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Andreasson, Jörgen
Publications (10 of 11) Show all publications
Andreasson, J. (2018). Organizational preconditions and supportive resources for Swedish healthcare managers: Factors that contribute to or counteract changes: Factors that contribute to or counteract changes. (Doctoral dissertation). KTH Stockholm: us-ab Stockholm
Open this publication in new window or tab >>Organizational preconditions and supportive resources for Swedish healthcare managers: Factors that contribute to or counteract changes: Factors that contribute to or counteract changes
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish Healthcare managers’ organizational preconditions and supportive resources are important for their ability to work with planned change in a sustainable way. This thesis further investigates these factors together with an output measure, healthcare process quality (HPQ).

The overall aim was to investigate how healthcare managers’ organizational preconditions and support contribute to or counteract managers’ work with planned change in order to implement process development in a sustainable way. Specific aims were: to improve knowledge of managers’ views of and approaches to increasing their employees’ influence on and engagement in models for improving care processes (study I); to investigate relationships among managers’ organizational preconditions, support, and work to improve quality of care and HPQ over time (study II); to investigate whether managers’ coaching style, preconditions, implementation strategy, appraisal of change, and clinical autonomy are associated with HPQ (study III ); and to assess the influence of support from superiors, colleagues, external sources, subordinates, and private life on managers’ own health (study IV ).

The data for Studies I – III came from five hospitals collected over a three-year period. The data were collected by means of interviews (Study I, qualitative analysis) and annual questionnaires (Studies II and III, quantitative and mixed-method analyses). The data for Study IV were based on questionnaires administered to first- and second-line managers in municipal care, twice during a two-year period.

The results revealed that the healthcare managers were key actors in implementing planned change, but were dependent on their employees’ engagement in order to succeed. Managers’ appraisal of work with planned change became more positive with strong support from other managers, employees, and the organization as well as with long managerial experience. Support from private life and networks, as well as the managers’ attitudes towards their managerial role, predicted their own health. For new managers or managers with many employees, organizational support predicted their health-related sustainability. Managers practising a more distanced style of coaching (e.g., clearly delegating responsibility for implementation work to employees) were associated with better HPQ outcomes than were managers who were more involved in implementation. In conclusion, implementation of planned change are facilitated by, engaged managers, employees with knowledge of implementation work and of the healthcare system, as well as organizational structures that support the managers. Strong support from various sources as well as managerial experience are important for managers’ appraisal of work with planned change. Strong managerial support and a more delegated leadership style are both important factors related to higher estimated HPQ.

Place, publisher, year, edition, pages
KTH Stockholm: us-ab Stockholm, 2018
Keywords
Healthcare, Managers, Support, Organizational preconditions, Healthcare process quality
National Category
Work Sciences
Identifiers
urn:nbn:se:hb:diva-15250 (URN)978-91-7729-921-9 (ISBN)
Public defence
Sal T2, Hälsovägen 11, Huddinge (Swedish)
Opponent
Supervisors
Available from: 2019-08-06 Created: 2018-10-26 Last updated: 2019-08-06Bibliographically approved
Andreasson, J., Ljungar, E., Linda, A., Jonas, H. & Dellve, L. (2018). Professional Bureaucracy and Health Care Managers’ Planned Change Strategies: Governance in Swedish Health Care. Nordic Journal of Working Life Studies, 8(1), 23-41
Open this publication in new window or tab >>Professional Bureaucracy and Health Care Managers’ Planned Change Strategies: Governance in Swedish Health Care
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2018 (English)In: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 8, no 1, p. 23-41Article in journal (Refereed) Published
Abstract [en]

To increase efficiency and quality, process development has been implemented in many Swedish hospitals. These hospitals are usually organized as professional bureaucracies in which health care managers have limited decision control. The new governance principles has been implemented without removing bureaucratic elements. This study analyzes how managers implement planned change in these professional bureaucracies, considering if managers coaching style, organizational preconditions, implementation strategy, appraisal of change and clinic autonomy, is associated with health care process quality (HPQ). The study is based on interviews with health care managers and longitudinal assessments of HPQ. The results revealed significant differences between coaching style, organizational preconditions, and HPQ over time. The conclusion is that leadership and preconditions is of importance for the health care manager’s ability to work with planned change, as that the health care managers understand how management methods, governance principles, and professional bureaucracies work in practice.

Keywords
Bureaucracy, health care organizations, health care managers, implementation, lean management
National Category
Work Sciences
Identifiers
urn:nbn:se:hb:diva-15253 (URN)10.18291/njwls.v8i1.104849 (DOI)2-s2.0-85044859048 (Scopus ID)
Available from: 2018-10-26 Created: 2018-10-26 Last updated: 2018-12-07Bibliographically approved
Andreasson, J., Linda, A., Andrea, E. & Dellve, L. (2017). The importance of healthcare managers’ organizational preconditions and support resources fortheir appraisal of planned change and its outcomes. Journal of Hospital Administration, 6(1), 25-33
Open this publication in new window or tab >>The importance of healthcare managers’ organizational preconditions and support resources fortheir appraisal of planned change and its outcomes
2017 (English)In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 6, no 1, p. 25-33Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.

Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.

Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.

Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change

Place, publisher, year, edition, pages
Sciedupress, 2017
Keywords
Healthcare managers, Preconditions, Support resources, Planned change, Healthcare process quality, Appraisal of change
National Category
Work Sciences
Identifiers
urn:nbn:se:hb:diva-15252 (URN)10.5430/jha.v6n1p25 (DOI)
Available from: 2018-10-26 Created: 2018-10-26 Last updated: 2018-11-01Bibliographically approved
Andreasson, J., Eriksson, A. & Dellve, L. (2015). Health care managers' views on and approaches to implementing models for improving care processes.. Journal of Nursing Management
Open this publication in new window or tab >>Health care managers' views on and approaches to implementing models for improving care processes.
2015 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes.

BACKGROUND: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

METHOD: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory.

RESULTS: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8594 (URN)10.1111/jonm.12303 (DOI)000372022600019 ()25851462 (PubMedID)2-s2.0-84959465137 (Scopus ID)
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2018-12-07Bibliographically approved
Holden, R., Eriksson, A., Andreasson, J., Williamsson, A. & Dellve, L. (2015). Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals. Applied Ergonomics, 47, 181-192
Open this publication in new window or tab >>Healthcare workers' perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals
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2015 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 47, p. 181-192Article in journal (Refereed) Published
Abstract [en]

As the application of lean in healthcare expands, further research is needed in at least two areas: first, on the role of context in shaping lean and its consequences and second, on how healthcare workers perceive lean. Accordingly, this context-sensitive, mixed methods study addressed how hospital workers' perceptions of lean varied across contexts in three Swedish hospitals. Registered nurses and physicians at the hospitals and across units differing in acuity completed standardized surveys (N = 236, 57% response rate) about their perceptions of hospital-wide lean implementation. Perceptions varied by: hospital context, with one hospital's employees reporting the least favorable perceptions; unit acuity, with higher-acuity units reporting more favorable perceptions; and professional role, with nurses reporting more favorable perceptions than physicians. Individual interviews, group interviews, and observations provided insight about these dissimilar contexts and possible explanations for context-specific variability. Findings are discussed with respect to strategies for implementing lean in healthcare; the importance of attending to levels, context, and worker consequences of lean; and directions for future research.

Place, publisher, year, edition, pages
Pergamon Press, 2015
Keywords
lean, health care, Ledarskap, lärande, etik
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Social Sciences Interdisciplinary
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-2009 (URN)10.1016/j.apergo.2014.09.008 (DOI)000347663600021 ()25479987 (PubMedID)2-s2.0-84919683821 (Scopus ID)2320/14571 (Local ID)2320/14571 (Archive number)2320/14571 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2018-12-21Bibliographically approved
Dellve, L., Williamsson, A., Strömgren, M., Holden, R., Åhlström, L., Andreasson, J. & Eriksson, A. (2015). The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up. In: : . Paper presented at NOVO conference. Trondheim
Open this publication in new window or tab >>The impact of implementation of lean at hospitals for work conditions and health-related conditions among health care professionals: a three year follow-up
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2015 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction The public sector has during the last decades been struggling with the challenge of how to increase the efficiency, the quality of performance, as well as with problems related to work environment and recruitments. Hospitals have struggled with increased focuses on costumer orientation, rationalizations and care processes redesign, and have often used Lean production (LP) as management model.

Aim to assess the long-term importance of implementing LP in hospitals for the psychosocial work conditions.  Based on earlier research (e.g. Westgaard & Winkel, 2011), the following hypothesis were tested (1) Strategic large scale  implementation of LP is associated with negative impact on mental health; (2) Implementation of LP is associated with weak negative impact on psychosocial work conditions; (3) The association between implementation of LP and psychosocial conditions is moderated by profession and participatory approaches.

Method  Five hospitals working with improvements of care processes were studied 2012-2014 using questionnaires to employees (T1 n=1303) and interviews at strategic and operative levels. Analyzes with mixed models repeated measurements were performed. The explaining variables for the models were implementation of lean at strategic resp operative level, and time (T1, T2, T3). The outcome variables were work-related health (SRH, work ability, stress-symptoms) and psychosocial work conditions.

Results  Physical, cognitive and mental stress-related symptoms were only weakly associated with strategic or operative LP initiatives. There were no overall differences in self rated health and work ability with regard to implementation of LP. A higher degree of LP at operative level was associated with decreased work demands. There was, especially initially, more beneficial or improved working conditions in relation to higher degree of LP at operative levels. The long-term follow-up showed that quantitative demands increased and predictability as well as leadership decreased in the non-lean hospitals. There were different patterns with regard to profession and participatory approaches that will be presented.

Place, publisher, year, edition, pages
Trondheim: , 2015
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Bussiness and IT; Människan i vården
Identifiers
urn:nbn:se:hb:diva-8621 (URN)
Conference
NOVO conference
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareAFA Insurance
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2017-05-02Bibliographically approved
Andreasson, J., Åhlström, L. & Eriksson, A. (2015). The importance of nurse managers’ preconditions and support resources for their attitude and work with improved quality of care. In: : . Paper presented at NOVO Conference. Trondheim
Open this publication in new window or tab >>The importance of nurse managers’ preconditions and support resources for their attitude and work with improved quality of care
2015 (English)Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
Trondheim: , 2015
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8628 (URN)
Conference
NOVO Conference
Funder
AFA InsuranceForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2017-05-02Bibliographically approved
Andreasson, J., Eriksson, A. & Dellve, L. (2014). Health care manager’s views on and approaches to implementing models for care processes.. In: : . Paper presented at 11th International Symposium on Human Factors in Organisational Design and Management (ODAM) and 46th Annual Nordic Ergonomics Society Conference (NES), Copenhagen 17-20 Aug, 2014.
Open this publication in new window or tab >>Health care manager’s views on and approaches to implementing models for care processes.
2014 (English)Conference paper, Published paper (Refereed)
Abstract
Keywords
leadership, care processes, Ledarskap, lärande, etik
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-7305 (URN)2320/14643 (Local ID)2320/14643 (Archive number)2320/14643 (OAI)
Conference
11th International Symposium on Human Factors in Organisational Design and Management (ODAM) and 46th Annual Nordic Ergonomics Society Conference (NES), Copenhagen 17-20 Aug, 2014
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2018-10-25Bibliographically approved
Dellve, L., Eriksson, A., Williamsson, A., Holden, R., Strömgren, M. & Andreasson, J. (2014). Lean implementation approaches at different levels in Swedish hospitals: the impor¬tance for working conditions, worker engagement, health and performance.. In: : . Paper presented at 11th International Symposium on Human Factors in Organisational Design and Management (ODAM) and 46th Annual Nordic Ergonomics Society Conference (NES).
Open this publication in new window or tab >>Lean implementation approaches at different levels in Swedish hospitals: the impor¬tance for working conditions, worker engagement, health and performance.
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2014 (English)Conference paper, Published paper (Refereed)
Abstract [en]

This paper reports result from one-year follow up in a research program with the overall aim to investigate how implementations of lean in health care affect working conditions, health, and performance of employees at five Swedish hospitals. This paper summarizes the implementation approaches, and their importance at short-term follow up for performance (with regard to active work with improvements), perceived working conditions and stress-related health among the healthcare workers. The implementation strategies and pace varied between the hospitals and between the strategic and operative levels. This short-term follow up showed that physical stress-related symptoms had increased overall but the cognitive stress had increased only in hospitals implementing lean. In hospitals with high implementation pace, there were more improvement work among the employees, but higher quantitative demands and lower job satisfaction.

Keywords
organizational intervention, health care serice, Ledarskap, lärande, etik
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Social Sciences Interdisciplinary
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-7301 (URN)2320/14576 (Local ID)2320/14576 (Archive number)2320/14576 (OAI)
Conference
11th International Symposium on Human Factors in Organisational Design and Management (ODAM) and 46th Annual Nordic Ergonomics Society Conference (NES)
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2018-01-10Bibliographically approved
Dellve, L., Andreasson, J. & Jutengren, G. (2013). Hur kan stödresurser understödja hållbart ledarskap bland chefer i vården?. Socialmedicinsk Tidskrift, 90(6), 866-877
Open this publication in new window or tab >>Hur kan stödresurser understödja hållbart ledarskap bland chefer i vården?
2013 (Swedish)In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6, p. 866-877Article in journal (Refereed) Published
Abstract [sv]

Chefer kan ha stor betydelse för anställdas hälsa, stress, engagemang i arbetet och prestation. Få tidigare studier har undersökt vilket stöd chefer behöver för ett hållbart och bra ledarskap. Artikeln presenterar resultat från en prospektiv studie om betydelsen av chefers stödresurser för hållbart ledarskap. I studien, som är en del av Chefios-projektet, ingår chefer i kommunal vård och omsorg (n=344). Data från enkätstudier med instrumentet ”Gothenburg Manager Stress Inventory” har analyserats. Resultatet visar att ett stödjande privatliv och en personlig inställning till chefsuppdrag har stor betydelse för chefers hållbarhet över tid. Chefens kontrollspann och erfarenhet som chef påverkade betydelsen av stödresurser. För chefer med kortare chefserfarenhet eller fler underställda (>30) har även stöd från ledning, chefskollegor och externt stöd betydelse.

Place, publisher, year, edition, pages
Stiftelsen Socialmedicinsk Tidskrift, 2013
Keywords
ledarskap, stöd, stress, arbetsmiljö, offentlig sektor
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-9386 (URN)2320/13289 (Local ID)2320/13289 (Archive number)2320/13289 (OAI)
Available from: 2016-03-16 Created: 2016-03-16 Last updated: 2017-11-30Bibliographically approved
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