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Lundberg, K., Kjellström, S. & Sandman, L. (2019). Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones. Nursing Ethics, 26(2), 480-495
Open this publication in new window or tab >>Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 2, p. 480-495Article in journal (Refereed) Published
Abstract [en]

Background:

When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively.

Aim:

This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones.

Design:

Abductive qualitative design.Participants and research context:Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali.

Ethical considerations:

The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014).

Findings:

Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties.

Discussion/conclusion:

These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Codes of ethics; dual loyalties; empirical approaches; ethical problems; ethics education; ethics of care/care ethics; military ethics; military nursing; nursing ethics; professional ethics; qualitative research; theory/philosophical perspectives; topic areas
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-37236 (URN)10.1177/0969733017718394 (DOI)XYZ ()28766395 (PubMedID)2-s2.0-85062835004 (Scopus ID)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2019-03-22Bibliographically approved
Robert, G., Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., . . . Donetto, S. (2019). Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol). In: : . Paper presented at 14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK.
Open this publication in new window or tab >>Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol)
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45081 (URN)
Conference
14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Avby, G. & Kjellström, S. (2019). LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice. BMC Health Services Research, 19(1), Article ID 319.
Open this publication in new window or tab >>LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 319Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Innovation has been identified as an important engine for improving the quality, productivity and efficiency of health care. Little is known about how to stimulate innovation capacity in primary health care in general; even less is known about how specific interventions should be designed to support managements' work with practice-based innovations. Research has shown that if managers and teams are excellent at handling the challenges of production (exploitation) and development (exploration), they are better at innovation. The aim of the study is to develop a dynamic management support programme to increase innovation leadership skills in daily practice.

METHODS: The study has an interactive approach that allows the need for empirical and theoretical knowledge to emerge and merge, and a quasi-experimental cross-over design. Eight primary health care centres will participate in the study. In the first phase, the management teams at four health care centres will participate in the intervention, and the other four centres will serve as a control group. Thereafter, the units will switch places and the control group will experience the intervention. All staff at the 8 units will answer questionnaires at four points in time (before, during, after, 6 months later) to evaluate the effects of the intervention.

DISCUSSION: The study will contribute to knowledge on how to organize processes of innovation and support exploitation and exploration behaviours by co-producing and testing a tailor-made management support programme for innovation work in primary health care. An expected long-term effect is that the support system will be disseminated to other centres both within and beyond the participating organizations.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Experimental cross-over design, Exploitation, Exploration, Health care research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-43775 (URN)10.1186/s12913-019-4152-8 (DOI)000468786300007 ()31113453 (PubMedID)2-s2.0-85066506650 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-06-17Bibliographically approved
Kjellström, S. & Golino, H. (2019). Mining concepts of health responsibility using text mining and exploratory graph analysis. Scandinavian Journal of Occupational Therapy, 26(6), 395-410
Open this publication in new window or tab >>Mining concepts of health responsibility using text mining and exploratory graph analysis
2019 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 6, p. 395-410Article in journal (Refereed) Published
Abstract [en]

Background: Occupational therapists need to know about people’s beliefs about personal responsibility for health to help them pursue everyday activities.

Aim: The study aims to employ state-of-the-art quantitative approaches to understand people’s views of health and responsibility at different ages.

Methods: A mixed method approach was adopted, using text mining to extract information from 233 interviews with participants aged 5 to 96 years, and then exploratory graph analysis to estimate the number of latent variables. The fit of the structure estimated via the exploratory graph analysis was verified using confirmatory factor analysis.

Results: Exploratory graph analysis estimated three dimensions of health responsibility: (1) creating good health habits and feeling good; (2) thinking about one’s own health and wanting to improve it; and 3) adopting explicitly normative attitudes to take care of one’s health. The comparison between the three dimensions among age groups showed, in general, that children and adolescents, as well as the old elderly (>73 years old) expressed ideas about personal responsibility for health less than young adults, adults and young elderly.

Conclusions: Occupational therapists’ knowledge of the concepts of health responsibility is of value when working with a patient’s health, but an identified challenge is how to engage children and older persons. 

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
exploratory graph analysis, health, occupational therapy, Responsibility for health, text mining, adolescent, adult, aged, article, child, confirmatory factor analysis, controlled study, exploratory research, female, groups by age, habit, human, interview, major clinical study, male, mining, occupational therapist, quantitative analysis, responsibility, thinking, young adult
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-39756 (URN)10.1080/11038128.2018.1455896 (DOI)000466582700001 ()29792082 (PubMedID)2-s2.0-85047374766 (Scopus ID)HOA HHJ 2019;HHJIMPROVEIS (Local ID)HOA HHJ 2019;HHJIMPROVEIS (Archive number)HOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2019-06-07Bibliographically approved
Kjellström, S., Stålne, K. & Törnblom, O. (2019). Nya perspektiv på individuell och kollektiv ledarskapsutveckling i komplexa organisationer. Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Nya perspektiv på individuell och kollektiv ledarskapsutveckling i komplexa organisationer
2019 (Swedish)Report (Refereed)
Abstract [sv]

Detta forskningsprojekt om ledarskapsutveckling i företag finansierades av KK-stiftelsen och genomfördes under 2017-2019 av forskare från Jönköping University, från Malmö universitet och med de deltagande företagen Sandvik, Svenska Spel och NCC. Syftet med forskningsprojektet var att undersöka hur ledarskapsutveckling kan bedrivas och användas för att utveckla företagens förmåga att hantera en komplex omgivning. Forskningsprojektet var samproducerande i och med att forskare tillsammans med företagen utforskade olika perspektiv på hur ledarskapsutveckling bedrivs och kan bedrivas på ett systematiskt vis. Ledarskapsutvecklingen studerades i ett avgränsat sammanhang hos Sandvik och Svenska Spel gällande nyligen genomförda organisationsförändringar och hos NCC gällande hur man organiserar för att hantera stora projekt.Ledarskapsutveckling kan dels innebära en utveckling av ledarna som individer i termer av kompetenser som krävs för att utföra sitt arbete som ledare eller av vidare förhållningssätt till ledarrollen som kan vara formell eller informell. Begreppet involverar även utvecklingen av ett kollektivt ledarskap där ledarskapet fördelar sig över en grupp, avdelning eller hel organisation. Forskningsprojektets samproducerande forskningsansats kan ses som ett exempel på när sådant kollektivt ledarskap utövas av deltagarna.

Forskningsprojektet resulterade i akademiska publikationer såväl som ett antal utvecklingsprojekt i företagen. De akademiska resultaten var följande fyra forskningsartiklar:

Studie 1: Perspektiv på ledarskapsutveckling, som bygger på intervjuer med ledare från de olika företagen och beskriver sex olika perspektiv och sätt att förstå ledarskapsutveckling som ordnats efter ökad komplexitet.

Studie 2: Metoder för ledarskapsutveckling, som ger en översikt över olika metoder för ledarskapsutveckling. En pilotversion av en dialogkarta skapades som kan vara användbar för att ledare såväl som HR-personal ska kunna få en överblick över möjliga sätt att systematiskt stödja ledarskapsutvecklingen.

Studie 3: Komplexa organisationer som driver ledarskapsutveckling, som beskriver hur två av företagen, Sandvik och Svenska Spel, har genomfört organisationsförändringar som ökat komplexiteten i organisationsstrukturerna på ett liknande sätt. Förändringarna har gett upphov till nya ledarroller och tillfällen för utveckling av ledarna som berörs samt utveckling av ett mer kollektivt ledarskap.

Studie 4: Ett ramverk för ledarskapsutveckling, som introducerar hur ledarskapsutvecklingen kan förstås ur fyra olika perspektiv: individens utveckling, kollektivets utveckling, den strukturella utvecklingen och uppgiftens komplexitet.

För företagen resulterade forskningsprojektet i utvecklingsaktiviteter och lärande. Några lärdomar och rekommendationer är att organisationer bör involvera inte bara ledare utan även medarbetare i aktiviteter kring ledarskapsutveckling, initiera6diskussioner kring vad gott ledarskap och ledarskapsutveckling innebär, utveckla inte bara individer utan också det kollektiva ledarskapet, samt att ledarskapsutveckling inte bara sker vid enstaka kurser eller insatser utan kan ske vid det dagliga arbetet, exempelvis vid förändringar i arbetsuppgifter, roller eller organisatoriska förändringar. I detta forskningsprojektet har vi sett det som en central uppgift för en ledare, utöver att leda och bidra till verksamhetens mål, att kontinuerligt och systematiskt stödja den egna och kollegors ledarskapsutveckling. I en föränderlig värld finns inte något slutgiltigt svar på vad ett önskvärt ledarskap är – ledarskapet behöver ständigt utvecklas.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2019. p. 29
Series
Arbetsrapporter från Hälsohögskolan ; 01
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-44707 (URN)
Funder
Knowledge Foundation
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-06-20Bibliographically approved
Suutari, A.-M., Areskoug Josefsson, K., Kjellström, S., Nordin, A. & Thor, J. (2019). Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co-production in an atrial fibrillation “learning café”. Health Expectations
Open this publication in new window or tab >>Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co-production in an atrial fibrillation “learning café”
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

An improvement initiative sought to improve care for atrial fibrillation (AF) patients; many felt insecure about how to cope with AF.

Objective

To reveal AF patients' and professionals' experiences of pilot-testing a Learning Café group education programme, aimed at increasing the patients' sense of security in everyday life.

Design

Using an organizational case study design, we combined quantitative data (patients' sense of security) and qualitative data (project documentation; focus group interviews with five patients and five professionals) analysed using inductive qualitative content analysis.

Setting

AF patients and a multiprofessional team at a cardiac care unit in a Swedish district hospital.

Improvement activities

Two registered nurses invited AF patients and partners to four 2.5-hour Learning Café sessions. In the first session, they solicited participants' questions about life with AF. A physician, a registered nurse and a physiotherapist were invited to address these questions in the remaining sessions.

Results

AF patients reported gaining a greater sense of security in everyday life and anticipating a future shift from emergency care to planned care. Professionals reported enhanced professional development, learning more about person-centredness and gaining greater control of their own work situation. The organization gained knowledge about patient and family involvement.

Conclusions

The Learning Café pilot test?exemplifying movement towards co-production through patient-professional collaboration?generated positive outcomes for patients (sense of security), professionals (work satisfaction; learning) and the organization (better care) in line with contemporary models for quality improvement and with Self-Determination Theory. This approach merits further testing and evaluation in other contexts.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
atrial fibrillation, coping behaviours, co-production, health-care quality improvement, patient education, Self-Determination Theory
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45651 (URN)10.1111/hex.12955 (DOI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22
Avby, G., Kjellström, S. & Andersson Bäck, M. (2019). Tending to innovate in Swedish primary health care: a qualitative study. BMC Health Services Research, 19(1), Article ID 42.
Open this publication in new window or tab >>Tending to innovate in Swedish primary health care: a qualitative study
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 42Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. 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 innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.

METHODS: Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.

RESULTS: This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.

CONCLUSIONS: This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Culture and climate for innovation, Health care reform, Innovation, Leadership, Practice features, Primary care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42700 (URN)10.1186/s12913-019-3874-y (DOI)000456156900007 ()30658638 (PubMedID)2-s2.0-85060149714 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-02-20Bibliographically approved
Norrman Brandt, E., Kjellström, S. & Andersson, A.-C. (2019). Transformational change by a post-conventional leader. Leadership & Organization Development Journal, 40(4), 457-471
Open this publication in new window or tab >>Transformational change by a post-conventional leader
2019 (English)In: Leadership & Organization Development Journal, ISSN 0143-7739, E-ISSN 1472-5347, Vol. 40, no 4, p. 457-471Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this paper is to examine people’s experience of a change process and if and how post-conventional leadership principles are expressed in the change process.

Design/methodology/approach: The study used a retrospective exploratory qualitative design. In total, 19 semi-structured interviews and 4 workshops were conducted and analyzed in accordance with a thematic qualitative analysis.

Findings: The post-conventional leadership appears to have facilitated an organizational transformation where explorative work methods aimed at innovation and improvement as well as holistic understanding was used. Dispersed power and mandate to employees, within set frames and with clear goals, created new ways of organizing and working. The leader showed personal consideration, acknowledged the importance of the emotionally demanding aspects of change and admitted the leader’s own vulnerability. Balance between challenge and support created courage to take on new roles and responsibilities. Most employees thrived and grew with the possibilities given, but some felt lack of support and clear directions.

Practical implications: Inspiration from this case on work methods and involvement of employees can be used on other change efforts.

Social implications: This study provides knowledge on leadership capabilities needed for facilitation of transformational change.

Originality/value: Few transformational change processes by post-conventional leaders are thoroughly described, and this study provides in-depth descriptions of post-conventional leadership in transformational change. 

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019
Keywords
Action logics, Adult development, Leadership agility, Post-conventional leadership, Retrospective study, Transformational change
National Category
Social Sciences
Identifiers
urn:nbn:se:hj:diva-45337 (URN)10.1108/LODJ-07-2018-0273 (DOI)2-s2.0-85068092316 (Scopus ID)
Available from: 2019-07-12 Created: 2019-07-12 Last updated: 2019-07-12Bibliographically approved
Norrman Brandt, E., Kjellström, S. & Andersson, A.-C. (2018). A transformational change process by a post heroic leader. In: : . Paper presented at European Society for Research on Adult Development (ESRAD), ​25th to 27th May 2018, University of Greenwich, London, UK.
Open this publication in new window or tab >>A transformational change process by a post heroic leader
2018 (English)Conference paper, Published paper (Refereed)
National Category
Social Sciences
Identifiers
urn:nbn:se:hj:diva-40478 (URN)
Conference
European Society for Research on Adult Development (ESRAD), ​25th to 27th May 2018, University of Greenwich, London, UK
Available from: 2018-06-18 Created: 2018-06-18 Last updated: 2018-06-18Bibliographically approved
Törnblom, O., Stålne, K. & Kjellström, S. (2018). Analyzing roles and leadership in organizations from cognitive complexity and meaning-making perspectives. Behavioral Development, 23(1), 63-80
Open this publication in new window or tab >>Analyzing roles and leadership in organizations from cognitive complexity and meaning-making perspectives
2018 (English)In: Behavioral Development, ISSN 1942-0722, Vol. 23, no 1, p. 63-80Article in journal (Refereed) Published
Abstract [en]

Organizations can be seen as social systems with hierarchical structures and roles at different levels of complexity with correspondingly different complexity of tasks. This article applies the perspectives of two theories from the field of adult development, namely, the model of hierarchical complexity (MHC) and ego development theory (EDT) to analyze stratified systems theory (SST). Although the theories are not regarded as strictly comparable and commensurable on account of differences in basic assumptions and methods of the theories, the analysis leads to the conclusion that descriptions of role complexity and individual capabilities in SST, to some extent, correspond to descriptions of developmental levels according to the MHC and EDT. Both comparisons support the notion that task and leadership complexity increases with organizational level, and thereby demonstrates support for the existence of qualitatively different levels of leadership. However, based on the methodological choices of the study, it is beyond the scope of the article to validate the key concepts, constructs in SST, as well as provide support or nonsupport for the proposed value of application in practice. Furthermore, we point out the lack of a more thorough analysis and comparison between the theories built on rich empirical material. Nevertheless, we conclude that the MHC, EDT and SST are fruitful lenses that can further the understanding of organizations as social systems with hierarchical structures.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2018
Keywords
role complexity, leadership at different levels, the model of hierarchical complexity, ego development theory, stratified systems theory
National Category
Work Sciences
Identifiers
urn:nbn:se:hj:diva-40407 (URN)10.1037/bdb0000067 (DOI)
Available from: 2018-06-15 Created: 2018-06-15 Last updated: 2018-06-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8952-8773

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