Studying Resilient Action Strategies of First Line Managers

Background: One important key to an organization’s long-term competitiveness is the ability of first line managers (FLMs) to handle their role as a leader in daily work. FLMs main task is to contribute to a high and stable production output according to customer demands from an input that is characterized by instability and variability. To do so, FLMs must develop resilient action strategies – ways of working and daily problem solving that systematically facilitate to cope with instability. In this study protocol we present a methodological approach developed to evaluate and improve these. Methods/Design: The research approach is collaborative and developmental and performed together with two companies. The approach integrates and extends the theory and application of a model on interactive research and a framework on activity analysis. It will be applied using data collection techniques like interviews, diaries, observations, document analysis, and questionnaires. The analysis and development stages will be performed both separate and in collaboration in workshops and the result is planned to end up in the joint writing of a generic handbook on advantageous action strategies for FLMs’. Discussion: This study contributes with a new integration of two methodological approaches which provides a novel way to understand and develop dynamic on-the-job behaviour in work settings

Enacting quality improvement in ten European hospitals: a dualities approach

Background: Hospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals’ quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to. Methods: A set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway). Results: Six dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness. Conclusions: We advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.publishedVersio

Translating research on quality improvement in five European countries into a reflective guide for hospital leaders: the 'QUASER Hospital Guide'

Objective The aim was to translate the findings of the QUASER study into a reflective, dialogic guide to help senior hospital leaders develop an organization wide QI strategy. Design The QUASER study involved in depth ethnographic research into QI work and practices in two hospitals in each of five European countries. Three translational stakeholder workshops were held to review research findings and advise on the design of the Guide. An extended iterative process involving researchers from each participant country was then used to populate the Guide. Setting The research was carried out in two hospitals in each of five European countries. Participants In total, 389 interviews with healthcare practitioners and 803 hours of observations. Intervention None. Main outcome measure None. Results The QUASER Hospital Guide was designed for leadership teams to diagnose their organization’s strengths and weaknesses in the eight QI challenges. The Guide supports organizational dialogue about QI challenges, enables leaders to share perspectives, and helps teams to develop solutions to their situated problems. The Guide includes extensive examples of QI strategies drawn from the data and is published online and on paper. Conclusions The QUASER Hospital Guide is empirically based, draws on a dialogical approach to Organizational Development and complexity science and can facilitate hospital leadership teams to identify the best solutions for their organization

Interactive Oral Assessment Supporting Active Learning

The CDIO standards stress the importance of using a variety of examination methods for effective learning assessment as well as active learning methods to help the students develop skills in applying knowledge to new settings. Oral assessment methods in a more traditional form where students answer questions in oral form instead of in written seems to be underrepresented in practice as well as in the literature although it has many benefits in supporting active learning and reaching learning outcomes. The oral examination method has been used during ten years within the field of Industrial Engineering and Management at the School of Engineering at Jönköping University in Sweden. The aim of this paper is to show how the oral assessment method has been successfully used in contributing to active learning in engineering education and lessons learned from this experience. The experience shows that by having students undertaking the assessment in groups, an active learning occasion is created by interaction between students as well as students and teacher. Through the design of the assessment the teacher has the opportunity to help the students to make connections between detailed knowledge and system understanding as well as among key concepts and to the application of knowledge to new settings. The assessment procedure also supports the teacher to discern the learning outcomes from each student. Further, the interaction between the teacher and the students during the assessment helps the teacher to capture what improvements need to be made in teaching and learning

Interactive Oral Assessment Supporting Active Learning

The CDIO standards stress the importance of using a variety of examination methods for effective learning assessment as well as active learning methods to help the students develop skills in applying knowledge to new settings. Oral assessment methods in a more traditional form where students answer questions in oral form instead of in written seems to be underrepresented in practice as well as in the literature although it has many benefits in supporting active learning and reaching learning outcomes. The oral examination method has been used during ten years within the field of Industrial Engineering and Management at the School of Engineering at Jönköping University in Sweden. The aim of this paper is to show how the oral assessment method has been successfully used in contributing to active learning in engineering education and lessons learned from this experience. The experience shows that by having students undertaking the assessment in groups, an active learning occasion is created by interaction between students as well as students and teacher. Through the design of the assessment the teacher has the opportunity to help the students to make connections between detailed knowledge and system understanding as well as among key concepts and to the application of knowledge to new settings. The assessment procedure also supports the teacher to discern the learning outcomes from each student. Further, the interaction between the teacher and the students during the assessment helps the teacher to capture what improvements need to be made in teaching and learning

A novel approach to understand nested layers in quality improvement

Studies on healthcare quality improvement (QI) increasingly point at the importance of understanding multilevel organizational issues, especially interaction between national, hospital and clinical level. In a EU-study involving ten hospitals in five countries one hospital stood out in successful multilevel QI work, which is elaborated in this paper. It is suggested that there is a potential in using linkages and dependencies in terms of organisational development and resource support (O) and method, process and IT support (T) affecting the individual caregiver (H), to understand the nestedness and interaction between operational system levels in QI.Quality and Safety in European Union Hospitals (QUASER

Utvärdering av interventionsarbete med hälsofrämjande åtgärder – en metodologisk ansats

Författaren arbetar som doktorand med en avhandling om förändringsarbete inom postutdelningsverksamheten, Servicenätet Leverans,Posten Sverige AB. Verksamheten har sedan mitten av 1990-talet varit föremål för genomgripande omstrukturering och effektivisering för att möta kraven på konkurrens från andra aktörer på marknaden. För brevbärarpersonalen har detta medfört introduktion av ett nytt arbetskoncept,vilket har påkallat insatser för att främja brevbärarpersonalens hälsa och välbefinnande under arbetsutförandet

Att följa hela Posten-projektet på nära håll

I forskargruppen ingick doktoranden Anette Erlandsson-Karltun. På henne låg en alldeles särskild operativ uppgift, nämligen att på nära håll följa, medverka i och dokumentera hela det förändringsarbete som Servicenätet Posten bedrev inom ramen för projektet ”Brevbärarnas arbetssituation” (BAS), och som utmynnade i förbättringar som slutligen vidtogs vid de totalt 602 utdelningskontoren i landet. Anette Erlandsson-Karltuns första uppgift blev att hösten 2001 genomföra en kartläggning av brevbärarnas arbetsmiljö och av införandet på kontoren av det s.k. ”Bästa Metod” konceptet. En liknande insats ägde rum från oktober 2003 – maj 2004. Det var en utvärdering av implementeringsprocessen vid ett pilotkontor vad gäller fyra förbättringsåtgärder: belysning, märkning och justering av kamfack, arbetsteknik och nyttjande av ny manual för organisering av innearbetet på utdelningskontoren. Ytterligare en utvärdering genomförde hon (tillsammans med Anna Roos) på ett större urval utdelningskontor under våren och sommaren 2005 efter att förbättringarna vidtagits vid samtliga landets kontor. Under perioderna mellan dessa tre omfattande undersökningar fungerade Anette Erlandsson-Karltun som kontaktperson och forskarstöd till projektmedarbetare och ledningspersoner inom Servicenätet Posten. I motsats till andra i forskargruppen som inriktade sig på specifika problem och insatser hade Anette Erlandsson-Karltun en bred och långsiktig uppgift, nämligen att följa - och bidra till - Postens satsning på detta projekt från start till mål

Evaluation of intervention measures : a methodological approach

It is common for researchers to evaluate interventions by having the participants answer standardized questions before and after, and measuring the effect of the intervention as a statistical difference between the two. There is a risk that the results of such a calculation will be misleading due to the subject interpreting the response scales differently on each occasion. This risk has previously been observed by Golembiewski et al, who indicated that we are dealing with a psychometric problem set that is especially evident in interventions. The question is whether the individual’s own yardstick for assessing or valuing a certain circumstance/area is the same before and after the intervention, or whether the yardstick has changed due to the subject gaining new experience within the conceptual framework. Golembiewski calls this phenomenon beta change. The purpose of this paper is to illustrate empirically the occurrence of beta change and its possible consequences for the interpretation of the results, with the aid of a model devised by Terborg et al. The material is taken from a health-promoting intervention project in the mail distribution division of the Swedish Post Office