and adopting innovations. Linear regression analysis was used for the hypotheses testing and further data assaying. The findings define that women and men managers demonstrate an equally positive attitude towards innovations in organizations but the former outperform the latter in adopting innovations and encouraging employees to innovate. The work lays the ground for further research in the region of Central Asia and emerging countries with dynamic but unstable economic development. The involvement of more women managers in innovations will further a long-term impact on subordinates' satisfaction, dedication to organization and performance. The social implication of the present work lies in increasing executives and senior officials’ awareness of the positive effect of gender diversity on organization innovative capability.

First-line managers’ practices and learning in unpredictable work within elderly care

ABSTRACT Despite the number of studies confirming a high degree of unpredictability in managerial work, little is still known about how managers’ workplace learning happens within organisations in such circumstances. This paper therefore aims to contribute knowledge about managers’ learning in managerial practice when work is unpredictable, by investigating how first-line managers deal with unforeseen situations and how they learn in such circumstances in everyday work. Data was collected via qualitative interviews with 40 first-line managers in Swedish elderly care. By using a theoretical framework based on practice and workplace learning theories, the paper analyses how managers address unpredictability in work through three embedded practices: maintaining, modifying and inventing. The paper goes beyond research on leadership training and leadership development by contributing knowledge about the everyday learning of first-line managers when their work is unpredictable. The unpredictable managerial work does not always create chaos; instead, there are very orderly ways of learning from dealing with unforeseen situations. The unforeseen is not as unpredictable as it might seem in managerial work. On the other hand, that which is not yet known calls for an inventing practice, which results in managers learning to take new paths that can create new practices.

Organisational strategy making and first-line manager challenges: a building and dwelling perspective

Organisational strategy making and first-line manager challenges: a building and dwelling perspective

Safeguarding and Inspiring: In-Patient Nurse Managers' Dual Roles during COVID-19.

In Canada, and internationally, in-patient nurse managers' leadership roles during the current COVID-19 pandemic have not been recognized. Yet these nurse managers play critical roles in safeguarding both staff and patients, and inspiring staff to provide complex patient care. This paper describes how 13 acute-care nurse managers enacted and experienced transformational and complexity leadership during COVID-19. This case study of leadership at one multi-site, academic health sciences centre, examined how the first phase of the pandemic impacted the first-line manager's role, the strategies used to navigate organizational and patient care challenges, supports available and overall key learnings about leadership during a pandemic. Results reveal the dual roles assumed by nurse managers during the COVID-19 crisis. Nurse managers in this organization safeguarded patients, families and staff while ensuring 24-hour unit operations. Through leader-staff relationships, managers inspired staff to keep going despite the constant uncertainty and ambiguity. Nurse leaders in this case study exemplified characteristics of transformational and complexity leadership as their roles intensified in the context of COVID-19. Recommendations for nursing and healthcare leaders regarding the ongoing and future pandemics are discussed.

Conditions for workplace learning: a gender divide?

Purpose The purpose of this paper is to examine and discuss conditions for workplace learning in gender-segregated workplaces in the public sector, how social constructions of gender contribute to (or constrain) the workplace learning conditions within two workplace contexts. Design/methodology/approach The research was carried out through an interactive approach with data from 12 semi-structured interviews with workers and first-line managers from technical maintenance and home care in a Swedish municipality, validated at an analysis seminar with 27 participations, from both workplace contexts the Swedish Work Environment Authority and us researchers. Findings The results indicate that gender affects conditions for workplace learning and contributes to an enabling learning environment in the male-dominated workplace context and to a constraining learning environment in the female-dominated workplace context. The identified differences are created in both organisational structures and the organisations’ cultures. Research limitations/implications When analysing conditions for workplace learning from a gender perspective, the approach of comparative, cross-case analyses is useful. An interactive approach with women and men describing and analysing their work experiences together with researchers is a fruitful way of making gender visible. Practical implications The theoretical approach in this study illuminates how social constructions of gender operate and affect conditions for workplace learning and contributes to a deeper understanding of underlying causes to unequal conditions in different workplace contexts. Social implications The findings imply a gender divide which, from the theoretical strands, can be seen as an expression of asymmetrical power relations and where these gendered learning conditions probably also affect the quality of the services. Originality/value The findings contribute to existing gender theoretical literature by demonstrating that gender is essential to take into consideration when understanding working conditions in different workplace contexts. This study contributes to workplace learning literature by exploring the different ways in which social constructions of gender contribute to enabling and constraining learning environments.

Gender differences in managers\u2019 attitudes towards employees with depression: a cross-sectional study in Sweden

BackgroundDepression is prevalent among employees and a major reason for sickness absence. First-line managers’ attitudes towards employees with depression might influence return to work and the scant literature indicates gender differences in attitudes. The objective of this study was to investigate gender differences in managers’ attitudes to employees with depression.MethodsA cross-sectional study was conducted among 4737 Swedish managers in 2017 (response rate 71%, n = 3358). Attitudes towards depression were measured with the instrument “Managerial stigma towards employees with depression” (12 items). The response patterns of women and men, the level of stigma and the direction of the gender differences were investigated with independent t tests and binary logistic regression analyses with covariates.ResultsThe likelihood of reporting high negative attitudes (score ≥ 36) was lower among women than men (odds ratio, 1.64; 95% confidence interval, 1.28–2.10) after adjusting for age, level of education, work sector, distribution of women and men among the staff, current workplace experience in management, lifetime experience in management, managerial position and presence of staff members at the current workplace who had depression and/or anxiety disorders.ConclusionsBased on these findings, a gender-sensitive approach is suggested for future interventions to improve managers’ attitudes towards employees with depression and other mental disorders.

HR? It’s Not My Job! Toward the Framework of First-Line Manager's HR Role Identity

Although prior research has confirmed that HRM system strength and HR professionals’ support can positively result in the first-line manager’s HR implementation and effectiveness, little is known about the ways in which HRM many other actors at different organizational levels influence first-line managers’ identification of performing their HR duties. The purpose of this conceptual paper is to explore the distinguishable impacts of HRM actors across all organizational hierarchies on first-line managers’ HR role identity, and consequently on their HR implementation behaviors. We conceptualize multi-actor HR involvement construct and develop level-specific implementation climate to connect such each HR involvement to line managers’ HR role identity. Given the articulated explanation of this multilevel model, we suggest the potential contextual antecedents for first-line managers’ perceptual and behavioral outcomes to achieve their HRM goals.

Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff's Work-related Problems

SummaryPurposeThe purpose of this study was to assess nursing staff's work-related problems as perceived by their managers and thereafter develop strategies that would serve as a guide for nurse managers to manage these problems.MethodsA descriptive research design was used. The participants included in the study consisted of the following two groups: Group 1—a convenience sample of 150 first-line managers working at three different hospitals; and Group 2—a panel of experts for the Delphi technique, selected using the Snowball sampling technique. Tools for data collection included the following: Tool 1—questionnaire about nursing staff's problems; Tool 2—Delphi technique to develop strategies for managing nursing staff's problems; and Tool 3—opinionnaire format.ResultsThe recruited first nurse managers were of the opinion that job stress, work overload, conflict, workplace violence, poor performance, staff turnover, demotivation, lack of empowerment, and staff absenteeism were among the common problems faced by staff nurses at work.ConclusionFrom the expert panelists’ perspectives, the newly developed strategy in this study was considered valid; the researchers recommend the strategy developed in this study to be universalized in different health care settings and used as a guide for nurse managers.

A multifaceted intervention for evidence-based pressure ulcer prevention: a 3 year follow-up.

To assess sustainability of an intervention used to implement pressure ulcer prevention. The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing. The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed. The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses. Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.

First-Line Nurse Managers' Challenges at the Crossroads of Norwegian Health Care Reforms.

Norwegian municipal health care has large public service offerings, funded by tax revenues; however, the current Norwegian welfare model is not perceived as sustainable and future-oriented. First-line nurse managers in Norwegian municipal health care are challenged by changes due to major political and government-initiated reforms requiring expanded utilization of home nursing. The aim of this theoretical study was to describe challenges the first-line nurse managers in a Nordic welfare country have encountered on the basis of government-initiated reforms and to describe strategies to maintain their responsibilities in nursing care. First-line nurse managers' competence, clinical presence, and support from superiors were identified as prerequisites to maintain sight of the patients in leadership when reforms are implemented. The strategies first-line nurse managers in Norwegian municipal health care use to implement multiple reforms, regulations, and new acts require solid competencies in nursing, leadership, and administration. Competence in nursing enables focus on the patient while leading the staff. Supports from superiors and formal leadership networks are described as prerequisites for managing the challenges posed by change and to persist in leadership positions.

Someone to Lean On: First-Line Managers’ ChangeAgency Across Distance

Someone to Lean On: First-Line Managers’ ChangeAgency Across Distance

First-Line Managers' Experiences of Working with a Structured Support Model for Systematic Work Environment Management.

Background: This paper describes the experiences of first-line managers when working with a structured support model for systematic work environment management in their work groups. First-line managers play a key part in influencing the work environment. Methods: In this study, a sample of managers implementing a structured support model, the Stamina model, in Swedish municipalities were interviewed. A total of 31 (n = 31) interviews were conducted at two time points during a one-year period. The collected data were analysed using a qualitative thematic approach. Results: The results showed that managers experienced discomfort when giving the responsibility of working with work environmental issues to employees. However, managers also experienced and were impressed by how well it worked in allowing employees to take on work environmental issues. Managers found that they balanced between being quiescent and, at the same time, actively monitoring progress in the work groups. Conclusions: The results from this study implicate that managers need to be sensitive to the needs and capacity of their work groups. The oracle in Delphi stated know yourself. We conclude: Know your group!

“Stuck in the middle” first-line healthcare managers’ responsibilities and needs of support when applying Lean

PurposeThe purpose of this paper is to present the supportive conditions that the first-line health-care managers claim that they need from their own managers and what they experience as their own roles and responsibilities in relation to their coworkers when applying Lean principles and practices.Design/methodology/approachA survey with a Web-based questionnaire was designed and used in a Swedish health-care organization two years after the initiation of Lean to investigate the managers’ views on their role, conditions and ability to create change according to Lean. The result from two of the questions will be presented where one focuses on the relationship to the first-line managers’ own manager and the second on the relationship to their coworkers.FindingsThe results show that to initiate improvement, work based on Lean first-line managers ask for own managers who are assured about Lean, include them in discussions and ask for follow-ups and results about Lean. Concerning first-line managers’ relation to their coworkers they experience themselves as responsible for leading toward creating a culture where problems and mistakes are viewed as possibilities to improve, for encouraging that new work procedures are tested and for creating commitment and inspiration in relation to their coworkers.Originality/valueThe questions can be used separately or as part of an entire questionnaire before and along the Lean process to highlight organizational issues such as shared responsibility and supportive relations when developing health care.