Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden – process managers’ experiences

Nilsson, Kerstin; Sandoff, Mette

doi:10.1108/lhs-04-2014-0043

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…The development of any process requires basic shared understanding of the process among those working with or in it. Establishing such understanding requires leadership skills such as communication and motivation to get people involved step by step in developing the process [ 21 ]. Along with continued implementation of VBHC, the organizational culture also needs to further evolve towards a more patient-oriented way of working.…”

Section: Discussionmentioning

confidence: 99%

“…Conflicts over organizing principles and structures have been found to form obstacles to implementing process orientation [ 20 ]. When implementing process-oriented management strategies it has been found important to clarify process managers’ responsibility and work content [ 21 ]. Furthermore it was important to emphasize process managers’ basic requirements in order to do a good job [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Experiences from implementing value-based healthcare at a Swedish University Hospital – a longitudinal interview study

Nilsson

Bååthe

Andersson

et al. 2017

BMC Health Serv Res

Self Cite

144

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BackgroundImplementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013.MethodsAn explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis.ResultsValue for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical.ConclusionsHealthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences from implementing value-based healthcare at a Swedish University Hospital – a longitudinal interview study

Nilsson

Bååthe

Andersson

et al. 2017

BMC Health Serv Res

Self Cite

144

View full text Add to dashboard Cite

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“…This means that NPM questions the concept of the patient and tries to redefine the patient as a customer with self‐determination, a view that was previously excluded from the healthcare discourse (Nordgren, ). As a reaction, there is a debate about replacing NPM (Lindberg et al., ) and both values‐based care and evidence‐based care are being discussed as options (Johansson, Denvall, & Vedung, ; Nilsson, ).…”

Section: Introductionmentioning

confidence: 99%

“The Emperor's new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act

2016

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The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.

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“…When development leaders were asked to assist managers of operational sections, they were able to contribute substantially as facilitators. These findings can be compared to findings on process leaders working in healthcare (Nilsson & Sandoff, 2015a, 2015b. Process leaders working in a hierarchical organization experienced similar challenges to those of development leaders.…”

Section: An Administrative and Investigative Rolementioning

confidence: 99%

“…They realized that they could contribute substantially but needed a "command" from somebody in charge. They felt that their situation outside the hierarchical structure was frustrating and emphasized that this constituted a challenge (Nilsson & Sandoff, 2015a, 2015b.…”

Section: An Administrative and Investigative Rolementioning

confidence: 99%

How Municipal Development Leaders Experienced Their Professional Role and Responsibility

Sandoff¹,

Nilsson²

2016

MOS

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The purpose of this study has been to explore how municipal development leaders experienced their professional role and responsibility while working to support urban development at development departments in city constituencies in Gothenburg. An explorative approach was used and 18 interviews were conducted and qualitatively analyzed. Development leaders' expertise and their professional contributions were not utilized effectively. Instead of being a force to be reckoned with through their contributions to urban development, their initiatives, professionalism and concern did not lead to any kind of actual decisions or development, but only to feelings of personal resignation. The intention has not been fulfilled of professionally enhancing urban development by employing development leaders at development departments on the city constituency level. The reasons are that the development leaders' work assignment was only vaguely described and that the organizational and managerial structure was inadequately defined. Limitations and shortcomings are discussed in relation to work assignments, organizational structure, professionalization, and urban development work, based on municipal development leaders' experiences of their role and responsibility.

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Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden – process managers’ experiences

Abstract: 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.

Cited by 15 publications

References 28 publications

Experiences from implementing value-based healthcare at a Swedish University Hospital – a longitudinal interview study

Experiences from implementing value-based healthcare at a Swedish University Hospital – a longitudinal interview study

“The Emperor's new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act

How Municipal Development Leaders Experienced Their Professional Role and Responsibility

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