Tyske sykehusleger i Norge i et institusjonelt perspektiv

Sammendrag Ifølge litteraturen er institusjonelle logikker sosialt konstruert av institusjonelle aktører, kan reproduseres eller endres gjennom politiske beslutninger og fungerer som institusjonell mal for stater, organisasjoner og profesjoner. I avhandlingen benyttes denne teori- og begrepsverden til å analysere endringer i institusjonelle logikker i tysk og norsk sykehussektor i perioden 1991 – 2008. Mulige endringer i og påvirkning av institusjonelle logikker er rammen for avhandlingens to overordnete forskningsspørsmål: 1. Hva kjennetegner utviklingen av institusjonelle logikker i norsk og tysk sykehussektor i tidsrommet 1991 – 2008? I hvilken grad er den profesjonelle logikken styrket eller svekket i forhold til markedslogikker? 2. I hvilken grad kan ulik primærinstitusjonalisering, sammen med andre faktorer, ha betydning for sykehuslegers organisasjonstilhørighet, opplevelse av psykososialt arbeidsmiljø og faglig oppdatering? Første spørsmål tar utgangspunkt i New Public Management (NPM) i tysk og norsk sykehussektor, som sees som indikator på at profesjonelle logikker utfordres og svekkes. Denne analysen baserer seg på en sammenligning og gjennomgang av reformtiltak som i avhandlingen og litteraturen kobles til NPM. Andre spørsmål drøfter funn i lys av data fra en landsdekkende survey. Surveyen ble gjennomført i Norge våren 2009. Her ble svarene til tyske sykehusleger (eksperimentgruppen, n=338) sammenlignet med svarene til et utvalg norske sykehusleger i Norge (kontrollgruppen, n=287). Avhandlingen dokumenterer endringer i institusjonelle logikker i begge land, men der profesjonelle logikker er mer svekket i Norge enn Tyskland. I likhet med Norge har Tyskland styrket pasienters rettigheter, innført et innsatsbasert finansieringssystem basert på Diagnose relaterte grupper, og pålagt sykehus å innføre helhetlige kvalitetssikringssystem. I Tyskland ble disse endringene innført og vedtatt i starten av 2000-tallet. Norge innførte lignende reformtiltak på midten av 1990-tallet. Et vesentlig skille mellom landene er at Tyskland ikke har gjennomført overgripende, strukturelle reformer i sektoren, og som bryter med etablerte styrings- og ledelsestradisjoner i landet. Kontrastert til utviklingen i Tyskland, vurderes endringene i Norge som et mer markert brudd med etablerte styrings- og ledelsestradisjoner. Denne prosessen startet i Norge omtrent på 1980-tallet. Profesjonslogikken svekkes ytterligere ved at den norske stat utover 1990- og 2000-tallet inntar en mer aktiv rolle i styringen og ledelsen av sykehusene. Det er særlig innføring av enhetlig ledelse i 1999 og helseforetaksreformen i 2001, som tolkes som en svekkelse av profesjonelle logikker i norsk sykehussektor. Avhandlingen viser at tyske legers primærinstitusjonalisering, sammen med andre faktorer, kan ha relevans for tyske legers organisasjonstilhørighet, opplevelse av psykososialt arbeidsmiljø og orienteringsgrad til å holde seg faglig oppdatert. Det begrunnes med at jeg fant statistisk, signifikante forskjeller mellom eksperiment- og kontrollgruppen på undersøkte områder, samt at varigheten på ansettelsesforholdet i Norge hadde relativt lite betydning for undersøkte fenomen (Kirchhoff, 2010, 2011, 2012). Funnene indikerer at slike forskjeller i svært få tilfeller betyr at tyske sykehusleger opplever større utfordringer med å tilpasse seg norsk sykehussektor, sammenlignet med leger i kontrollgruppen. Tvert om scorer legene i eksperimentgruppen i snitt høyere på opplevd organisasjonstilhørighet (Kirchhoff, 2011), opplever mindre problemer med tidspress (Kirchhoff, 2010), og har en høyere orienteringsgrad til å holde seg faglig oppdatert (Kirchhoff, 2012), sammenlignet med de norske legene i kontrollgruppen. Avhandlingen gir ny kunnskap om tyske sykehusleger i Norge, og som i mange år har vært den antallmessig største gruppen utenlandske leger i Norge.The institutional logics perspective implies that institutional logics are socially constructed, can be reproduced or changed through political decisions, and may work as institutional templates for states, organizations, and professions. In the thesis this analytical framework is used to analyze changes, in the period 1991–2008, in institutional logics in the German and Norwegian hospital sectors. Possible changes in and influence of institutional logics constitute the main research questions in the thesis: 1. What characterizes the development of institutional logics in Norwegian and German hospital sector in the period 1991 - 2008? To what extend are professional logics strengthened or weakened in relation to market logics? 2. To what degree can differences in primary institutionalization, together with other factors, have significance for hospital physician’s perception of organizational commitment, psychosocial work climate, and professional competence? The starting point of the first question is the manifestation of New Public Management (NPM) in the German and Norwegian hospital sectors. The relative presence of NPM in both countries is used as an indicator to judge whether professional logics are challenged or weakened. This analysis is based on a comparison and discussion of reforms that in the literature and thesis is linked to NPM. The second question discusses results from a national survey that was completed in Norway in spring 2009. Here, the answers of German hospital physicians (experimental group, n=338) were compared with the answers of Norwegian hospital physicians (control group, n=287). The thesis shows changes in institutional logics in both countries. During this period, professional logics are substantially more weakened in Norway when compared with that in Germany. As Norway, Germany has improved patient’s legal rights, introduced a new payment system based on Diagnosis Related Groups, and imposed mandatory total quality management systems in the sector. In Germany, these changes were introduced and legally approved by the federal government in the beginning of the 2000s. Norway introduced likewise reforms in the mid-1990s. A major distinction between Norway and Germany is that Germany has not conducted overarching structural reforms in the sector that break with established management and governance traditions. In contrast to the development in Germany, changes in Norway are evaluated as a more pronounced break with established management and governance traditions. This process started in Norway approximately in the 1980s. Professional logics weakened further in Norway beyond 1990 and 2000s, as the state took a more active role in the governance and management of hospitals. Particularly, the introduction of unified management in 1999 and the hospital reform in 2001 are interpreted as indicators for weakening professional logics in the Norwegian hospital sector. Results in the thesis indicate that German physician’s primary institutionalizations, and other factors, have some impact on German hospital physician’s organizational commitment, psychosocial work climate, and professional competence. I found statistically significant differences between the experimental and the control group in the areas that were examined. The results also indicate that the duration of German physician’s employment in Norwegian hospitals had relatively little importance for the investigated phenomena (Kirchhoff, 2010, 2011, 2012). The results indicate that German hospital physicians in Norway experience no greater challenges in adapting to changes in the Norwegian hospital sector, when compared with Norwegian hospital physicians in the control group. On the contrary, physicians in the experimental group score on average higher on perceived organizational commitment (Kirchhoff, 2011), experience less problems with time pressure (Kirchhoff, 2010), and have a perceived higher orientation to be up-to-date in medicine (Kirchhoff, 2012), when compared with Norwegian hospital physicians in the control group. The thesis provides new knowledge about German hospital physicians in Norway, which for many years has been numerically the largest group of foreign physicians in Norway

Endringer i klageregler : stor økning i klager etter samhandlingsreformen?

Vi diskuterer rettssikkerhetsmessige aspekter ved endringene i klageregler for pasienter i primærhelsetjenestene. Endringene synes ikke å ha ført til økt rettssikkerhet for pasienter.publishedVersio

Can we mandate partnership working? Top down meets bottom up in structural reforms in Scotland and Norway

Purpose Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals. Design/methodology/approach The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways. Findings The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources. Originality/value Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.publishedVersio

Record, Relate, Remember: Narrative Constructions of Memory and Generation in Antiquity and the Middle Ages

Die zentralen Funktionen des Erfahrens, Erzählens und Erinnerns in der Konstruktion und Überlieferung von persönlich-individuellen sowie sozial-kollektiven Identitäten haben in den vergangenen Jahren zunehmend Beachtung gefunden. Insbesondere das Verhältnis zwischen Text, Kontext und historisch-literarischem Diskurs bietet fortwährend Anlass zum interdisziplinären Dialog. Die narrativen Prozesse der Generationen- und Gedächtnisbildung in vormodernen Gesellschaften nehmen einen zentralen Stellenwert in Fragestellungen der modernen Geschichts- und Literaturwissenschaft, der Philosophie, der Philologien sowie der historische Anthropologie und Sozialwissenschaft ein. Die soziale Dimension des generationellen Gedächtnisses und das fundierende Potential von generationsüberspannenden Erzählungen in der Ausbildung sozialer Gemeinschaften ist heute ein Kernthema der Cultural Memory Studies. Die vom 2.-4. März 2011 in Bamberg abgehaltene internationale Nachwuchstagung bot Raum und Anlass für einen theoretischen sowie praxisorientierten Austausch zwischen jungen wie etablierten WissenschaftlerInnen zum Thema der narrativen Konstruktion von Gedächtnis und Generation in Antike und Mittelalter. Der vorliegende Band vereint eine Auswahl der in diesem Rahmen präsentierten Konferenzvorträge. Er möchte gleichsam als Anregung und Wegbereiter für zukünftige Forschungen und Gespräche dienen, die sich dieser wichtigen Themenstellung widmen mögen.Over the last few years, much attention has been devoted to the crucial functions of recording, relating and remembering in the construction of, and customs associated with, personal and collective identities. The resulting interdisciplinary dialogue has paid much attention to the relationship between text, context and historical and literary discourse. Indeed, the narrative processes which often underpin the construction of generational communities and memories in pre-modern societies represent a key element in current trends of interdisciplinary research, comprising the academic disciplines of History, Literary Studies, Philosophy, Philology, Historical Anthropology and the Social Sciences. The social capacities of generational memory, along with the creative potential of transgenerational narratives in the development of social communities, form a key topic in the burgeoning field of Cultural Memory Studies. From 2-4 March 2011, an international and interdisciplinary conference was organised at the University of Bamberg aimed at bringing together researchers from all career stages to engage in a collaborative dialogue on the narrative construction of generation and memory in Antiquity and the Middle Ages. The present volume comprises a selection of papers delivered at that conference. It seeks to provide insight and guidance for future research projects conducted in this field, and thus to encourage scholars to engage with this important topic in their research

Phosphatidylserine-exposing extracellular vesicles in body fluids are an innate defence against apoptotic mimicry viral pathogens

Some viruses are rarely transmitted orally or sexually despite their presence in saliva, breast milk, or semen. We previously identified that extracellular vesicles (EVs) in semen and saliva inhibit Zika virus infection. However, the antiviral spectrum and underlying mechanism remained unclear. Here we applied lipidomics and flow cytometry to show that these EVs expose phosphatidylserine (PS). By blocking PS receptors, targeted by Zika virus in the process of apoptotic mimicry, they interfere with viral attachment and entry. Consequently, physiological concentrations of EVs applied in vitro efficiently inhibited infection by apoptotic mimicry dengue, West Nile, Chikungunya, Ebola and vesicular stomatitis viruses, but not severe acute respiratory syndrome coronavirus 2, human immunodeficiency virus 1, hepatitis C virus and herpesviruses that use other entry receptors. Our results identify the role of PS-rich EVs in body fluids in innate defence against infection via viral apoptotic mimicries, explaining why these viruses are primarily transmitted via PS-EV-deficient blood or blood-ingesting arthropods rather than direct human-to-human contact

Tilhørighet til arbeidsplassen: en komparativ studie av tyske og norske sykehusleger i Norge

ORGANIZATIONAL COMMITMENT. A COMPARATIVE STUDY OF GERMAN AND NORWEGIAN HOSPITAL PHYSICIANS IN NORWAY The article analyses whether German physicians in Norway are any less organizationally committed to Norwegian hospitals than Norwegian physicians are. The article is based on national survey data collected in spring 2009 (N=627) among Norwegian and German hospital physicians in Norway. We used questions from a validated survey instrument to illustrate that German and Norwegian physicians, despite comprehensive hospital reforms in Norway, are relatively highly organizationally committed to their workplace. Generally, German hospital physicians show slightly more organizational commitment then Norwegian hospital physicians. Our study demonstrates that the same independent variables explaining organizational commitment in a Norwegian physician sample do not necessarily have the same effect on organizational commitment in a German physician sample. Differences between our national samples can to some extent be explained by focusing on German physicians’ prior working conditions in Germany and traditions for clinical leadership within German public hospital organizations

Preparation of the η2-1,2-Diphosphaallyl Complex (η5-C5Me5)(CO)FeP(SiMe3)-P=C(SiMe3)2 and Reaction with Ni(CO)4 and PMe3. Formation of the η3-Ferradiphosphaallyl Complex [η5-C5Me5)(CO)(μ-CO)Fe-P=P-C(SiMe3)3]Ni(CO)2

Weber L, Kirchhoff R. Preparation of the η2-1,2-Diphosphaallyl Complex (η5-C5Me5)(CO)FeP(SiMe3)-P=C(SiMe3)2 and Reaction with Ni(CO)4 and PMe3. Formation of the η3-Ferradiphosphaallyl Complex [η5-C5Me5)(CO)(μ-CO)Fe-P=P-C(SiMe3)3]Ni(CO)2. Organometallics. 1994;13(3):1030-1033