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In the implementation of integrated care, the role of managers is important and their mutual collaboration should be addressed more visibly. The purpose of this study was to investigate how cross-boundary collaboration is constructed in the discourse of middle-level managers in health and social care.

The study was based on a discursive approach. Group discussions with three groups of Finnish middle managers (n = 39) were analyzed using discourse analysis.

Five ways of talking about cross-boundary collaboration were identified, labeled “ideal”, “structure”, “defence”, “money” and “support” discourses. In the ideal discourse, cross-boundary collaboration appeared as a “good thing” and is self-evident. Structural discourse defined managers as passive actors in self-sustaining entities. Defensive discourse highlighted the problems of cross-boundary collaboration and the hierarchy within the health and social sectors. Financial discourse constituted the ultimate obstacle to successful cross-boundary collaboration, and both strengthened and explained defensive discourse. Supportive discourse portrayed other managers as partners and as an important resource.

Cross-boundary collaboration can be experienced as a resource, helping managers cope with their workload. However, identification of and continuous attention to challenges at macro, meso and micro levels of integrated care is crucial for successful collaboration. Thus, critical discussion of collaboration needs to be given space.

The study design and discursive approach highlights the power of language and give voice to middle managers who are key actors when implementing integrated care.

Integrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).

The data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.

Three central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.

This Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.

The purpose of this paper is to describe a Finnish pilot project aiming to support high-needs clients in their everyday lives by developing an integrated care approach based on the multi-sectoral collaboration of care professionals. The Help Team for school-aged children will be described as an example of the integrative practices developed on the project.

Altogether 250 professionals from primary and secondary health care and social care and from the education sector were designated to collaborate in 37 local, multi-sectoral teams, aiming to develop integrated care practices for high-needs clients. Teamwork was supported by coaches and project seminars, the Breakthrough method and other LEAN methods. The project was evaluated internally by means of a survey and interviews with the participants.

As a result of the project, all 37 teams developed a specific collaboration model for their selected target group comprising different kinds of high-needs clients.

The sustainability of the outcomes of the project depends on how managers and decision-makers are committed to applying the collaboration models in future.

Many of the collaboration models developed in the project will be implemented in practice in a wider area.

The project highlighted the need to pay attention to the problems of people with multiple care needs and the challenges they pose for integrated care.

The project was based on the client-centered development work done by frontline professionals. Due to the high level of involvement of the professionals themselves, the project proved highly instructive for them. It is extremely important to engage frontline level professionals in development work and support them in collaborating beyond the traditional “silos”.

The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management.

Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue.

In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management.

The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions.

The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies.

Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients’ active agency. The potential restrictions and consequences of a “business-like” orientation must be paid careful attention when dealing with patients with multimorbidity.

The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed.

The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.

By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

The aim of the paper is to understand and define how the polyphony of management is constructed in interaction and to describe this through concrete management meeting cases. Polyphony refers to the diverse voices of various organization members, and how these voices are present, disclosed and utilized in management.

The study is based on the social constructionist and discursive perspectives of management, which question the traditional, individualistic approaches of management. The issue was examined through a qualitative case study by analysing the micro‐level management discourse in three healthcare organizations.

Discursive practices that enhance or inhibit polyphony are often unnoticed and unconscious. Key moments of management discourse are an example of unconscious mundane practices through which members of organizations construct the reality of management.

The empirical results are locally contextual. In the future, research will be able to apply the approach to diverse contexts as well as link micro‐level discourses to the construction of broader health and social management discourses.

The paper increases the understanding of how to enhance participation and staff contribution, and how to utilize the knowledge of all members of the organization.

Both managers and other staff members are fully involved in the social construction of management. Micro‐level discourse should be paid attention to in management work as well as in the education of managers and staff.

The study increases the understanding of micro‐level issues of management and challenges the conventional, taken‐for‐granted assumptions behind organization and management theories.

Not only does leadership produce changes, but those changes produce leadership in organisations. The purpose of this paper is to present a theoretical and empirical analysis of the transformation of leadership at two different historical points in a health care organisation. It leans on the perspective of social constructionism, drawing especially from the ideas of Berger and Luckmann (1966). The paper seeks to improve understanding of how leaders themselves construct leadership in relation to organisational change.

The empirical material was gathered in a longitudinal case study in a nursing organisation in two different historical and situational points. It consists of written narratives produced by nurse leaders that are analysed by applying discourse analysis.

The empirical study revealed that the constructions of leadership were dramatically different at the two different historical and situational points. Leadership showed up as a complex, fragile and changing phenomenon, which fluctuates along with the other organisational changes. The results signal the importance of agency in leadership and the central role of “significant others”.

The paper questions the traditional categorisation and labelling of leadership as well as the cross-sectional studies in understanding leadership transformation. Its originality relates to the longitudinal perspective on transformation of leadership in the context of a health care organisation.

The purpose of this paper is to analyse the impact of reforms designed to address economic and demographic challenges in England with reference to the authors’ own empirical work providing a critique of their impact and suggesting a way to improve the quality of social care for older people.

The research was a qualitative study conducted in a participatory manner in which older people were positioned as co-creators of the research study. This involved setting the scope of the study and identifying and refining the themes used in the analysis of an inquiry board and interviews.

The research findings highlight the threat of recent moves that emphasise “independence” and “self-management” particularly as they risk marginalising some groups of older people and reducing the quality of care. An alternative approach drawn from the ethics of care is suggested.

The research study focused on a narrow selection of older people and future work will wish to explore concepts of “care” and “independence” in additional contexts and of reforms in other geographies.

The researchers argue that the current reform agenda threatens the quality of care services and suggest improvements to the way in which services might be organised and presented.

It is intended that the research will contribute to social policy debates and particularly those that focus on social care. The study also looks to contribute to current work in the fields of critical gerontology, feminist ethics and the management of public services more generally.

The paper presents a novel and critical viewpoint of current social care policy in England and will therefore be of interest to policy-makers and to professionals.

The purpose of this paper is to analyse how accounts of collaboration practice were made and used to construct accountability in the empirical context of coordination associations, a Swedish form of collaboration between four authorities in health and social care. They feature pooled budgets, joint leadership and joint reporting systems, intended to facilitate both collaboration and (shared) accountability.

Empirical data were collected in field observations in local, regional and national settings. In addition, the study is based on analysis of local association documents such as evaluations and annual reports, and analysis of national agency reports.

Accountability is constructed hierarchically with a narrow focus on performance, and horizontal (shared) accountability as well as outcomes are de-emphasised. Through this narrow construction of accountability the coordination associations are re-created as hierarchical and accountability is delegated rather than shared.

Features such as pooled budgets, joint leadership and joint reporting systems can support collaboration but do not necessarily translate into shared accountability if accountability is interpreted and constructed hierarchically.

When practice conforms to what is counted and accounted for, using the hierarchical and narrow construction of accountability, the result may be that the associations become an additional authority. That would increase rather than decrease fragmentation in the field.

This research derives from first-hand observations of actor-to-actor episodes complemented with the analysis of documents and reports. It provides critical analysis of the construction and evaluation of accounts and accountability related to practice and performance in collaboration. The main contribution is the finding that despite the conditions intended to facilitate inter-organisational collaboration and horizontal accountability, the hierarchical accountability persisted.

Finland represents one of the Nordic welfare states where the role of the public sector as the organiser and provider of health and social care is strong. However, the amount of voluntary work in social and health care services is surprisingly big. The strongest advocates for keeping the volunteers outside are hospitals and health centres while at the same time they are suffering from shortages of staff and staff is reporting lack of time to provide needed care for their patients. The purpose of this paper is to report the results of a study of the attitudes of professionals towards voluntary work in hospitals.

The paper is based on an exploratory study done in three hospitals, two from an urban area and one in a rural area. The interviewees represent nursing and care staff (n=21). The main questions were how staff members see options, constraints and drawbacks of volunteering regarding professional roles, work division, coordination and management.

Attitudes of staff varied from positive to conditional. The approaches towards voluntary work varied from holistic to task-centred or patient-centred and were linked with organisational approach, professional approach or considerations of patients’ well-being. Critical views were expressed related to managerial issues, patients’ safety and quality of care. Increasing the amount of voluntary work done in hospitals would require a considered strategy and a specifically designed process for coordination, management and rules on the division of labour.

The research raised themes for further quantitative studies to elaborate the findings on the similarities and differences of the opinions of different staff categories and to be able to develop further the heuristic model of volunteer management triangle suggested in the paper.

The study raises questions of the need and promotion of volunteers in general and especially in health care services. It also raises critical views related to voluntary work in hospitals.

The study is a new initiative to discuss voluntary work and how to manage volunteers in hospitals. It provides valuable knowledge for practitioners in health care involved in volunteer management and coordination.