Swedish Health Care Organizations Research Articles

Medical secretaries’ fears and opportunities in an increasingly digitalised workplace environment

PurposeThe purpose of this mixed-methods study was to explore how medical secretaries experience digital transformation in a Swedish healthcare organisation, with a focus on workplace climate and health.Design/methodology/approachData were collected using a sequential exploratory mixed-methods design based on grounded theory, with qualitative data collection (a Quality Café and individual interviews) followed by quantitative data collection (a questionnaire).FindingsFour categories with seven underlying factors were identified, emphasising the crucial need for effective organisation of digital transformation. This is vital due to the increased knowledge and skills in utilising technology. The evolving roles and responsibilities of medical secretaries in dynamic healthcare settings should be clearly defined and acknowledged, highlighting the importance of professionality. Ensuring proper training for medical secretaries and other occupations in emerging techniques is crucial, emphasising equal value and knowledge across each role. Associations were found between some factors and the health of medical secretaries.Research limitations/implicationsThis study adds to the knowledge on digital transformation in healthcare by examining an important occupation. Most data were collected online, which may be a limitation of this study.Practical implicationsSeveral aspects of the medical secretaries’ experiences were identified. Knowledge of these is valuable for healthcare managers to make digital transformation more effective while avoiding excessive strain on medical secretaries.Originality/valueMedical secretaries are expected to contribute to the digitalisation of healthcare. However, minimal research has been conducted on the role of medical secretaries in workplace digitalisation, focusing on workplace roles and its dynamics.

Mentoring programmes – building capacity for learning and retaining workers in the workplace

PurposeThe purpose of the paper is to contribute to an understanding of the relational work carried out in mentoring programmes and the implications for learning capabilities in future practices.Design/methodology/approachThis study is based on field research of a mentoring programme bringing together senior and newly graduated workers in a large Swedish health care organisation. In total, 54 qualitative interviews with mentors, mentees, HR, managers and union representatives are included.FindingsThe findings point to the role of trust and a psychological sense of community in the socialisation work that goes on in relationships between the mentor and the mentee. This in turn leads to increased social capital in the form of learning and retaining workers. The conditions for being vulnerable and asking questions, as well as daring to be independent, are an essential and decisive part of constructing bonding within the professional group and bridging out to other professions and parts of the organisation.Practical implicationsThe practical contribution from this study is the workplace conditions that are central to organising mentoring programmes, with implications for learning capabilities in future practices.Originality/valueWith its theoretical focus on social capital, the study shows the importance of relationships for learning and retaining both newly graduated and experienced employees in a context of high employee turnover. It is central to achieving strong and mutually beneficial relationships through continual and trustful interaction between actors. By using the concepts of social capital, socialisation agents and psychological sense of community, this study contributes to an understanding of mentoring and workplace learning.

Leaving early or staying on? Retirement preferences and motives among older health-care professionals

AbstractThere is a need for improved knowledge about how workplace conditions and organisational factors may obstruct or facilitate work in late life. By means of both quantitative and qualitative data, this study aims to explore retirement preferences among employees (aged 55 and older) in a large Swedish health-care organisation and to identify work-related motives influencing their retirement preferences. The quantitative analysis showed large variation in retirement preferences in the organisation. The qualitative results were summarised into two overarching types of motives for late and early retirement preferences, general and group-specific. The general motives were shared by the early and late preference groups, and included recognition, flexibility, health and work motivation. The group-specific motives were exclusively related to either an early or a late retirement preference. Criticism towards the organisation and strenuous working conditions were specific motives for an early retirement preference, while positive accounts of work and a wish to utilise one's own competencies as well as being financially dependent on work was stated as specific motives for wanting to retire late. The results illustrate the need to improve organisational practices and routines, as well as working conditions, in order to make an extended working life accessible for more than already-privileged groups of employees.

“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.

Reconciling value-based objectives for security and identity management

PurposeIn this paper, using values of individuals in a Swedish health-care organization, electronic identity management objectives related to security are defined.Design/methodology/approachBy using value-focused thinking, eliciting values from interviews of three groups of health-care staff’s objective hierarchies for three stakeholder groups are identified and defined. Objective hierarchies allow comparison across multiple stakeholder groups such that strategic objectives for identity management can be compared and contrasted.FindingsThis qualitative investigation, which used value-focused thinking, revealed 94 subobjectives, grouped into 12 fundamental and 14 means objectives, which are essential for developing measures that address potential value conflicts in a health-care organization around electronic identity management. The objectives developed in this study are grounded socioorganizationally and provide a way forward in developing measures aimed to reducing potential conflicts at a policy level.Originality/valueIn a final synthesis, congruence (or lack thereof) in the electronic identity management approach for a Swedish health organization is suggested. This also creates a foundation to evaluate and weight different objectives for strategic decision management.

Employees’ Conceptions of Coworkership in a Swedish Health Care Organization

The concept of coworkership is widely established as a top-down communication strategy within organizations. However, interpretations may differ between organizational levels, and the employees’ point of view is still largely unexplored. The aim of this study was to explore and describe conceptions of coworkership among employees with different professions in a Swedish health care organization. Twelve focus group interviews were conducted with 68 employees, and the data were analyzed using phenomenography. Coworkership was experienced as a collective process, which included colleagues but not explicitly managers. Five categories emerged, representing different conceptions of coworkership: group coherence and striving toward a common goal, cooperation over professional and organizational boundaries, work experience and trusting each other’s competence, social climate and sense of community, and participation and influence. The collective process in terms of cooperation is closely related to team climate, which in turn influences the quality of patient care and a health-promoting work environment.

Lean from the First-line Managers’ Perspective – Assuredness about the Effects of Lean as a Driving Force for Sustainable Change

AbstractThe purpose of this article is to present the results from a survey concerning first-line managers’ assuredness about the effects of Lean after two years of Lean application in a Swedish healthcare organization. The purpose is also to reflect about assuredness as a driving force for sustainable change. Questionnaires were sent to all first-line managers in a healthcare organization in order to investigate how these managers consider their role, ability and conditions to create change according to Lean. One of the questions included 17 statements about how assured these managers were about the effects of Lean. The results from this question will be presented in this paper. The study showed that the majority of the first-line managers in this particular healthcare organization were assured that developmental work supported by Lean contributes to a higher patient focus, supports first-line managers with useful tools and methods, contributes to the development of an improvement culture and that the Lean concept in general is a support in improvement work. The question can either be used separately or as a part of an entire questionnaire in healthcare organizations. Asking first-line managers about their assuredness about the effects of Lean on a regular basis is one way to follow the Lean process from their perspective. The survey question might encourage discussions about the process of Lean and hopefully contribute to a greater understanding about the importance of assuredness and about the desired effects when applying Lean.

Experiences from implementing value-based healthcare at a Swedish University Hospital \u2013 a longitudinal interview study

BackgroundImplementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013.MethodsAn explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis.ResultsValue for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical.ConclusionsHealthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

Gender differences in Reasons for Sickness Presenteeism - a study among GPs in a Swedish health care organization

BackgroundIt is common that physicians go to work while sick and therefore it is important to understand the reasons behind. Previous research has shown that women and men differ in health and health related behavior. In this study, we examine gender differences among general practitioners who work while sick.MethodsGeneral practitioners (GP’s) working in outpatient care in a Swedish city participated in the study (n = 283; women = 63 %; response rate = 41 %). Data were obtained from a large web-based questionnaire about health and organization within primary care. Two questions about sickness presenteeism (going to work while sick) were included; life-long and during the past 12 months, and five questions about reasons. We controlled for general health, work-family conflict and demographic variables.ResultsFemale physicians reported sickness presenteeism more often than male physicians. Work-family conflict mediated the association between gender and sickness presenteeism.Women reported reasons related with “concern for others” and “workload” more strongly than men. Men reported reasons related with “capacity” and “money” more strongly than women. These differences are likely effects of gender stereotyping and different family-responsibilities.ConclusionsGender socialization and gender stereotypes may influence work and health-related behavior. Because sickness presenteeism is related with negative effects both on individuals and at organizational levels, it is important that managers of health organizations understand the reasons for this, and how gender roles may influence the prevalence of sickness presenteeism and the reasons that female and male GPs give for their behavior.

The influence of social challenges when implementing information systems in a Swedish health-care organisation.

To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation.

Organization of change agents during care process redesign in Swedish health care

Background: Swedish health care organizations (HCOs) are changing using management concepts such as Lean, in attempts of improving efficiency, quality of care and work environment. Since there are pre-conditional challenges for operative managers to engage in change, HCOs tend to assign supportive functions such as change agents (CAs) to facilitate change. Research on the use of CAs in HCOs is sparse, thus the aim of this study explores role assignments and conditions of formally appointed CAs contributing to care process redesign.Methods: A purposive sample of three Swedish hospitals initiating Lean-inspired care process redesign during 2010–2011 was done. In-depth interviews were held with fifty-one key functions during change. Focus group interviews were conducted with thirty-eight health care professionals. Data were analysed by content analysis.Results: Top managers’ goal was to have operative management responsible for change during care process redesign, with support from assigned CAs. Organizing of CAs varied concerning, e.g. their hierarchical positions, job descriptions and practices, and conditions to act as driving forces towards change. Being granted formal power, having earned legitimacy and credibility, clarity regarding roles and responsibilities in change; a good sense of timing and ability to build relationships and trust, were identified as beneficial for CAs to support change.Conclusions: Role assignment and organizing of CAs varies. A position closer to the operative levels, formalized and clarified responsibilities, earned legitimacy and timing support adaptation and alignment of planned change, such as Lean-inspired care process redesign.

What if It Was Like a Departure Lounge at an Airport? - eHealth for Healthcare Staff in a Swedish Healthcare Organization, a Participatory Design Study.

eHealth is implemented in everyday work practice as a tool to improve accessibility and patient participation as well as healthcare efficiency. The aim of this study was to explore healthcare staff's experiences and ideas about how eHealth ought to be designed to be a useful tool in everyday work practice in a Swedish healthcare organization. Healthcare staff (n=7) at the micro level in a Swedish healthcare organization, participated in four Participatory Design workshops about eHealth design. eHealth could be a more useful and efficient tool in everyday work practice if it were designed more purposefully for its local setting and intended users, like the information system in 'a departure lounge of an airport'. Including healthcare staff in design discussions concerning eHealth tools for everyday work practice may improve the efficiency of eHealth as an everyday tool and support for healthcare staff.

Exploring communication processes inworkplace meetings: A mixed methods study in a Swedish healthcare organization.

BACKGROUND: An efficient team and a good organizational climate not only improve employee health but also the health and safety of the patients. Building up trust, a good organizational climate and a healthy workplace requires effective communication processes. In Sweden, workplace meetings as settings for communication processes are regulated by a collective labor agreement. However, little is known about how these meetings are organized in which communication processes can be strengthened.OBJECTIVE: The aim of this study was to explore communication processes during workplace meetings in a Swedish healthcare organization.METHODS: A qualitatively driven, mixed methods design was used with data collected by observations, interviews, focus group interviews and mirroring feedback seminars. Data were analyzed using descriptive statistics and conventional content analysis.RESULTS: The communication flow and the organization of the observed meetings varied in terms of physical setting, frequency, time allocated and duration. The topics for the workplace meetings were mainly functional with a focus on clinical processes. Overall, the meetings were viewed not only as an opportunity to communicate information top down but also a means by which employees could influence decision-making and development at the workplace.CONCLUSIONS: Workplace meetings have very distinct health-promoting value. It emerged that information and the opportunity to influence decisions related to workplace development are important to the workers. These aspects also affect the outcome of the care provided.

The role of management accounting and control in making professional organizations horizontal

Purpose– In the last decade, greater attention has been paid to the role of management accounting and control (MAC) in making professional organizations more horizontal. The authors argue that earlier research has not shown how the interrelatedness between professional identities and MAC influences attempts to make organizations more horizontal. In this paper the authors respond to the call for more research on the relationship between horizontalization and accounting and control. The purpose of this paper is to contribute to the emerging literature on the relationship between accountability arrangements and professional identities.Design/methodology/approach– Theoretically the authors have an actor-network theory (ANT) approach. Empirically, the authors followed two episodes where actors at top management levels in two Swedish health care organizations introduced horizontalization.Findings– The two episodes support the view that the role of MAC when making professional organizations more horizontal is limited. Professionals dominate what happens at the operational level and they do not act on MAC rules and performance targets in opposition of their professional identity. However, in alliance with other interessement devices MAC may have a role in creating overflows, that is, pointing out imperfections in the existing frame. The authors noticed no signs that professionals developed hybrid identities as in previous research.Originality/value– The authors apply ANT to move beyond the commonly used contingency and new institutional sociology perspectives.

Understanding champion behaviour in a health-care information system development project – how multiple champions and champion behaviours build a coherent whole

Champions are commonly suggested as a means of promoting the adoption of information systems. Since there are many different definitions of the concepts of champion and champion behaviour in the literature, practitioners and researchers may be confused about how to exactly use these concepts. A qualitative analysis of a single case study in a Swedish health-care organisation enabled us to explain how different champion behaviours relate to each other and how multiple champions interact. Combining our rich case observations with an analysis of champion literature reveals how champion behaviours form a coherent and meaningful whole in which networks of different types of champions at different levels in an organisation utilise their network of relations, their knowledge of the organisation and their insight into strategic decision-making politics to time and orchestrate the framing of innovations and the involvement of the right people. In conclusion, championing is a complex performance of contextually dependent collective social interaction, varying over time, rather than a heroic act of one individual promoting an idea. Future studies need to focus more on how the relations between different champions and their behaviours develop across innovations and over time, in order to develop a richer understanding of championing.

The International Society of Biological and Environmental Repositories presents Abstracts from their Annual MeetingBridging the Canyon – Connecting Biobank Communities through Innovations in Global Health, Research and Environmental PreservationMay 5–9, 2015Phoenix, Arizona

The International Society of Biological and Environmental Repositories presents Abstracts from their Annual MeetingBridging the Canyon – Connecting Biobank Communities through Innovations in Global Health, Research and Environmental PreservationMay 5–9, 2015Phoenix, Arizona

Bottom-up priority setting revised. A second evaluation of an institutional intervention in a Swedish health care organisation

BackgroundTransparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. AimsObjectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. MethodsAn action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. ResultsVertical and horizontal priority setting occurred and resources were reallocated. Participants’ attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. ConclusionsExisting health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.

Ethics and Lean Management – a paradox?

Purpose – The purpose of this paper is to research the practice of ethics in Swedish health care organizations using Lean Management. Design/methodology/approach – A qualitative study was conducted. Findings – Findings indicate that ethics is not a consideration when hospitals are implementing Lean Management. Social implications – Organizations generally have diverse value systems when building their codes of professional ethics for examining ethical principles, whereas Lean Management has established base principles with different codes of professional ethics differing from the intrinsic values humans create according to moral philosophy. It could be said that Lean Management relies on minimalistic ethic. While hospitals implement Lean Management, there are still many barriers to resolve to achieve useful implementation. Managing change while emphasizing ethical values could be a success factor for those organizations and their customers. Originality/value – Studying ethical values in Lean Management implementation.

Prevalence of spondyloarthritis and its subtypes in southern Sweden

ObjectiveTo estimate the prevalence of spondyloarthritis and its subtypes.MethodsThe Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar...

Three key concerns for a successful EPR deployment and usage.

The health care environment is unique because of the large and complex organisation with a traditional hierarchic structure that is governed by laws and regulations. This paper examines how a large Swedish health care organisation work with usability issues regarding Electronic Patient Record (EPR) deployment and usage. EPR systems have great impact on work environment and clinical work routines will not be performed in the same way as before. This paper analyse how the EPR management and core business understand their EPR responsibilities and work with usability aspects at different levels in the organisations. The paper reveals that there is a conflict about responsibility between EPR management and core business management. The reasons for the confusion are contradictive understanding of what an EPR system is, an IT system or a tool for the core business to perform better health care work. This leads to that care staff's experience regarding the EPR system's usability, is not being listened to within the organisation. Three key concerns for a successful EPR deployment and usage are identified and further analysed; education, evaluation and support & improvement ideas.