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Article
Publication date: 5 February 2018

Kerstin Nilsson, Fredrik Bååthe, Annette Erichsen Andersson and Mette Sandoff

The aim of this study has been to explore learning experiences from the two first years of the implementation of value-based healthcare (VBHC) at a large Swedish…

Abstract

Purpose

The aim of this study has been to explore learning experiences from the two first years of the implementation of value-based healthcare (VBHC) at a large Swedish University Hospital.

Design/methodology/approach

An explorative design was used in this study. Individual open-ended interviews were carried out with 19 members from four teams implementing VBHC. Qualitative analysis was used to analyse the verbatim transcripts of the interviews.

Findings

Three main themes pinpointing learning experiences emerged through the analysis: resource allocation to support implementation, anchoring to create engagement and dedicated, development-oriented leadership with power of decision. Resource allocation included the need to set aside time and administrative resources and also the need to adjust essential IT-systems. The work of anchoring to create engagement involved both patients and staff and was found to be a never-ending task calling for deep commitment. The hospital top management’s explicit decision to implement VBHC facilitated the implementation process, but the team leaders’ lack of explicit management mandate was experienced as obstructing the process. The development process contributed not only to single-loop learning but also to double-loop learning.

Originality/value

Learning experiences drawn from implementing VBHC have not been studied before, and thus the results of this study could be of importance to managers and administrators wanting to implement this concept in their respective organizations.

Details

Leadership in Health Services, vol. 31 no. 1
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 2 October 2017

Kerstin Nilsson, Fredrik Bååthe, Annette Erichsen Andersson and Mette Sandoff

This study explores four pilot teams’ experiences of improvements resulting from the implementation of value-based healthcare (VBHC) at a Swedish University Hospital. The…

Abstract

Purpose

This study explores four pilot teams’ experiences of improvements resulting from the implementation of value-based healthcare (VBHC) at a Swedish University Hospital. The aim of this study is to gain a deeper understanding of VBHC when used as a management strategy to improve patients’ health outcomes.

Design/methodology/approach

An exploratory design was used and qualitative interviews were undertaken with 20 team members three times each, during a period of two years. The content of the interviews was qualitatively analysed.

Findings

VBHC worked as a trigger for initiating improvements related to processes, measurements and patients’ health outcomes. An example of improvements related to patients’ health outcomes was solving the problem of patients’ nausea. Improvement related to processes was developing care planning and increasing the number of contact nurses. Improvement related to measurements was increasing coverage ratio in the National Quality Registers used, and the development of a new coding system for measurements. VBHC contributed a structure for measurement and for identification of the need for improvements, but this structure on its own was not enough. To implement and sustain improvements, it is important to establish awareness of the need for improvements and to motivate changes not just among managers and clinical leaders directly involved in VBHC projects but also engage all other staff providing care.

Originality/value

This study shows that although the VBHC management strategy may serve as an initiator for improvements, it is not enough for the sustainable implementation of improvement initiatives. Regardless of strategy, managers and clinical leaders need to develop increased competence in change management.

Details

Leadership in Health Services, vol. 30 no. 4
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 10 October 2016

Mette Sandoff and Kerstin Nilsson

This study aims to explore challenges arising from the development of teamwork in a new organizational structure, based on the experiences of the staff involved.

Abstract

Purpose

This study aims to explore challenges arising from the development of teamwork in a new organizational structure, based on the experiences of the staff involved.

Design/methodology/approach

An explorative and qualitative approach was used, with individual interviews as the data collection method. These interviews were analyzed using qualitative and interpretative analysis with a modified editing style.

Findings

The results describe how the lack of essential organizational prerequisites for teamwork and the absence of the leadership qualities needed to facilitate teamwork contribute to difficulties in working in a team-orientated way. Shortage of information among the team members and few scheduled meetings signify insufficient coordination within the working team. Without a team leader who can keep things together, read the team members’ needs and support and guide them, team work is difficult to uphold because the members will need to seek support elsewhere. Assumed synergies from working together as team member experts will be thwarted.

Originality/value

This study contributes knowledge about the difficulties in creating team-orientated cooperation in a new organizational structure when leadership as well as structures and processes supporting team work are absent. The challenges described are drawn from the experiences of the staff concerned, providing insights to form a basis for theoretical and practical discussion.

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Article
Publication date: 19 June 2009

Mette Sandoff and Gill Widell

The purpose of this paper is to suggest a frame of reference about the relations between the responsibility and the commitment of employees on the one side and type of…

Abstract

Purpose

The purpose of this paper is to suggest a frame of reference about the relations between the responsibility and the commitment of employees on the one side and type of organization on the other. The basis is a discussion of the tension between docility and freedom.

Design/methodology/approach

Results from earlier empirical studies of disciplinary practices among teachers and warders form the starting point. In this paper the phenomenon of hedonism is added. Hedonism is investigated from a psychological perspective and applied to work organizations with the help of attribution theories, theories on coping and motivation and theories on the conflict between the individual and the organization, i.e. of power, culture and coherence.

Findings

The paper has developed a typology on coping strategies in work contexts, which describes four possible “ideal” roles an individual can take, referring to three dimensions, the dichotomy between freedom and docility, the individual's locus of control as external or internal, and the coherence between individual and organizational values.

Practical implications

The model can be used for empirical studies and contribute to the development of work organizations where people feel committed enough to take responsibility both for monotonous and dull everyday tasks and for exceptional and acute unique problem solving situations.

Originality/value

Most studies on disciplining and docility focus on the painful side of coping. Few studies focus on what people do in order to cope with commitment and responsibility. This paper considers the different power struggles embedded in the work context, and give varying interpretations of them.

Details

International Journal of Sociology and Social Policy, vol. 29 no. 5/6
Type: Research Article
ISSN: 0144-333X

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Article
Publication date: 24 October 2008

Mette Sandoff and Gill Widell

The purpose of this study is to put forward examples of disciplinary practices, i.e. to interpret Foucault's ideas with data collected from today's working‐life in schools…

Abstract

Purpose

The purpose of this study is to put forward examples of disciplinary practices, i.e. to interpret Foucault's ideas with data collected from today's working‐life in schools and prisons. Besides describing disciplinary practices the intention is to describe how individuals cope with the dilemmas that follow. On the grounds of the analysis a discussion about the tension between freedom and docility and different individuals’ strategies for coping with this tension is also promoted.

Design/methodology/approach

Data are collected from teachers in schools and warders in prisons. The empirical question relates to how disciplinary practises are expressed and the dilemmas that follow. In the analysis the concepts of Foucault, time, space and visibility, as relations of power, are used.

Findings

The article shows examples of disciplining and the dilemmas following from disciplining, both at individual and organisational level. Encountering new demands in their work, teachers tend to stick harder to their profession while warders tend to freely use their life experiences to develop their work. One conclusion is that freedom may be easier when individual values and organisational values are in coherence with one another, and docility is more often used when they differ.

Originality/value

That there are tensions between individuals’ striving for freedom and organisations’ striving for their disciplining is no news but on the grounds of the empirical data dilemmas and how teachers and warders cope with them in their work are described. The data also encourage further discussion while it brings findings of different ways of coping, for example when it comes to professionals and non‐professionals.

Details

International Journal of Sociology and Social Policy, vol. 28 no. 11/12
Type: Research Article
ISSN: 0144-333X

Keywords

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Article
Publication date: 1 October 2005

Mette Sandoff

This paper is based on the empirical study of human resources and service work and its purpose is to reveal that the international hotel industry is becoming more…

Abstract

Purpose

This paper is based on the empirical study of human resources and service work and its purpose is to reveal that the international hotel industry is becoming more standardized. The argument presented here is that progressive standardization within customized service production is paradoxical. The aim here is to discuss the paradox and in so doing, to highlight the fact that control, predictability and risk minimization are just as important to hotel operations as customized service.

Design/methodology/approach

The data, in the form of qualitative interviews conducted in five European capital cities, are drawn from international first class hotel groups. Three international hotel groups are represented, and four hotels have been picked out from each group. In addition to the hotel‐based interviews, head office interviews with the three hotel group directors of human resources were undertaken.

Findings

Attempts to standardize service production are popular due to the unpredictable character of service operations. The traditional view – as reflected in the service management literature, is that service should be customized in order to satisfy customers. It seems paradoxical to strive for standardization and customization at the same time and the findings show that customized service is seldom found in practice.

Originality/value

The data reveal the divide in the discourse between academia and practice on standardization versus customization.

Details

International Journal of Contemporary Hospitality Management, vol. 17 no. 6
Type: Research Article
ISSN: 0959-6119

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Article
Publication date: 5 May 2015

Kerstin Nilsson and Mette Sandoff

The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers’ experiences of leading…

Abstract

Purpose

The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers’ experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization.

Design/methodology/approach

This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style.

Findings

The process managers’ experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager’s responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager.

Research limitations/implications

Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings.

Originality/value

This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers’ experiences, a subject that has not been investigated earlier.

Details

Leadership in Health Services, vol. 28 no. 2
Type: Research Article
ISSN: 1751-1879

Keywords

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Article
Publication date: 16 November 2015

Kerstin Nilsson and Mette Sandoff

The purpose of this paper is to establish a knowledge bank for the development of overall hospital processes. Description and analysis are used to show how process…

Abstract

Purpose

The purpose of this paper is to establish a knowledge bank for the development of overall hospital processes. Description and analysis are used to show how process managers experience their situation and the various possibilities it offers for active management in the context of managing processes of inpatient care and treatment at Swedish hospitals.

Design/methodology/approach

A qualitative and explorative design with open-ended interviews with 12 process managers at three Swedish hospitals was used. Transcribed interviews were analysed by means of latent content analysis.

Findings

The two main categories emerging from the analysis were characteristics of process leadership and prerequisites of process management. Quality, relational and knowledge dimensions, and structure, time and information dimensions emerged as their respective sub-categories. The overall theme describes the interdependence between leadership characteristics and the prerequisites necessary for effective process management.

Research limitations/implications

No generalizations could be made from the results of the qualitative interview studies but a deeper understanding of the phenomenon was reached, which in turn can be transferred to similar settings.

Originality/value

This study contributes qualitative descriptions of leadership characteristics and the prerequisites necessary for active process management in the context of managing processes of inpatient care and treatment at Swedish hospitals, a subject that has not been investigated earlier.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

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