Artikeln behandlar hundra år av ledarskapsforskning i sammanfattning.

“Berätta för mig om datajournalprojektet? ”Med den uppmaningen i huvudet gick jag till mitt första möte med fyra anställda på en medicinsk avdelning på X-sjukhuset som ett år tidigare implementerat en datorbaserad patientjournal. Patientjournaler tillhör ju, liksom exempelvis flygledarjournaler, en viss sorts intellektuella artefakter som tills nyligen skrevs för hand med penna på papper. Den kunskap som ligger bakom produktionen av dessa föremål lärs ofta in på plats från en överordnad genom upprepad handling. När arbetsverktyg som dessa datorbaseras sker det inte smärtfritt. Både arbetsrutiner och arbetsrelationer förändras liksom även innehållet i dokumentet. Eftersom jag dessutom ville skaffa erfarenhet av narrativ metod så beslöt jag att låta fyra anställda och projektledaren på kliniken berätta så fritt som möjligt utan inblandning från min sida; därav ovanstående enkla uppmaning. Varför narrativ metod, undrar möjligen en del. Det är inte en vanlig metod inom forskning om informationssystem. Nej, men personligen tror jag och många andra med mig att historier spelar en ofta bortglömd roll i olika organisationers försök att utveckla, implementera och använda informationsteknologi. Detta, och den amerikanske sociologen Elliot Mishlers kritik om att ett alltför strukturerat sätt att intervjua förvandlar människor till artificiella objekt samtidigt som viktiga aspekter i exempelvis förändringsprocesser går förlorade, gjorde mig intresserad av att pröva narrativ metod. Dessutom är patientjournalen i sig en berättelse om en patients sjukdom. Många människor på olika arbetsplatser genomgår numera också dessa så flitigt förekommande IT-projekt, en del lyckade och andra mindre lyckade. En målgrupp för denna studie är därför personer som på olika sätt deltar i och arbetar med implementering av ny informationsteknologi inom sjukvården. En annan målgrupp är kollegor intresserade av narrativ metod.

Today there is often a need to re-innovate who you are and what you do and re-think the tools that are used and the business models that guide action. The purpose of this paper is to show how transforming a document, such as a patient record, might start a horizontal and vertical movement, a movement of coordination and enhancement in an organizational setting, such as a hospital clinic. The observations presented here and the conclusions drawn were obtained during a three year case study following implications of constructing and computerizing a patient record at three different hospitals. The results were then analyzed, interpreted and discussed within a framework combining theories about knowledge management and with cognitive theories about use of interpretative schemes and representations. This paper tries to look beyond the implications of reconstructing a patient record on a micro-level or explore if it is good or bad to computerize it. Instead this paper theorizes about how re-thinking the interpretative scheme for what a patient record is and how it may be used might restructure a health care setting. It proposes that what the employees want to achieve with the knowledge management system depends on what strategy they have for it.

“Sociology for me is not only about the big institutions, such as governments, organizations, business firms or societies as a whole. It is very much about the individual and our individual experiences. We come to understand ourselves much better through grasping the wider social forces that influence our lives.” ( Anthony Giddens, published at www.polity.co.uk, a leading social science and humanities publisher. )

This quotation helps identify one reason for integrating ideas about knowledge management with concepts from Anthony Giddens structuration theory in the theoretical framework that I use as an analytical tool in this research. Structuration theory concerns itself with the “social forces that influence our lives” and these forces interest me. In the same article Giddens continuous: ”We live in a world of quite dramatic change…There are three major sets of changes happening in contemporary societies and it is the task of sociology to analyze what they mean for our lives today. First there is globalisation….The second big influence is that of technological change. Information technology is altering many of the ways in which we work and in which we live. The nature of the jobs people do, for example, has been transformed….The third fundamental set of changes is in our everyday lives. Our lives are structured less by the past than by our anticipated future”.

In this paper I agure that there is a continous structuring going on in society. I therefore concern myself with a pair of twin concepts that are interrelated. The first one is knowledge structuring; the second is knowledge domination. These two concepts are of vital importance when trying to understand, assess and monitor implications of transformations of work processes and tools at work.

Today there is an increased demand for charismatic leaders because of the importance of a phenomenon such as media and a need to be visible. But behind this type of leadership it is not uncommon to find narcissistic and disturbed personalities. It is known since earlier that a leader who is threatening causes stress among the employees. He or she might use his or her power to frighten others in the organization where he or she is working. The purpose of this paper is to explore, describe and discuss the relationship between leadership and stress in a real life situation in an organizational setting characterized by a specific corporate culture.

Improving the artifacts a knowledge worker uses and how he or she exercises his or her knowledge is a desire that is part of being professional, especially since modern man are supposed to live in a knowledge society. In the knowledge society there is a continuous structuring and re-structuring, construction and re-construction and learning and re-learning going on due to implementing new information and communication technology. But many of these projects fail in spite of management spending huge amounts of money on them. This paper focuses on and wants to create an awareness of how an artefact such as a new knowledge management system becomes a driving force behind expanding the knowledge of an anesthesist and has implications for continuous learning among a group of employees at the anesthesia and intensive care unit. In addition to this, implementing new technology is an underestimated opportunity for learning. This paper suggests that a significant educational effort is taking place in society channelled through many these IT-projects, even when they fail.