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  • 1. Blomberg, H.
    et al.
    Welander, J.
    A narrative study of newly graduated registered Swedish nurses’ establishment in the profession and the portrayal of a healthcare organisation2019In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate how the participants talk about their experiences as newly graduated nurses, managers and nursing colleagues in the context of “newcomers’ establishment in the profession” and to identify how they portray the healthcare organisation in their narratives. Design/methodology/approach: A narrative approach is used to reveal and illustrate three perspectives on the topic “new-comers’ establishment”. In total, 14 interviews are conducted with 4 managers, 4 nursing colleagues and 6 newly graduated registered nurses. The focus of this study is how a healthcare organisation embraces and retains newly graduated registered nurses and how this is perceived. Findings: The newcomers’ establishment is facilitated by an orientation programme and an orientation period, individual support provided by managers and colleagues, and the creation of trust to boost confidence in nursing situations. The organisation is portrayed as struggling with high workloads, nursing shortages, high levels of responsibility and showing concern and an interest in the newcomer. The parties criticise the university for not teaching the most basic knowledge, thereby revealing the existence of a theory-practice gap. Originality/value: The research shows how building trust amongst the organisation’s members is essential for creating a satisfying workplace and the retention of newly graduated registered nurses. Empirical descriptions of newly graduated nurses, managers and nursing colleagues experiences of “newcomers establishment” are rare, which is why the description of such “establishment” in this research increases the value of the paper.

  • 2.
    Frykman, Mandus
    et al.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Muntlin Athlin, Åsa
    Uppsala Universitet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    Mazzocato, Pamela
    Karolinska Institutet, Sweden.
    The work is never ending: uncovering teamwork sustainability using realistic evaluation2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 1, p. 64-81Article in journal (Refereed)
    Abstract [en]

    Purpose-The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork. Design/methodology/approach-Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamworkat an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used. Findings-The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced. Practical implications-The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period. Originality/value-By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

  • 3.
    Korlén, S.
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Essén, A.
    Stockholm School of Economics, Stockholm, Sweden.
    Lindgren, P.
    Karolinska Institute, Stockholm, Sweden.
    Amer-Wahlin, I.
    Karolinska Institute, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institute, Stockholm, Sweden.
    Managerial strategies to make incentives meaningful and motivating2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 2, p. 126-141Article in journal (Refereed)
    Abstract [en]

    Purpose: Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach: The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings: The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value: Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers. 

  • 4.
    Ulhassan, W.
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Westerlund, H.
    Stockholm University, Stockholm, Sweden.
    Thor, J.
    Jonkoping University, Jonkoping, Sweden.
    Sandahl, C.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Does Lean implementation interact with group functioning?2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, p. 196-213Article in journal (Refereed)
    Abstract [en]

    Purpose: As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time. Design/methodology/approach: Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n=133) and 2011 (n=130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis. Findings: At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p=0.02) and the Ward-II (p=0.04), but not at Ward-I (p=0.11). Research limitations/implications: Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change. Practical implications: Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members' relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging. Originality/value: This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean. 

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