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  • 1.
    Aarons, Gregory
    et al.
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Child & Adolescent Serv Res Ctr, San Diego, CA USA..
    Green, Amy
    Univ Calif San Diego, La Jolla, CA 92093 USA..
    Moullin, Joanna
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Univ Technol Sydney, Sydney, NSW, Australia..
    Ehrhart, Mark
    San Diego State Univ, San Diego, CA 92182 USA.;Univ Cent Florida, Orlando, FL 32816 USA..
    Ducarroz, Simon
    Ctr Reg Prevent Canc, Ctr Hygee, St Priest En Jarez, France..
    Sevdalis, Nick
    Kings Coll London, London, England..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Inst, Stockholm, Sweden.
    James, Sigrid
    Univ Kassel, Kassel, Germany..
    Willging, Cathleen
    Pacific Inst Res & Evaluat, Behav Hlth Res Ctr Southwest, Albuquerque, NM USA..
    Fostering international collaborations in implementation science2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13Article in journal (Other academic)
  • 2.
    Astnell, Sandra
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden.
    Augustsson, Hanna
    Karolinska Institutet, Stockholm, Sweden.
    Stenfors-Hayes, Terese
    Karolinska Institutet, Stockholm, Sweden.
    Integrating health promotion with quality improvement in a Swedish hospital2015In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 31, no 3, p. 495-504Article in journal (Refereed)
    Abstract [en]

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  • 3. Athlin, Muntlin Å
    et al.
    Farrokhnia, N
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska Institutet, Sweden.
    Teamwork in the emergency department-a systematic evaluation of a new working routine2011Conference paper (Refereed)
  • 4.
    Augustsson, Hanna
    et al.
    Karolinska Institutet, Sweden.
    Richter, Anne
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees’ Openness to Organizational Change Content and Process on Intervention Outcomes2017In: Journal of Applied Behavioral Science, ISSN 0021-8863, E-ISSN 1552-6879, Vol. 53, no 3, p. 349-368Article in journal (Refereed)
    Abstract [en]

    This study investigates how individual- and group-level openness to organizational change, concerning change content and process, affects intervention outcomes. The intervention aimed to improve primary health care employees' competence in and use of information and communication technologies (ICT). Employees' (n = 1,042) ratings of their openness to the change content and process as well as of their workgroup's openness to the change content before the intervention were used to predict ICT competence and its use 18 months later. Openness to the change process predicted both ICT competence and use of competence, while openness to the change content and group openness predicted use of competence only. These results show that individual- and group-level openness to organizational change are important predictors of successful outcomes. Furthermore, employees should be open both to the content of the change and to the process by which the intervention is implemented in order to maximize outcomes.

  • 5.
    Frykman, M.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lundmark, R.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Villaume, K.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Line managers’ influence on employee usage of a web-based system for occupational health management2018In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 11, no 4, p. 193-209Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate line managers’ influence on employee usage of a web-based system for occupational health management. Design/methodology/approach: Questionnaires were used to measure line managers’ transformational leadership at baseline and their change-supportive managerial activities during weeks 16–52. Employee initial (weeks 16–52) and sustained (weeks 53–144) use of the web-based system was measured by extracting their frequency of logins to the system from electronic records. Data were collected from six white-collar organizations from 2011 through 2013. Mixed Poisson regressions were used to analyze the influence of transformational leadership and change-supportive managerial activities on employee usage. Findings: As predicted, line managers’ change-supportive activities influenced the employees’ initial and sustained use of the system. Line managers’ transformational leadership had no direct effect on employees’ use of the system, however transformational leadership was indirectly associated with employees’ initial and sustained use of the system through line managers’ change-supportive activities. Originality/value: The study adds to the understanding of the role line managers’ play during the implementation of occupational health interventions. The findings suggest that the line managers’ change-supportive activities directed toward the intervention are important for employees’ initial and sustained use of the system. The influence of transformational leadership was indirect, suggesting that line managers may need to direct their leadership behaviors toward the intervention to facilitate implementation. © 2018, Emerald Publishing Limited.

  • 6.
    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.

  • 7.
    Hasson, Henna
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    Nilsen, Per
    Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Linkoping, Sweden..
    Augustsson, Hanna
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm.
    Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives: a study protocol2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, article id 67Article in journal (Refereed)
    Abstract [en]

    Background: A considerable proportion of interventions provided to patients lacks evidence of their effectiveness This implies that patients may receive ineffective, unnecessary, or even harmful care Thus, in addition to implementing evidence based practices, there is also a need to abandon interventions that are not based on best evidence, i e, low value care However, research on de implementation is limited, and there is a lack of knowledge about how effective de implementation processes should be earned out The aim of this project is to explore the phenomenon of the de implementation of low value health care practices from the perspective of professionals and the health care system. Methods: Theories of habits and developmental learning in combination with theories of organizational alignment will be used The project's work will be conducted in five steps Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de implementation In Step 4, a conceptual framework for de implementation will be developed based on the previous steps In Step 5, strategies for de implementation are identified using a co design approach. Discussion: This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de implementation of low value care The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de implementation in daily practice, and what consequences it has on their work Furthermore, the health care system perspective will be considered and new knowledge on how de implementation can be understood across health care system levels will be obtained The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact The project employs a solution oriented perspective by developing a framework for de implementation of low value practices and suggesting practical strategies to improve de implementation processes at all levels of the health care system The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.

  • 8.
    Karanika-Murray, M.
    et al.
    Nottingham Trent University, United Kingdom.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Richter, A.
    Karolinska Institutet, Stockholm, Sweden.
    Improving employee wellbeing through leadership development2017In: The Routledge Companion to Wellbeing at Work, Taylor and Francis Inc. , 2017, p. 332-344Chapter in book (Other academic)
  • 9.
    Korlen, Sara
    et al.
    Karolinska Inst, LIME, Med Management Ctr, Stockholm, Sweden..
    Richter, Anne
    Karolinska Inst, LIME, Med Management Ctr,Stockholm, Sweden..
    Amer-Wahlin, Isis
    Karolinska Inst, LIME, Med Management Ctr, Stockholm, Sweden..
    Lindgren, Peter
    Karolinska Inst, LIME, Med Management Ctr, S-17177 Stockholm, Sweden.;Swedish Inst Hlth Econ, Box 2017, S-22002 Lund, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, LIME, Med Management Ctr, S-17177 Stockholm, Sweden..
    The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 963Article in journal (Refereed)
    Abstract [en]

    BackgroundIn publicly funded health care systems, governance models are developed to push public service providers to use tax payers' money more efficiently and maintain a high quality of service. Although this implies change in staff behaviors, evaluation studies commonly focus on organizational outputs. Unintended consequences for staff have been observed in case studies, but theoretical and methodological development is necessary to enable studies of staff experience in larger populations across various settings. The aim of the study is to develop a self-assessment scale of staff experience of the governance of economic efficiency and quality of health care and to assess its psychometric properties.MethodsFactors relevant to staff members' experience of economic efficiency and quality requirements of health care were identified in the literature and through interviews with practitioners, and then compared to a theoretical model of behavior change. Relevant experiences were developed into sub-factors and items. The scale was tested in collaboration with the Department of Rehabilitation Medicine at a university hospital. 93 staff members participated. The scale's psychometric properties were assessed using exploratory factor analysis, analysis of internal consistency and criterion-related validity.ResultsThe analysis revealed an eight factor structure (including sub-factors knowledge and awareness, opportunity to influence, motivation, impact on professional autonomy and organizational alignment), and items showed strong factor loadings and high internal consistency within sub-factors. Sub-factors were interrelated and contributed to the prediction of impact on clinical behavior (criterion).ConclusionsThe scale clearly distinguishes between various experiences regarding economic efficiency and quality requirements among health care staff, and shows satisfactory psychometric quality. The scale has broad applications for research and practice, as it serves as a tool for capturing staff members' perspectives when evaluating and improving health care governance. The scale could also be useful for understanding the underlying processes of changes in provider performance and for adapting management strategies to engage staff in driving change that contributes to increased economic efficiency and quality, for the benefit of health care systems, patients and staff.

  • 10.
    Korlén, S.
    et al.
    Medical Management Centrum, Institutionen för lärande, Informatik management och etik (LIME), Karolinska institutet, Stockholm, Sweden.
    Essén, A.
    Center for Human Resource Management and Knowledge Work, Stockholm School of Economics Institute for Research, Stockholm, Sweden.
    Amer-Wåhlin, I.
    Institutionen för kvinnors och barns hälsa, Karolinska institutet, Stockholm, Sweden.
    Lindgren, P.
    Institutet för hälso-och sjukvårdsekonomi (IHE), Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Leaders as intermediates between economic incentive models and professional motivation2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 22-23Article in journal (Refereed)
    Abstract [en]

    The application of economic incentives to providers in health care governance is debated. Advocates argue that it drives efficiency and improvement, opponents claim that it leads to unintended consequences for patients and professionals. Research shows that incentives can increase well-defined activities and targets, but there is a lack of substantial evidence that applications in health care lead to desired outcomes. The motivational literature acknowledges internal sources of motivation as important determinants of behavior, and the literature about professions suggests that professional values of serving patient needs is a key motivator. The management literature identifies the important role of leaders in aligning external demands and rewards to staff preferences, using their own management and leadership skills. Findings in health services research confirm the vital role of leaders for successful implementation and improvement work. In sum, internal motivators and the role of leaders are important to acknowledge also when understanding how economic governance models are put into practice. Our recently published qualitative case study provides empirical examples of how clinical leaders function as intermediaries between a local care choice model, including financial incentives, and the motivation of staff. The strategies deployed by the leaders aimed to align the economic logics of the model to the professional focus on increasing patient value. The main conclusion from these empirical examples, as well as previous research, is that health care managers play a key role in aligning economic incentive models with professional values and in translating such models in to feasible tasks related to the provision of high quality care.

  • 11.
    Korlén, Sara
    et al.
    Karolinska Institutet, Sweden.
    Amer-Wåhlin, Isis
    Karolinska Institutet, Sweden.
    Lindgren, Peter
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Professionals’ perspectives on a market-inspired policy reform: A guiding light to the blind spots of measurement2017In: Health Services Management Research, ISSN 0951-4848, E-ISSN 1758-1044, Vol. 30, no 3, p. 148-155Article in journal (Refereed)
    Abstract [en]

    Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals’ analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.

  • 12.
    Lundmark, Robert
    et al.
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Hasson, Dan
    Karolinska Institutet, Sweden.
    Tafvelin, Susanne
    Umeå Universitet, Sweden.
    Leading for change: line managers’ influence on the outcomes of an occupational health intervention2017In: Work & Stress, ISSN 0267-8373, E-ISSN 1464-5335, Vol. 31, no 3, p. 276-296Article in journal (Refereed)
  • 13.
    Molnar, Malin Mattson
    et al.
    Stockholm University, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Hellgren, Johnny
    Stockholm University, Sweden.
    Hasson, Henna
    Stockholm County Council, Sweden.
    Tafvelin, Susanne
    Karolinska Institutet, Sweden.
    Leading for safety: A question of leadership focusIn: Safety and Health at Work, ISSN 2093-7911Article in journal (Refereed)
    Abstract [en]

    Background

    There is considerable evidence that leadership influences workplace safety, but less is known about the relative importance of different leadership styles for safety. In addition, a leadership style characterized by an emphasis and a focus on promoting safety has rarely been investigated alongside other more general leadership styles.

    Methods

    Data was collected through a survey to which 269 employees in a paper mill company responded. A regression analysis was conducted to examine the relative roles of transformational, transactional (management-by-exception active; MBEA), and safety-specific leadership for different safety behavioral outcomes (compliance behavior and safety initiative behaviors) and for minor and major injuries.

    Results

    A safety-specific leadership contributed the most to the enhanced safety of the three different kinds of leadership. Transformational leadership did not contribute to any safety outcome over and above that of a safety-specific leadership, while a transactional leadership (MBEA) was associated with negative safety outcomes (fewer safety initiatives and increased minor injuries).

    Conclusion

    The most important thing for leaders aiming at improving workplace safety is to continuously emphasize safety, both in their communication and by acting as role models. This highlights the importance for leadership training programs aiming to improve safety to actually focus on safety promoting communication and behaviors rather than general leadership. Furthermore, an overly monitoring and controlling leadership style can be detrimental to attempts at achieving improved workplace safety.

  • 14.
    Mosson, R.
    et al.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Unit for Implementation and Evaluation, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Lundmark, R.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Richter, A.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    How do iLead?: Validation of a scale measuring active and passive implementation leadership in Swedish healthcare2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e021992Article in journal (Refereed)
    Abstract [en]

    Objectives This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale. Methods Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses. Results The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (Ï ‡ 2 (99) =382.864∗∗, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory. Conclusions The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.

  • 15.
    Mosson, Rebecca
    et al.
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Stockholm Cty Council, Unit Implementat & Evaluat, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Stockholm Cty Council, Unit Implementat & Evaluat, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Richter, Anne
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Stockholm Cty Council, Unit Implementat & Evaluat, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Self-other agreement of leadership: A longitudinal study exploring the influence of a leadership intervention on agreement2018In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 11, no 4, p. 245-259Article in journal (Refereed)
    Abstract [en]

    Purpose A common component in leadership interventions is the provision of feedback on leadership behaviors. The assumption is that, when there is a discrepancy in this feedback between managers' and others' ratings of leadership, this will increase managers' self-awareness and motivate them to close this gap. The purpose of this paper is to investigate how agreement between managers and their subordinates changes over time as a result of a leadership intervention. Design/methodology/approach Questionnaire data were collected from line managers (N=18) and their subordinates (N=640) at pre-intervention, post-intervention and at a six-month follow-up. The managers participated in a leadership intervention that aimed to increase their knowledge and skills related to the leadership behaviors described in the Full-Range Leadership Model. Inter-rater agreement and reliability were calculated to justify aggregating the subordinates' ratings. The managers and their subordinates were grouped according to three agreement categories: in agreement, managers' over-rating and managers' under-rating based on the managers' views of their leader behaviors in relation to their subordinates'. Findings Manager-subordinate agreement on the managers' leadership increased between pre-intervention and post-intervention but then decreased at the six-month follow-up (17, 61 and 44 percent, respectively). Most managers (n=15) changed agreement categories over time, and only three managers remained in the same agreement category throughout. The subordinates' mean leadership ratings changed more than the managers' mean ratings. Originality/value This is the first study to explore how manager-subordinate agreement changes when managers participate in a leadership intervention in a health care context. It shows that an intervention that includes upward feedback, by which managers self-rating of their leadership is compared with their subordinates' ratings, can be an effective way to increase agreement.

  • 16.
    Mosson, Rebecca
    et al.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Richter, Anne
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    The Impact of Inner and Outer Context on Line Managers’ Implementation Leadership2018In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 48, no 5, p. 1447-1468Article in journal (Refereed)
    Abstract [en]

    Line managers have an important role in leading implementation of evidence-based practice (EBP). In this task, they are highly influenced by their context. However, little is known about how contextual factors impact managers’ implementation leadership. The aim of the present study is to explore how contextual factors influence line managers’ leadership when implementing EBP. Twenty-eight semi-structured interviews were performed with line managers in social care. A hybrid thematic analysis was carried out. The Consolidated Framework for Implementation Research Framework (CFIR) was used to guide the deductive analysis approach. Findings showed that contextual factors in all of CFIR’s inner setting constructs and in two constructs of the outer-setting domain (Cosmopolitanism and External resources and funding) had a high practical impact on managers’ implementation leadership. However, many of the contextual factors were either not offered to or did not actually reach the managers, which means that they had a limited impact in practice. Moreover, several factors only had a positive practical impact in interaction with other factors, rather than independently. Future research should systematically consider interactions between contextual factors. Identifying factors that have a potential impact in practice may help inform support initiatives to aid managers in developing their implementation leadership. 

  • 17.
    Tafvelin, Susanne
    et al.
    Karolinska Inst, Stockholm, Sweden.;Umea Univ, Dept Psychol, S-90187 Umea, Sweden..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden.;Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Holmstrom, Stefan
    Umea Univ, Dept Psychol, S-90187 Umea, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm, Sweden..
    Are Formal Leaders the Only Ones Benefitting From Leadership Training?: A Shared Leadership Perspective2019In: Journal of leadership & organizational studies, ISSN 1548-0518, E-ISSN 1939-7089, Vol. 26, no 1, p. 32-43Article in journal (Refereed)
    Abstract [en]

    Leadership training most often involves training of formal leaders, and little is known about the potential benefits of leadership training for other members of an organization. Using theories of shared leadership, the current study examined outcomes of transformational leadership training that targets both formal and informal leaders (i.e., both vertical and shared leadership). The training was set in a Swedish paper pulp factory and involved formal and informal leaders participating in 20 days of training over a period of 16 months. Based on employee survey data collected both pre- and postintervention our analyses revealed that both formal and informal leaders significantly improved their transformational leadership behaviors. Interestingly, the improvement in transformational leadership behaviors of formal and informal leaders tended to predict employee efficiency and well-being in different ways. Improvements in formal leaders' transformational leadership were related to employee well-being, while informal leaders' increases in transformational leadership were associated with efficiency. The results point toward the benefit of a shared leadership perspective on leadership training and indicate that improvements in transformational leadership may affect employees differently depending on who in the organization displays them.

  • 18.
    Tafvelin, Susanne
    et al.
    Umeå Universitet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    In agreement? Leader-team perceptual distance in organizational learning affects work performance2017In: Journal of Business Research, ISSN 0148-2963, E-ISSN 1873-7978, Vol. 75, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Leaders and their teams often differ in their perceptions of organizational issues, which have been suggested to influence both employee well-being and performance. The present study examined leader-team perceptual distance regarding organizational learning and its consequences for employee work performance. Sixty-eight leaders and their teams from the Swedish forest industry participated in the study. Polynomial regression with response surface analyses revealed that the perceptual distance between leaders and their teams regarding organizational learning was related to lowered work performance, beyond the influence of employee ratings alone. The analyses also indicated that work performance tended to decrease when the leader rated organizational learning as higher than the team. Our findings suggest that it is important for organizations to minimize the perceptual distance between the leaders and their teams and that further research on the construct of leader-team perceptual distance is warranted.

  • 19.
    Tafvelin, Susanne
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, S-17177 Stockholm, Sweden.;Umea Univ, Dept Psychol, Umea, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, S-17177 Stockholm, Sweden..
    Nielsen, Karina
    Univ Sheffield, Inst Work Psychol, Sheffield, S Yorkshire, England..
    Hasson, Henna
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, S-17177 Stockholm, Sweden.;Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Employees' and line managers' active involvement in participatory organizational interventions: Examining direct, reversed, and reciprocal effects on well-being2019In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 35, no 1, p. 69-80Article in journal (Refereed)
    Abstract [en]

    This study examined how employee participation and perceptions of line managers' support during a participatory organizational intervention were related to well-being over time. Although previous studies suggest that employees' and managers' active involvement in participatory organizational interventions may be related to well-being, little is known about the temporal aspects, such as at which time during the intervention these factors matter, or possible reciprocal effects. Building on conservation of resources theory, we tested hypotheses concerning direct, reversed, and reciprocal relationships between employee participation and perceptions of line manager support in relation to well-being. We used a four-wave panel design consisting of 159 hospital workers. Cross-lagged analyses showed that perceived line managers' support in the initiation and active phase was related to participation in the active phase. Participation in the initiation and active phase was related to well-being in the active and sustained phase, respectively. Results also revealed that participation in the initiation phase was related to perceived line managers' support in the active phase, which in turn predicted participation in the active phase, which translated into job satisfaction in the sustained phase supporting reversed and reciprocal effects in the form of resource caravans. Theoretical implications for research and practice are discussed.

  • 20.
    von Thiele Schwarz, Ulrica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Förberg, U.
    Karolinska Institutet, Stockholm, Sweden.
    Sundell, K.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Colliding ideals - An interview study of how intervention researchers address adherence and adaptations in replication studies2018In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 18, no 1, article id 36Article, review/survey (Refereed)
    Abstract [en]

    Background: For an intervention to be considered evidence-based, findings need to be replicated. When this is done in new contexts (e.g., a new country), adaptations may be needed. Yet, we know little about how researchers approach this. This study aims to explore how researchers reason about adaptations and adherence when conducting replication studies, describe what adaptations they make and how these are reported in scientific journals. Methods: This was an interview study conducted in 2014 with principal investigators of Swedish replication studies reporting adaptations to an intervention from another country. Studies (n = 36) were identified through a database of 139 Swedish psychosocial and psychological intervention studies. Twenty of the 21 principal investigators agreed to participate in semi-structured telephone interviews, covering 33 interventions. Manifest content analysis was used to identify types of adaptations, and qualitative content analysis was used to explore reasoning and reporting of adaptations and adherence. Results: The most common adaptation was adding components and modifying the content to the target population and setting. When reasoning about adaptations and adherence, the researchers were influenced by four main factors: whether their implicit aim was to replicate or improve an intervention; the nature of evidence outlying the intervention such as manuals, theories and core components; the nature of the context, including approaches to cultural adaptations and constraints in delivering the intervention; and the needs of clients and professionals. Reporting of adaptations in scientific journals involved a conflict between transparency and practical concerns such as word count. Conclusions: Researchers responsible for replicating interventions in a new country face colliding ideals when trying to protect the internal validity of the study while considering adaptations to ensure that the intervention fits into the context. Implicit assumptions about the role of replication seemed to influence how this conflict was resolved. Some emphasised direct replications as central in the knowledge accumulation process (stressing adherence). Others assumed that interventions generally need to be improved, giving room for adaptations and reflecting an incremental approach to knowledge accumulation. This has implications for design and reporting of intervention studies as well as for how findings across studies are synthesised. 

  • 21.
    von Thiele Schwarz, Ulrica
    et al.
    Karolinska Institutet, Sweden.
    Nielsen, Karina M
    Sheffield University, UK.
    Stenfors-Hayes, Terese
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    Using kaizen to improve employee well-being: Results from two organizational intervention studies2017In: Human Relations, ISSN 0018-7267, E-ISSN 1741-282X, Vol. 70, no 8, p. 966-993Article in journal (Refereed)
    Abstract [en]

    Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions.

  • 22.
    von Thiele Schwarz, Ulrica
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Stockholm, Sweden..
    Sundell, Knut
    Karolinska Inst, Stockholm, Sweden..
    Forberg, Ulrika
    Karolinska Inst, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden..
    When is a replication a replication?: An interview study of how intervention researchers manage adherence and adaptations in the research process2018In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13Article in journal (Other academic)
1 - 22 of 22
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