Attending Weak Signals: The Prevention of Work-related Illnesses

This article examines the characteristics of communication among managers, human resource (HR) experts, and occupational health care specialists, as they deal with such informal information as weak signals in the prevention of work-related illnesses, using a theoretical framework in which the prevention of work-related illness is analogous to theory on crisis management. This is a qualitative study in which individual and focus-group interviews were conducted in a Swedish context with occupational health care specialists, managers, and HR experts. The results suggest that organizational solutions have failed and continue to fail at controlling workers’ health problems, although the main difficulty is not in identifying the ‘right’ individually oriented weak signals. Rather, it is upper management’s reliance on formal information (e.g., statistics and surveys) – because of the difficulty in supplementing it with informal information (e.g., rumors and gossip) – that makes it difficult to improve traditional health and safety wor

Professionals and the New Public Management - Multi professional teamwork in psychiatric care

This study examines the cooperative work of several professions in Swedish multi-professional teams in child and adolescent psychiatric open care units in an environment of strong economic and efficiency controls resulting from the so-called New Public Management (NPM) reforms. Previous studies indicate teamwork is a network of semi-independent professionals who tend to represent their professional organisations and groups despite sharing a mutual interest in the patients. The research problem deals with finding explanations for what promotes and what hinders cooperation in a multi-professional health care team. A qualitative approach is used to study and interpret the individual professionals’ actions. Data were collected in interviews and from observations of planning and treatment discussions where it was possible to witness team members’ strategies and attitudes toward patients and their treatment. The main theoretical concepts are exogenous and endogenous institutions, boundary objects, standardised procedures, service ideal, discretionary power and professional dominance. Two NPM elements are applied: customised care and increased accountability. The study offers an actor perspective that complements the traditional cultural perspective. The latter perspective explains cooperation problems as the result of the professionals’ confusion over their expectations of themselves in their team roles and their expectations of others in their team roles. The actor perspective shows that while norms may influence cooperation, they are not determinative. Actors are aware of the institutionalised conditions, and take them into consideration; however, their actions are not determined by these conditions, nor even primarily guided by them. The determinative factor for actors’ actions is their context. Leaders and co-workers can create endogenous institutions that bridge their differences in professional norms and also bridge professional norms and NPM reforms. The institutionalised conditions are secondary factors that explain the outcome of cooperation efforts. This study offers an interpretation useful in understanding how the actors create endogenous institutions. Star and Griesemer’s theory on boundary-spanning objects does not address this aspect of cooperation. Unintended consequences of NPM reforms for patients are traditionally said to imply that NPM reforms are ill conceived and unrealistic. In the light of this study the significance of such consequences may be reinterpreted to be a possible mechanism of driving the development of the public organisation. Usually NPM reforms are regarded either destructive or harmless to professional autonomy. This is scarcely a realistic description of professionals’ long-term behaviour. This study offers co-optation as an alternative explanation, defined as the process by which actors absorb external strategic elements in their policy decisions. Co-optation of NPM reforms explains the gradual institutionalisation of NPM reforms. Research investigating professions has not dealt with the fact that multi-profession cooperation has the same character as mono-professional cooperation, to preserve collegiality through co-existence. Such professionals do not wish to challenge others’ approaches and practices; nor do they wish to learn from them. This result challenges the general idea of professional dominance in theories on professions

Driver NPM-reformers oavsedda effekter 'byråkratiers' utveckling?

I rapporten diskuteras vilka oavsedda konsekvenser som uppstår då en NPM-reform som prestationsbaserade löner införs för lärare i två kommuners skolor. Rektorer och tjänstemän inom kommunernas centrala personalavdelningar har intervjuats. De förväntade resultaten uppstod inte förrän efter tio år, då den nya lönesättningsproceduren anpassats till byråkratins formkrav och då nya kriterier som uppfattades som objektiva av berörda hade införts. Det studerade fallen visar att de oväntade effekterna inte tas till intäkt för att avbryta reformen, utan tvärtom utgör en mekanism till att reformen till slut blir institutionaliserad inom ramen för en bestående byråkrati. I rapporten argumenteras för att det är NPM-reformens oavsedda effekter som driver byråkratins utveckling

The multi-professional team as a post-NPM control regime : Can it integrate competing control regimes in healthcare?

This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (NPM) control regime in order to develop individualistic and holistic care in healthcare in the context of two competing logics: managerialism and professionalism. In a qualitative case study, three outpatient Child and Adolescent Psychiatric (CAP) care units are investigated using interviews, observations and shadowing. The study shows that the MPT has an integrative effect on the two logics when informal alliances are formed between psychologists/psychiatrists and unit managers. We conclude that the MPT may achieve patient care in a resource-effective and professional way but not individualistic and holistic care. An explanation may be that individualistic and holistic care is neither measurable/quantifiable as required by the resource-effectiveness goal nor in focus as a consequence of the logic of professionalism. A theoretical implication is that the negative effect of NPM on the professionals’ autonomy is mitigated by the MPT. Earlier studies may have underestimated the importance of “hard facts” introduced by a strong control regime, in this case, the NPM context. The control regime may take over and create collaboration; nonetheless, the outcome is not entirely the desired one

Experts’ contribution to strategy when strategy is absent : A case study of quality experts in hospitals

This study investigates how new categories of experts can contribute to strategydevelopment in public organizations. Interplay between managers and experts wasanalysed using principal-agent theory, stewardship theory, and partnership theory,each assigning the experts different kinds of strategic contribution. Results show thatexperts may contribute to an iterative and emergent strategy process as stewardsthrough a consultative process method that lets the means guide the goals. Experts’knowledge of what other actors in the organization perceive as important guides theexperts’ application of the technical methods and processing.Published online: 13 Apr 2020CC BY-NC-ND 4.0</p

Co-optation as a response to competing institutional logics : Professionals and managers in healthcare

Researchers working under the institutional logics perspective find the struggle between managerial logic and various professional logics one of the most intriguing issues in healthcare organizations. Previous research provided several explanations at both the organizational level (mediation, hybridization, and selective coupling) and the individual actor level (hierarchization, sense making, reinterpretation, and hijacking) for the coexistence of professional and managerial logics in healthcare. However, all of these explanations are based on the underlying institutional logics not changing. In this article, we show that co-optation can explain the coexistence of institutional logics, but that it also causes the underlying institutional logics to change. Co-optation means that an actor adopts a strategic element from another logic that retains the most important elements of its own logic. Empirically, this article illustrates co-optation processes through a qualitative study of outpatient units in child and adolescent psychiatric care in Sweden. Using an institutional logics framework, we describe and explain how managers co-opted elements of professional logics and professionals co-opted elements of managerial logic in their attempts to support their own interests. Even if co-optation is performed to protect the home logic, the co-opted elements ultimately change it. This study contributes to the institutional logics framework by describing and explaining how co-optation can be a dynamic response to competing logics at the individual actor level.Forte 2015-00822 Verksamhetsutvecklarnas roll i vårdens utvecklingsarbet