Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups

<p>Abstract</p> <p>Background</p> <p>In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.</p> <p>Methods</p> <p>Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.</p> <p>Results</p> <p>Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.</p> <p>Conclusion</p> <p>This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.</p

Workplace flexibility and control in temporary agency work

This article explores workers’ experiences of flexibility, control, and autonomy in organisations with extensive contracting of staff from temporary work agencies (TWAs). The starting point for this article is in theoretical perspectives on workplace flexibility and organisational control practices I argue that workers’ opportunities to control and have autonomy over their work and accomplish workplace flexibility are interconnected with the controlling practices that are present in their everyday working life. In organisations with extensive hiring of temporary agency workers (TAWs), this is complicated further, as workers from different organisations, with different management strategies, are working together at the same work site. Open-ended, semi-structured interviews were conducted with TAWs and regular employees in three user firms with extensive contracting of TAWs. A questionnaire was also completed by them. The results show that there are few opportunities for either TAWs or regular staff to achieve workplace flexibility in terms of making choices about where, when, and for how long they are going to work. The findings contradict assumptions that formal differences between the employment conditions of regulars and agency workers affect their opportunities for workplace flexibility. Similar technical control systems were used in the user firms despite differences between assembly line production and customer support. Despite these similarities in the opportunities for flexibility for both groups of workers, the findings showed some differences between TAWs’ and regulars’ everyday experiences of flexibility and control. The findings showed how close surveillance by technological systems was intertwined with a normative control, which means the awareness among TAWs of their replaceable position implicates anxiety about the consequences of absence from work. As a consequence of their vulnerable position, TAWs were striving to prove themselves to be competent to both the user firms and the agency. This highlights the dualistic controlling practices that TAWs are subjected to by user firms as well as the agency in their everyday work. This constitutes an effective and powerful system of organisational control.Personaluthyrningens konsekvenser för arbetsvillkor, attityder och sociala interaktione