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Creating proactive boundary awareness - Observations and feedback on lowerlevel health care managers’ time commitments and stress
Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
2012 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Aim. The aim of this thesis was to deepen the knowledge concerning health care managers’ everyday work experiences and their handling of stress and balance.

Background. Health care managers’ work is characterized by daily hassles, conflicting perspectives, and unclear boundary setting. They could therefore use support in boundary and stress management.

Methods. A qualitatively driven mixed methods approach was used. Qualitative interviews, focus groups and workplace observations were used for data collection in Study I. Physiological stress indicators, stress self-assessments, workplace observations and interviewing were used in Study II. Analyses were mainly carried out on the interview data, using grounded theory methodology (Study I) and conventional content analysis (Study II).

Results. Paper I shows that a first step in managers’ boundary setting is to recognize areas at work with conflicting expectations and inexhaustible needs. Strategies can then be formed through proactive, continuous negotiating of their time commitments. These strategies, termed ‘boundary approaches’, are more or less strict regarding the boundary setting at work. Paper II shows that nonnormative, interactive feedback sessions could encourage understanding and meaningfulness of previous stress experiences through a two-step appraisal process. In the first appraisal in the study, feedback was spontaneously reacted on, while in phase two it was made sensible and given meaning. However, during the sessions, some obstacles appeared to managers’ learning about their stress, preventing a second appraisal of the feedback.

Conclusions. Awareness and continuous negotiation regarding boundary dilemmas can be effective as a proactive stress management tool among managers. Further, non-normative feedback on stress indicators may initiate key 3 processes of sensemaking which can aid managers’ stress management by increasing awareness and supporting learning about their stress. Proactive boundary awareness is a concept leading to better understanding of lower-level managers’ management of their time commitments and stress, which can be supported by continuous reflection, feedback situations and a supportive context.

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet , 2012. , 66 p.
National Category
Environmental Health and Occupational Health
URN: urn:nbn:se:hj:diva-29557OAI: diva2:908279
Available from: 2016-03-03 Created: 2016-03-02 Last updated: 2016-03-03Bibliographically approved
List of papers
1. Regulating time commitments in healthcare organizations: Managers’ boundary approaches at work and in life
Open this publication in new window or tab >>Regulating time commitments in healthcare organizations: Managers’ boundary approaches at work and in life
2011 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 25, no 5, 578-599 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this paper is to explore managers' boundary setting in order to better understand their handling of time commitment to work activities, stress, and recovery during everyday work and at home.

Design/methodology/approach: The paper has qualitatively-driven, mixed method design including observational data, individual interviews, and focus group discussions. Data were analyzed according to Charmaz' view on constructivist grounded theory.

Findings: A first step in boundary setting was to recognize areas with conflicting expectations and inexhaustible needs. Second, strategies were formed through negotiating the handling of managerial time commitment, resulting in boundary-setting, but also boundary-dissolving, approaches. The continuous process of individual recognition and negotiation could work as a form of proactive coping, provided that it was acknowledged and questioned.

Research limitations/implications: These findings suggest that recognition of perceived boundary challenges can affect stress and coping. It would therefore be interesting to more accurately assess stress, coping, and health status among managers by means of other methodologies (e.g. physiological assessments).

Practical implications: In regulating managers' work assignments, work-related stress and recovery, it seems important to: acknowledge boundary work as an ever-present dilemma requiring continuous negotiation; and encourage individuals and organizations to recognize conflicting perspectives inherent in the leadership assignment, in order to decrease harmful negotiations between them. Such awareness would benefit more sustainable management of healthcare practice.

Originality/value: This paper highlights how managers can handle ever-present boundary dilemmas in the healthcare sector by regulating their time commitments in various ways.

Boundary setting, Coping, Health care, Managers, Mixed method, Stress
National Category
Environmental Health and Occupational Health
urn:nbn:se:hj:diva-29541 (URN)10.1108/14777261111161905 (DOI)22043654 (PubMedID)2-s2.0-80053079849 (ScopusID)
Available from: 2012-02-07 Created: 2016-03-01 Last updated: 2016-03-03Bibliographically approved

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Tengelin, Ellinor
Environmental Health and Occupational Health

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