Chefsintroduktion : En kvalitativ studie om nytillträdda chefers upplevelse av introduktionen till arbetet

Syftet med studien är att skapa en djupare förståelse för hur introduktionen upplevs av nytillträdda chefer samt vilka aspekter som är av betydande relevans för denna upplevelse. Studien har genomförts på en svensk myndighet med omkring 1200 anställda. Studien är av kvalitativ art och empiri har inhämtats genom semistrukturerade intervjuer med åtta verksamma chefer som har personalansvar. Vid tolkning av studiens resultat har vi inspirerats av en fenomenologisk ansats, varpå vi har fokuserat på likheter i respondenternas uppfattning av fenomenet. Av studiens resultat framgår att majoriteten av cheferna upplevt introduktionen som gedigen och informativ. Chefernas framträdande upplevelse har visat sig vara organisationens välkomnande klimat. Majoriteten av cheferna är av åsikten att organisationen möjliggjort för socialisationstillfällen i samband med introduktionen. Flertalet av cheferna föredrar att först installera sig i sin arbetsgrupp innan hela verksamhetsförståelsen kan erhållas. Avslutningsvis har den information som delgivits under introduktionen upplevts som tydlig. Ett flertal av cheferna har samtidigt upplevt den som överväldigande och svåråtkomlig.

Talent Management : Utan Talent Management?

Syftet med denna studie är att kontrastera en utvald organisations strategier för att attrahera, behålla, utveckla och avveckla de viktigaste resurserna mot Talent Management och dess komponenter. Studien ämnar således mot att göra en kontrastering mellan traditionellt kompetensförsörjningsarbete mot det mer moderna konceptet Talent Management. Författarna har valt att undersöka detta genom att samla empiri från intervjuer med sex medarbetare kombinerat med analys av interna dokument. Resultatet visar att delar av myndighetens arbete med kompetensförsörjning kan likställas med Talent Management men att vissa komponenter är uteblivna. Baserat på resultatet framhålls i resultatdiskussionen att myndigheten möter stora utmaningar gällande enhetligt arbete med kompetensutveckling, kompetensförsörjning och ledarskap på grund utav det delegerade ansvaret från central nivå. I slutskedet av avsnittet för resultatdiskussion redovisas även en sammanfattande slutsats som grundar sig i ett framgångsrikt arbete inom blocken attrahera och avsluta samtidigt som arbete inom blocket behålla och utveckla varierar inom organisationen, dels på grund av delegerat ansvar. Slutligen presenteras förbättringsförslag inom organisationen och vidare forskning inom ämnet. 

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

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.

The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study

BACKGROUND: Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). METHODS: In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression. RESULTS: In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST. CONCLUSIONS: The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

The well-being of relatives of patients with atrial fibrillation: a critical incident technique analysis

BACKGROUND: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient's condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed. AIM: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations. DESIGN AND METHOD: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF. RESULTS: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement). CONCLUSION: The well-being of relatives of patients with AF was affected depending on the patients' well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.