The complexity in the implementation process of empowerment-based chronic kidney care: a case study

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

Corporate community responsibility as an outcome of individual embeddedness

Purpose: The purpose of this article is to improve our understanding of the nature of social responsibility in actual practices and, specifically, the influence of individuals on these processes.  Design/methodology/approach: An abductive approach is applied (Alvesson and Sköldberg 1994), i.e. theory is developed by moving between theory and four empirical cases. The storeis highlight the importance of the individual and closeness to local stakeholders and the presence of overlapping rationales. Findings: The individuals’ simultaneous roles – as owners, managers, and community members – influence how they are held or see themselves as accountable and how they account for the firms’ engagement in the community. The activities are conducted in the name of the firm but originate from private as well as business-oriented concerns. Our conclusions encourage an extension of the CSR construct to approach it as an entangled phenomenon resulting from the firm and the individual embeddedness in internal and external cultures. Originality/value: This study brings the individual managers and owner-managers into focus and how their interplay with the surrounding context can create additional dimensions of accountability, which impact on the decisions taken in regard to CSR. A micro-perspective is applied. Corporate community responsibility, particularly in smaller and rural communities, contributes to recognize and understand how individuals influence, and are influenced by CSR.