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Article

Erik Masao Eriksson and Lars Nordgren

There is a current trend in healthcare management away from produced and standardized one-size-fits-all processes toward co-created and individualized services. The…

Abstract

Purpose

There is a current trend in healthcare management away from produced and standardized one-size-fits-all processes toward co-created and individualized services. The purpose of this paper is to increase understanding of the value concept in healthcare organization and management by recognizing different levels of value (private, group and public) and the interconnectedness among these levels.

Design/methodology/approach

The paper uses social constructionism as a lens to problematize the individualization of service logic’s value concept. Theories from consumer culture theory/transformative service research and public management add group and public levels of value to the private level.

Findings

An intersubjective (rather than subjective) approach to value creation entails the construction and sharing of value perceptions among groups of people. Such an approach also implies that group members may face similar barriers in their value creation efforts.

Practical implications

Healthcare management should be aware of the inherent individualism of service logic and, consequently, the need to balance private value with group and public levels of value.

Social implications

Identifying and addressing disadvantaged groups and the reasons for their disadvantaged positions is important in order to enhance the individual’s value creation prerequisites as well as to address public and societal values, such as equal/equitable health(care).

Originality/value

It is important to complement service logic’s value creation with group and public levels in order to understand the complexity and interconnectedness of value and the creation thereof.

Details

Journal of Health Organization and Management, vol. 32 no. 4
Type: Research Article
ISSN: 1477-7266

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Article

Lars Nordgren

The formation and spreading of market‐, management‐ and individual‐rights discourses into society, as well as the movement of consumerism, have paved the way for a…

Abstract

Purpose

The formation and spreading of market‐, management‐ and individual‐rights discourses into society, as well as the movement of consumerism, have paved the way for a transformation of the linguistic usage. The transformation suggests that the view of the care seeker has shifted from a waiting patient, via a consumer to a customer creating value. Another example of the process is that the former medical meeting between patient/doctor now is described as a service meeting. With this background, the purpose of this paper is to explore the transformation of linguistic usage and to analyse the performativity of the service management discourse in health care.

Design/methodology/approach

The concept of performativity (Butler) supported with discursive formation and subjectivization (Foucualt) is used as theoretical framework. The performativity of the discourse is understood as a vehicle within the discourse, which influences people on an ontological level that names and makes them active subjects in line with what the discourse is saying.

Findings

When the service management discourse travels into the world of health care, discursive tensions between medical‐, care‐ and management discourses follow. These become apparent in the distinction between the different discursive constructions of patient – related to passivity, and customer – related to the performative image of active participation in value creating health. Even if the customer in service management discourse is imagined as an agent for himself with power and individual responsibility it is doubtful if people view themselves as customers. The dialectics between the use of the customer concept in commercial service meetings and the patient – doctor meeting, which is illustrated, point to unexpressed and implicit presumptions of an ontological kind in the ways service management researchers describe service meetings. Recent health care research can be interpreted as if a majority of patients have a desire to be part of their value creating processes. Since the responsibilities and tasks of the professions in health care however are regulated by law and institutionalised, the process of delegating tasks to patients seems not to be a matter of course.

Practical implications

It seems to be problematic to replace the patient concept with the customer concept in general. This concept gives hardly much room for the vulnerability that characterises a sick person. A reasonable approach would of course be to use the customer concept in a nuanced way.

Originality/value

The paper demonstrates that the performativity of service management theories, through the use of discursive analysis, is valuable in order to understand shifts in linguistic usage.

Details

Journal of Health Organization and Management, vol. 22 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article

Lars Nordgren

This paper has two purposes: one is to analyse how the policy of freedom of choice emerged and was formed in the Swedish health care discourse; the second is related to…

Abstract

Purpose

This paper has two purposes: one is to analyse how the policy of freedom of choice emerged and was formed in the Swedish health care discourse; the second is related to how free choice influences the discourse in health care and how subjects are formed within the field, i.e. what the language of choice in health care does.

Design/methodology/approach

The research strategy is inspired by a combined theoretical framework borrowed from Michel Foucault's concepts of “discursive formation” and “subjectivization” completed with Judith Butler's concept of performativity.

Findings

The language of “freedom of choice” calls to mind the rhetoric of promises, i.e. that the patient should be free and responsible, in his or her relation to health care. Since patients seem to be insufficiently informed and supported about the actual benefits of possibilities and limitations associated with the severely restricted reform of free choice, the statements concerning opportunities to make personal health decisions will lose their significance. The advocacy of discourses of freedom of choice seems therefore mostly like empty words, as they are producing weak patients instead of free and empowered people.

Research limitations/implications

As the reform was initiated in the beginning of 2000 it is rather fresh.

Originality/value

The paper produces insights into the rhetoric of political promises and the limitations of the reform dealing with freedom of choice in health care.

Details

Journal of Health Organization and Management, vol. 24 no. 2
Type: Research Article
ISSN: 1477-7266

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Article

Lars Nordgren

The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare…

Abstract

Purpose

The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare units, in order to match the need of care for the patients.

Design/methodology/approach

By drawing on statements from patients, experiences from similar services (a literature review), empirical research into the effects of the reforms on free choice and the care guarantee and a theoretically informed discussion drawing on value‐creation and service productivity, it is claimed that a matching system is needed to be developed.

Findings

As healthcare lacks incentives and structures of matching capacity between various care providers, and for coordinating episodes of care for the patient, the result is management of capacity that is difficult and uncertain for patients. Continuity and coordination during all the healthcare process are seen as important values by patients. It is valuable for patients to be matched in the coordination of contacts with providers and specialists.

Practical implications

Healthcare matching generates the supportive data for innovative service research. For management, it could be applicable in different organisational areas, for patients in their choices of provider and for the providers, when matching the needs for patients. In further research, it would be of value to discuss the barriers of matching.

Originality/value

Outlining the conditions for a service system, healthcare matching, has not been done before.

Details

International Journal of Quality and Service Sciences, vol. 3 no. 3
Type: Research Article
ISSN: 1756-669X

Keywords

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Article

Lars Nordgren

The “old” concept of productivity seems to be misleading in health care, because it does not involve the contribution of the patient in value creation. The purpose of this…

Abstract

Purpose

The “old” concept of productivity seems to be misleading in health care, because it does not involve the contribution of the patient in value creation. The purpose of this paper will therefore be to explore possibilities for developing service productivity in theory and practice.

Design/methodology/approach

The analysis is based on a discursive reading of authoritative texts, an understanding of how health care work is organised and of several examples illustrating value creation. A proposed theoretical frame draws on “value creation”, “match matching” and “agency”. Empirical material is used, as are an analysis of a service meeting in health care, official texts in a Swedish context and narratives written by “users” and professionals.

Findings

The concept of service productivity in the context of health care encompasses values such as experienced health, quality of life, accessibility, trust, communication, avoidable suffering and avoidable deaths, and not only reduced costs, activities and outcomes.

Research limitation/implications

There is a need for more research concerning matchmaking and support of the customer. An overall aim for the providers should be to match the value creation process of the customer (patient).

Originality/value

This is a conceptual paper concerning value creation and service productivity in health care.

Details

International Journal of Public Sector Management, vol. 22 no. 2
Type: Research Article
ISSN: 0951-3558

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Article

Lars Nordgren

The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and…

Abstract

Purpose

The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and action logics such as politics, medicine, care and management creating complex conditions for hospital management. The purpose of this paper is to analyse hospital managers' management conditions in conjunction with hospital mergers.

Design/methodology/approach

Two case studies concerning hospital mergers illustrate these management conditions by means of analysing how different actions are communicated by politicians, county council directors, and hospital managers. The author's own experiences as a hospital manager have been made use of, as have document studies. In the analysis, conducted with the support of several theoretical perspectives, certain themes emerge which touch upon these management conditions.

Findings

In connection with hospital mergers, leading hospital actors carry out communicative games controlled by different action logics. No one wants to get stuck with the losing card. The article demonstrates the difficulties of implementing radical organizational changes in hospitals. A challenge for hospital managers lies in creating a shared dialogue and a consensus with the professions, the politicians and the media. The crucial position of power held by the politicians and the professions in critical situations has to be dealt with. Otherwise the hospital manager has to resign.

Originality/value

The paper aims to clarify under which management conditions the hospital manager acts.

Details

International Journal of Leadership in Public Services, vol. 8 no. 3
Type: Research Article
ISSN: 1747-9886

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Article

Anneli Hujala, Sanna Laulainen and Kajsa Lindberg

– 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.

Abstract

Purpose

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.

Design/methodology/approach

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

Findings

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 28 no. 5
Type: Research Article
ISSN: 1477-7266

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Article

Lars Lindkvist and Daniel Hjorth

This paper is a study of creating organization in the case of cultural projects; cultural entrepreneurship. This includes taking advantage of opportunities and using ones…

Abstract

Purpose

This paper is a study of creating organization in the case of cultural projects; cultural entrepreneurship. This includes taking advantage of opportunities and using ones social capital through networks. It is a case study of Vandalorum which is an Swedish international art and design centre with a strong regional connection. They want to offer close collaborations between artists, designers and the creative industry. It is located in Värnamo in the south of Sweden and was inaugurated in April 2011 after an establishment process running over 15 years. Renzo Piano has created the architectural concept of Vandalorum, inspired by traditional Swedish materials and building techniques. The paper aims to discuss these issues.

Design/methodology/approach

Through interviews with significant actors over many years and secondary analysis of data collected by others the authors describe and analyze the establishment process of Vandalorum Art and Design Centre.

Findings

The case of Vandalorum shows that organizing a cultural project like Vandalorum is characterized by no well-defined starting and stopping point, but – quite typically for entrepreneurship as an organization-creation process – builds momentum and legitimacy narratively.

Originality/value

The originality lies in answering the question that the authors chose to focus on, which is embedded in the opening story of Vandalorum: how can such a cultural project become legitimized in a place like that, outside and rather far from any large city? In a changed cultural landscape with reduced public contributions, the claim is that it is crucial to legitimize the idea and project in relation to the main/key stakeholders. Such legitimization is a key entrepreneurial achievement.

Details

International Journal of Managing Projects in Business, vol. 8 no. 4
Type: Research Article
ISSN: 1753-8378

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Article

Lars Norén and Agneta Ranerup

– The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare.

Abstract

Purpose

The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare.

Design/methodology/approach

The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents.

Findings

This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking.

Research limitations/implications

The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres.

Practical implications

The paper provides insights for politicians on how to use ADs to control competition and regulate choice.

Originality/value

The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.

Details

Journal of Health Organization and Management, vol. 29 no. 1
Type: Research Article
ISSN: 1477-7266

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Article

Susan L. Adkins

As CD‐ROM becomes more and more a standard reference and technicalsupport tool in all types of libraries, the annual review of thistechnology published in Computers in

Abstract

As CD‐ROM becomes more and more a standard reference and technical support tool in all types of libraries, the annual review of this technology published in Computers in Libraries magazine increases in size and scope. This year, author Susan L. Adkins has prepared this exceptionally useful bibliography which she has cross‐referenced with a subject index.

Details

OCLC Systems & Services: International digital library perspectives, vol. 10 no. 2
Type: Research Article
ISSN: 1065-075X

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