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This paper describes factors influencing doctor‐managers' decision making in specialised health care, health centres and at different levels of management.

Data were collected as part of a survey on physicians graduating in 1977‐1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4,144) from the baseline group (n=8,232). The category of doctor‐managers comprised physicians reporting as their main occupation: principal or assistant principal physician of hospital, medical director or principal physician of health centre, senior ward physician of hospital, and health centre physician in charge of a population area.

Independent of gender, all doctor‐managers responding to the survey reported that the most important base for decision making was personal professional experience. Position in organisation (first‐line manager, principal physician) had no impact on the base of decision making. Doctor‐managers in primary health care utilised knowledge on norms and knowledge available from their organisation in support of their decision making to a greater degree compared with doctor‐managers in specialised health care.

Evolution discourse from public administration is not yet receiving much response in Finnish doctor‐managers' activities, instead, they still act as clinicians.

Facing the growing challenges of the future, the paper shows that doctor‐managers should reconstruct their orientation and to act more like managers.

The background reports covering the ongoing reforms in Finnish social service and health care noted that people managing in this field were presented with certain challenges. These included such human resource management challenges as support for the implementation of new work practices, employee commitment, motivation and maintaining wellbeing at work. The purpose of this paper, as part of investigating some of these human resource challenges, is to investigate the occurrence of shared leadership among middle‐level managers in social service and health care, based on self‐evaluations of the managers' own leadership.

Questionnaires were sent to 703 middle‐level managers (managers above first‐line management level) in social service and health care in municipalities and municipal federations within the area of responsibility of a university hospital. There were 433 responses indicating a response rate of 62 per cent. The data from the questionnaires were assessed using quantitative methods in the form of distributions, cross‐tabulations and regression analysis.

Shared leadership was mainly practised by those female managers without a medical doctor's professional background in large organizations of primary health care and social service administration. There was no connection between a manager's age and work experience and the occurrence of shared leadership practices.

As evaluated by middle‐level managers, the social service and health care organizations under survey contained the seeds of change, ranging from individual leadership to shared leadership. Such change may promote innovation, work motivation and the readiness for development among employees.

This study explored the little researched phenomenon of shared leadership and its occurrence among middle‐level managers in Finnish social and health care.

The aim of this study is to produce information concerning factors which may hamper or promote the use of effectiveness data in secondary health care middle and upper management. Additionally, the study aims to acquire knowledge of the ways in which the managers would generate effectiveness data for use in their own work.

The study was conducted by interviewing department directors, chief medical officers and directors of nursing (n=38) in the surgical, medical and psychiatric divisions of the five largest hospital districts in Finland.

The use of effectiveness data in management was hampered by factors relating to research, managerial work and the organization. Factors relating to the production of effectiveness data, managerial behaviour and a universal demand for evidence‐based operations were considered conducive to the use of such information. Managers would cultivate the use of effectiveness data by improving its accessibility, usability and visibility.

The findings may help healthcare organizations in developing the use of effectiveness data in their decision‐making.

The paper addresses managers’ willingness to apply effectiveness data in decision‐making although the present quality, reliability and accessibility of effectiveness data do not meet the managers’ needs. The use of effectiveness data in management can be influenced by enhancing organizational patterns of action and supporting managerial decision‐making.

The purpose of this paper is to investigate how managers in social and health care evaluate the knowledge sources affecting their decision‐making, and how the evaluations were associated with the managers' professional background, activity sector, gender, age and management experience.

The study data are gathered from a questionnaire survey to the middle‐line doctor, nurse and social managers (n=404) within the responsibility area of a Finnish university hospital. Assessed the proportions of individual knowledge sources in the complete data set and their associations with the subjects' background data. In addition, grouping of individual knowledge sources variables are made using factor analysis.

The findings indicate that social and health care managers attempt to utilize diverse knowledge sources. Overall, professional experience and education, organization budget, and action plans of one's own unit are estimated as knowledge sources with the greatest impact. Manager's professional background and activity sector are associated with the kind of knowledge affecting their decision‐making. Some differences are noted between genders, but differences with respect to age or management experience are non‐significant.

Social and health care organizations represent expert organizations where decision‐making is steered by professions and management tasks.

This paper suggests that the future decision‐makers will be required to identify versatile knowledge areas across cultural barriers, and to be capable of making comprehensive decisions affecting the entire organization.

The purpose of this study is to examine components of good personnel management and how they come true in accounts of social and health care managers.

The data were obtained by means of a postal survey sent to middle‐line managers in positions above the first‐line management level in the responsibility area of Tampere University Hospital. The questionnaire was sent to 703 managers; 433 sent in responses indicating a response rate of 62 percent.

Middle‐line managers considered themselves as interactive, responsibility‐sharing and understanding leaders, but found shortcomings in the leadership style of their superiors. Only 18 percent of the middle‐line managers received feedback and only 42 percent received support from their superiors when needed. There were significant differences between genders, activity sectors and professional backgrounds in the responders' accounts concerning personnel management practices.

The results of this study reliably describe how middle‐line managers consider things to be, not necessarily how things are in reality.

The findings confirm the assumption that the importance of personnel management is still not perfectly understood in the upper management levels of the social and health care sector. At the same time the self‐evaluations of middle‐line managers implied an ambition towards better personnel management.

This study identifies components of good personnel management from literature and uses them as the basis for analysing the data.

The purpose of this paper is to map out managers' understanding of effectiveness and to assess the application of knowledge of effectiveness in secondary healthcare management. Additionally, the study aims to assess the present situation of effectiveness research and the measures used in divisions of treatment.

The study was conducted by interviewing department directors, chief medical officers and directors of nursing (n=38) in the surgical, medical and psychiatric divisions of the five largest hospital districts in Finland.

The concept of effectiveness was complex, and difficult to concretise and understand uniformly. Knowledge of effectiveness supports both clinical and administrative management. Managers have different ways of applying knowledge of effectiveness depending on their managerial role. Effectiveness studies and measurement are still relatively rare in secondary healthcare and rarely identified as such by management.

The concept of effectiveness is not clear in management. Managers have an unclear understanding of knowledge of effectiveness and its application in secondary healthcare management.

The paper addresses the need for a discussion on effectiveness in secondary health care. In addition, managers need knowledge and support for implementing the policy of effectiveness on all levels of management.

The aim of this paper is to examine leadership styles among middle‐level managers in social and health care using the leadership role definitions developed by Robert Quinn et al..

The data were obtained by means of a postal survey sent to middle‐line managers in social and health care services in municipalities and municipal federations within the responsibility area of one university hospital in Finland. The survey was sent to 703 managers, the response rate was 62 percent. Leadership styles differences were measured according to gender, professional background, activity sector, age, work experience and unit size. To determine statistical significance, t‐test was used.

Leadership roles of middle‐level managers were evenly distributed on a relatively high level. Statistically significant differences found in leadership styles were related to gender, professional background, activity sector and unit size. Leadership styles stressed intra‐organizational activities, while extra‐organizational roles received less attention.

Using Quinn's model to describe leadership roles provides one view of the type of leadership style adopted by social and health care managers in a situation involving several ongoing reforms including those addressing management practices. Previously, Quinn's model has been widely employed to depict leadership roles in business management but rarely to model management in social and health care as in this paper.

The purpose of this paper is to identify how the factors associated with sense of community at work are connected with job satisfaction among the front-line managers and middle managers in social and health-care services in Finland.

A questionnaire prepared for this study was sent to 241 social and health-care managers (front line and middle managers) in Finland. A total of 136 of managers responded to the survey (response rate was 56 per cent). Data were analyzed by using descriptive statistics, exploratory factor analysis and multiple linear regression analysis.

Alongside job meaningfulness, open communication and good flow of information within the organization, sense of security provided by close relationships at work and managers’ own superiors’ appreciation of their leadership skills all are related to managers’ job satisfaction.

The study adds to our understanding of factors which are connected to the job satisfaction among social and health-care managers’. The findings of this study can be used in the development of leadership to support managers in coping at work.

The purpose of this paper is to compare teachers' wellbeing in different types of schools (elementary, lower secondary and unified school) and to analyze how gender, type of employment, working hours and time served as a teacher affected teachers' wellbeing and perceptions of questions concerning leadership practices and work organization in school.

The holistic school wellbeing evaluation tool was used to study the wellbeing of 1,294 Finnish teachers. The questions covered four categories of wellbeing: school conditions, social relationships, means for self‐fulfillment and health status. Quantitative methodology was used for analysis.

The general picture was that teachers' wellbeing was highest in elementary schools and lowest in lower secondary schools. The wellbeing of a male teacher, a teacher who had fixed‐term employment and a teacher who worked part‐time was higher than that of a female teacher, a permanent teacher and a full‐time teacher. Single questions concerning work organization and leadership practices followed mainly the same lines. Teachers in unified schools had the lowest ratings when questions relating to obtaining help from the principal, or the possibility of receiving further education and equal treatment were asked.

More attention needs to be paid to permanent teachers employed over a long time with regards to enhancing their wellbeing. In the unifying process of schools, equal treatment, obtaining the principal's help for the teachers and the likelihood of updating education are especially important aspects.

The paper presents a theory‐based evaluation of teachers' wellbeing as well as focal points for school development both from the wellbeing and administrative points of view.