The Multiple Middle: Managing in Healthcare

__Abstract__ The future of the middle manager is a much debated topic; not only in healthcare but also in other sectors. The middle manager is either viewed as an important change agent or as a relict of the past. Despite these opposing views, the underlying definition of middle management is one and the same: middle management is defined as a place somewhere ‘in the middle’ of the work floor and higher management. This spatial definition of middle management is foregrounding management activities in ‘upward’ (higher management) and ‘downward’ directions (work floor), while backgrounding other management activities. As a consequence, we only have a partial and limited view of what middle management entails. The central aim of this thesis is to open up the middle by researching the multiplicity of the middle in healthcare, thereby gaining new insights in day-to-day work of middle management and important transitions in this work. This thesis foregrounds alternative middles that so far have received little attention in literature: the middle in-between 1) conflicting values of good care; 2) different justifications used towards stakeholders; 3) professional and managerial discourses; and 4) organizational boundaries between care, welfare and housing. The empirical analysis does not only sheds light on the type of work that is conducted in these middles, but also reveals how this work is reconfigured and partially distributed to clients and professionals. Moreover, the analysis provides an answer to the main question: ‘How is the daily work of middle management enacted and reconfigured in the Dutch c

The spiral structure of Marshall McLuhan’s thinking

We examine the spiral structure of the thinking and the work of Marshall McLuhan, which we believe will provide a new way of viewing McLuhan’s work. In particular, we believe that the way he reversed figure and ground, reversed content and medium, reversed cause and effect, and the relationship he established between the content of a new medium and the older media it obsolesced all contain a spiral structure going back and forth in time. Finally, the time structure of his Laws of Media in which a new medium obsolesced an older medium, while retrieving an even older medium and then when pushed far enough flipped into a still newer medium has the feeling of a spiral. We will also examine the spiral structure of the thinking and work of those thinkers and artists that most influenced McLuhan such as Vico, Hegel, Marx, Freud, Joyce, TS Eliot, Wyndham Lewis and the Vorticism movement

Who is ‘in’ and who is ‘out’? Participation of older persons in health research and the interplay between capital, habitus and field

Inclusion and exclusion processes in community engagement do not take place in a vacuum, but are embedded in social, political and institutional contexts. T

Can leadership make the difference?:A scoping review of leadership and its effects in child and youth care

Child and youth care (CYC) is operating in an unpredictable environment, making leadership in CYC a challenge. Leaders of CYC operate under public and political pressure to reform failed systems, compete for scarce resources, obtain and sustain a highly skilled workforce, and achieve organizational goals and tasks within a complex network. Although many studies underline the importance of leadership in CYC, there is no clear demarcation of the concept of leadership and its associated effects. By conducting a scoping review of the literature, this study aims to improve a conceptual understanding of leadership and provide insight into the influence of leadership on service delivery in CYC. The results show that the majority of the studies within the scope did not use clear definitions of leadership and did not specify the type or level of leadership. Despite this lack of clarity, most studies do discuss the positive effects of leadership behaviors. Leadership behaviors are primarily associated with positive effects on employee commitment and well-being; i.e. creating and communicating a vision, providing trust, safety and respect, inspire, motivate, stimulate and having a cooperative attitude. These leadership behaviors are not exclusively linked to a specific level of leadership and seem effective at all levels. However, the results also show that support from the top of the organization, noticeable in behavior, is a prerequisite for the other layers of management in the organization to be effective. The lack of clarity about type or level of leadership to which the conclusions apply, makes it difficult to develop and recommend targeted leadership interventions. Therefore, future studies should provide a clear definition of leadership, including job title, job content and leadership level. Our findings suggest that these leadership behaviors, can help CYC professionals navigate through their unpredictable environment and improve the quality of care.</p

Examining service complexity in children with parents who abuse substances

Children and youth who have parents who abuse substances are at risk of developing externalizing problems (e.g., rule-breaking, aggressive/antisocial behaviour, underage drinking/drug use) and face a variety of risk factors including family factors (e.g., parenting, level of monitoring, abuse, and neglect), and child-related factors (e.g., mental health, behavioural, substance use problems) that impact levels of family functioning, parenting strengths, school disengagement, externalizing difficulties, and service complexity. Currently, there is lack of information and recognition that children of parents with substance use disorders require mental health services, with limited research regarding the requirements of service intensity and complexity for children’s mental health when focusing on this specific population of children effected by parental substance abuse. To address this gap in literature, data was obtained from 18701 clinically referred children and youth (4 to 18 -years) across the Province of Ontario using the interRAI Child and Youth Mental Health Assessment. Findings revealed that treatment-seeking children of substance abusing parents rated higher on externalizing behaviours, school disengagement, family dysfunction, lack of parenting strengths, and service complexity than children with parents who do not abuse substances. Implications and recommendations for service professionals to support service system integration utilizing an assessment-to-intervention process to support families engaged in mental health and substance use problems are discussed