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Publications (10 of 24) Show all publications
Avby, G., Kjellström, S. & Andersson Bäck, M. (2017). A reform as a lever for innovation and professionalism?. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>A reform as a lever for innovation and professionalism?
2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38454 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-15Bibliographically approved
Andersson Bäck, M., Kjellström, S. & Avby, G. (2017). Identity work of successful primary care managers and competing institutional logics. In: : . Paper presented at EGOS 2017. 33rd EGOS Colloquium: The Good Organization: Aspirations, Interventions, Struggles, Copenhagen, July 6–8, 2017.
Open this publication in new window or tab >>Identity work of successful primary care managers and competing institutional logics
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38433 (URN)
Conference
EGOS 2017. 33rd EGOS Colloquium: The Good Organization: Aspirations, Interventions, Struggles, Copenhagen, July 6–8, 2017
Note

European Group for Organizational Studies, Sub-theme 57: The Multiplicity of Institutional Logics.

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-15Bibliographically approved
Avby, G., Nilsen, P. & Ellström, P.-E. (2017). Knowledge use and learning in everyday social work practice: A study in child investigation work. Child & Family Social Work, 22(Supplement S4), 51-61
Open this publication in new window or tab >>Knowledge use and learning in everyday social work practice: A study in child investigation work
2017 (English)In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 22, no Supplement S4, p. 51-61Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore knowledge use and learning among social workers in everyday child investigation work. Research was undertaken in two Swedish children’s services departments. The study applied an ethnographic approach. Methods for data collection included interviews, participant observations, reflective dialogues and a documentary analysis of case files. The social workers’ knowledge sources were classified into research-based, practice-based and ordinary knowledge. The findings show that the social workers preferred practice-based knowledge, which was primarily conveyed from colleagues and previous experience, and rarely consulted knowledge from sources found outside the practice setting. Furthermore, the findings suggest that the integration of knowledge was made possible through the social workers' engagement in both a verbal and a more cognitive (tacit) reasoning activity, processes that fostered learning at work. The social workers’ learning was predominantly adaptive as they learned to handle tasks in a fairly routinized way on the basis of rules or procedures. The findings lend support to the notion that the use of different knowledge forms could potentially trigger learning in everyday social work.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Child and family social work, ethnography, reserach in practice, evidence-based practice, knowledge use, learning
National Category
Work Sciences
Identifiers
urn:nbn:se:hj:diva-31194 (URN)10.1111/cfs.12227 (DOI)XYZ ()2-s2.0-84925046374 (Scopus ID)
Available from: 2015-03-11 Created: 2016-08-09 Last updated: 2018-01-19Bibliographically approved
Kjellström, S., Avby, G., Andersson Bäck, M., Areskoug Josefsson, K. & Andersson Gäre, B. (2017). Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden
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2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.

Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.

Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy Work Sciences
Identifiers
urn:nbn:se:hj:diva-38455 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-15Bibliographically approved
Andersson Bäck, M., Kjellström, S. & Avby, G. (2017). Medical manager hybrids for handling institutional complexity and change in primary care. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Medical manager hybrids for handling institutional complexity and change in primary care
2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38439 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-15Bibliographically approved
Kjellström, S., Avby, G., Areskoug Josefsson, K. & Andersson Bäck, M. (2017). Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.
2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: Organizations strive to handle external and internal demands, and a lot is being written about the struggles and shortages. However, there are organizations that thrive, combining quality of performance and beneficial working conditions. What can we learn from these cases and how are the best studied? Also, how do we move beyond a list of good looking features that we already know are essential, such as leadership and continuous quality improvement work, in order to produce knowledge which is of practical use.

Goal: This workshop takes point of departure in a study on well function primary care centers. The aim is to share our primary insights from this project and learn from it weaknesses and strengths to inspire to innovative, theoretical and practical meaningful research.

Method: Six primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private/non-profit and small/large units. In total 56 interviews were completed with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants). At this time, four different qualitative analysis approaches have been used.

Results/Conclusion: Each center reveals inspiring as well as challenging features. In the workshop, we will discuss how we can learn from studying good practice and design to further our understanding on sustainable healthcare and the use of qualitative methods in this context.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38457 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-15Bibliographically approved
Avby, G., Kjellström, S., Andersson Bäck, M., Areskoug Josefsson, K., Andersson Gäre, B., Sparf, A. & Siljehult, M. (2017). Samarbete bygger en stark primärvård. Dagens Nyheter 2017-08-17
Open this publication in new window or tab >>Samarbete bygger en stark primärvård
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2017 (Swedish)In: Dagens Nyheter 2017-08-17, ISSN 1101-2447Article in journal, News item (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Stockholm: Dagens nyheter, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38474 (URN)
Note

Replik DN Debatt 2017-08-10 "Svensk primärvård kan snabbt bli fullbemannad"

Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-01-16Bibliographically approved
Avby, G., Kjellström, S. & Andersson Bäck, M. (2017). Transforming primary healthcare: Exploring a new provider model as a lever for innovation and professionalism. In: : . Paper presented at EGPA (European Group for Public Administration), 30 August – 1 September 2017, Milano, Italy.
Open this publication in new window or tab >>Transforming primary healthcare: Exploring a new provider model as a lever for innovation and professionalism
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38437 (URN)
Conference
EGPA (European Group for Public Administration), 30 August – 1 September 2017, Milano, Italy
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-15Bibliographically approved
Kjellström, S., Avby, G., Areskoug Josefsson, K., Andersson-Gäre, B. & Andersson Bäck, M. (2017). Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden. Paper presented at 2017/09/07. Journal of Health Organisation & Management, 31(4), 487-502
Open this publication in new window or tab >>Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden
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2017 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 4, p. 487-502Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

Design/methodology/approach

Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

Findings

Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers? positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created.

Practical implications

Leaders need to consistently translate and integrate reforms with the professionals? drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work.

Social implications

The design of the reforms and leadership are essential preconditions for work motivation.

Originality/value

The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2017
Keywords
Primary care, Management, Incentives, Goals, Healthcare professional, Work motivation
National Category
Physiotherapy
Identifiers
urn:nbn:se:hj:diva-37233 (URN)10.1108/JHOM-04-2017-0074 (DOI)000409829700007 ()2-s2.0-85028911791 (Scopus ID)
Conference
2017/09/07
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2017-12-14Bibliographically approved
Avby, G. (2016). Att genom reflection organisera för en medveten och kunskapsrik praktik. Pedagogisk forskning i Sverige, 21(3-4), 261-282
Open this publication in new window or tab >>Att genom reflection organisera för en medveten och kunskapsrik praktik
2016 (Swedish)In: Pedagogisk forskning i Sverige, ISSN 1401-6788, E-ISSN 2001-3345, Vol. 21, no 3-4, p. 261-282Article in journal (Refereed) Published
Abstract [sv]

Ett i högre grad vetenskapsbaserat samhälle ställer ökade krav på att professionellt arbete ska grundas i evidens och att beslut ska vila på evidens- baserade kriterier. På ett generellt plan är idén bakom en evidensbaserad praktik att överbrygga gapet mellan teori och praktik, men hittills har den evidensbaserade agendan främst fokuserat på professionellas instrumentella kunskapsanvändning. Mindre intresse har visats för en mer indirekt användning av forskningsbaserad kunskap, en så kallad konceptuell kunskapsanvändning med avsikt att utmana och förändra etablerade tanke- och vanemönster. Ett grundläggande antagande bakom denna artikel är att lärande gynnas när praktikern använder olika kunskapskällor. Artikeln bidrar till att utvidga och fördjupa reflektionens betydelse i professionell praktik. 

Place, publisher, year, edition, pages
Malmö högskola, 2016
National Category
Pedagogy
Identifiers
urn:nbn:se:hj:diva-31206 (URN)
Available from: 2016-08-09 Created: 2016-08-09 Last updated: 2017-10-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6784-0133

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