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Continuous Quality Development by Means of New Understanding: A four year study on an Intensive Care Unit during times of hard work and demanding organisational changes
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Kvalitetsutveckling genom en ny förståelse av verksamheten : En fyra års studie på en Intensivvårdsavdelning, i tider av hårt arbete och utmanade organisatoriska förändringar (Swedish)
Abstract [en]

The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2003. , p. 65
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1306
Keywords [en]
Health services research, Intensive Care Unit, Mechanical system, Complex Adaptive System, Diminishing resources, Workload, Sickness absenteeism, Sense of Coherence, Stress related symtoms, Organisational Climate, Longitudinal study
Keywords [sv]
Hälso- och sjukvårdsforskning
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-3782ISBN: 91-554-5808-4 (print)OAI: oai:DiVA.org:uu-3782DiVA, id: diva2:163680
Public defence
2003-12-12, Pelsarsalen, Länssjukhuset Gävle, ing. 35, 801 87, Gävle, 13:00
Opponent
Supervisors
Available from: 2003-11-18 Created: 2003-11-18Bibliographically approved
List of papers
1. The staff’s views on what’s the job – the starting point for quality improvement in health care
Open this publication in new window or tab >>The staff’s views on what’s the job – the starting point for quality improvement in health care
2003 (English)In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 16, no 1, p. 47-54Article in journal (Refereed) Published
Abstract [en]

Abstract:

Describes 12 members of staff’s views of their job and tasks in an intensive care unit of a middle-sized Swedish hospital. Open-ended questions were asked and the interviews were analysed using thematic technique. The character of the work and the work tasks was the key variable in the analysis. The participants thought of intensive care as turbulent and ambiguous, powerful but also menacing and a concept comprised of a dichotomy of fundamental values. The work task of the participants was conceptualised in terms of managing the health status of the patient, seeking to appreciate the patient’s needs and ensuring that the staff worked harmoniously and effectively as a team. Speculates that the existence of a real dichotomy in fundamental values might be caused by the difficult medical reality on the ward. The study confirms a necessity for a two-dimensional quality system where the deeper dimension deals with the disparate set of meaning status in the future perspective.

Keywords
Employee attitudes, Health care, Hospitals, Quality improvement, Quality systems, Sweden
Identifiers
urn:nbn:se:uu:diva-91082 (URN)10.1108/09526860310460488 (DOI)
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved
2. Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
Open this publication in new window or tab >>Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
2003 (English)In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 16, no 7, p. 354-60Article in journal (Refereed) Published
Abstract [en]

Abstract:

The objective was to elucidate hospital leaders’ understanding of the organisational structures and processes and their understanding of their leading role during an intensive period of reorganisation. From a qualitative exploratory study using semi-structured interviews and thematic analysis four themes were identified: understanding the function of leadership and management, understanding organisational structures and processes, their own role as leader, and the outside world. The results indicate that the organisation is characterised by disintegration and erratic structures. The leaders perceive that they lead a learning organisation but in practical care work the organisation functions more like an organisation streamlined for mass production. This discrepancy between their understanding and practical daily care work led to dissatisfaction and existential chaos among the leaders. Our findings show an example of “clashes with the individual attractor pattern”, an urgent, but not yet very clear problem in health-care organisations of today.

Keywords
Adaptive system theory, Downsizing, Health services, Leadership, Learning organizations
Identifiers
urn:nbn:se:uu:diva-91083 (URN)10.1108/09526860310510860 (DOI)
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved
3. The flexible working time model: a successful adaptation to diminishing resources but also a threat to quality improvment and staff´s wellbeing
Open this publication in new window or tab >>The flexible working time model: a successful adaptation to diminishing resources but also a threat to quality improvment and staff´s wellbeing
2003 (English)In: Scandinavian Journal of Management, ISSN 0956-5221, E-ISSN 1873-3387Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:uu:diva-91084 (URN)
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved
4. Managing complexity: acknowledge the attraction patterns by supporting sensemaking and allowing the quality system to serve as the panoptic system
Open this publication in new window or tab >>Managing complexity: acknowledge the attraction patterns by supporting sensemaking and allowing the quality system to serve as the panoptic system
2002 (English)In: International journal of health care quality assurance incorporating leadership in helath services, ISSN 1366-0756, E-ISSN 2051-3135, Vol. 15, no 5, p. 213-6Article in journal (Refereed) Published
Abstract [en]

This paper is of a theoretical type ending with a model describing the frame and function of a quality system. Quality in health care is largely dependent on the behaviour and action of the health care staff. Furthermore behaviour and action emanate from the individual and group sensemaking. When viewing the organisation as a complex adaptive system, the necessity of becoming aware of, and co-evolving with the process of sensemaking becomes very clear. It has potential to view the individual’s attraction patterns as the channel for creativity. The quality system can serve as the framework on which to enlighten this vital dimension. The concept of meaning status in the group is useful when it comes to managing a complex system through a quality system. When so, the core objective of the quality system is to support and enhance the awareness of all the disparate meanings (future-perspective), stimulate reflection upon them and transform them into a collective meaning status (presence) in order to make effective decisions and a successful adaptation to change.

Keywords
Health care, Modelling, Quality systems
Identifiers
urn:nbn:se:uu:diva-91085 (URN)10.1108/09526860210437430 (DOI)
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved

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