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As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.

This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.

The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.

The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.

This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000–2016) on management and reforms in the Nordic hospital landscape.

A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals.

The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept.

The search was limited to the period 2000–2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations.

The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals.

This review summarizes the literature on how academic literature (2000–2016) – in a Nordic reform context – has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.

Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.