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Organizing Principles and Management Climate in High-Performing Municipal Elderly Care
University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Psychology, University of Gothenburg, Sweden. (Socialpsykologi)ORCID iD: 0000-0003-0629-353X
University of Skövde, School of Health and Education. University of Skövde, Health and Education. (Kvinna, barn och familj, Woman, Child and Family)ORCID iD: 0000-0001-7164-0433
University of Skövde, School of Business. University of Skövde, Enterprises for the Future. (Medarbetarskap och organisatorisk resiliens, Followership and Organizational Resilience (FORE))ORCID iD: 0000-0001-8136-4233
2016 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 29, no 1, 82-94 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – Previous research has shown that user-oriented care predicts older persons’ satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The present study set out to investigate the organizing principles and management climate characterizing successful elderly care organizations.

Design – The care organization in one highly ranked municipality was selected and compared with a more average municipality. On-site semi-structured in-depth interviews with managers as well as participatory observations at managers’ meetings were conducted in both municipalities.

Findings – The results revealed three key principles for successful elderly care: 1) organizing care from the viewpoint of the older service user, 2) recruiting and training competent and autonomous employees, 3) instilling a vision for the mission which guides operations at all levels in the organization. Furthermore, using climate theory to interpret the material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing things right characterizing the more average municipality.

Value – We suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the upper management, i.e., the views of the older persons, the co-workers, and the mission. The results can guide future care quality developments and increase the understanding of the importance of organizational climate at the senior management level.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2016. Vol. 29, no 1, 82-94 p.
Keyword [en]
Elderly care, Leadership, Management, Older people, Organizational climate, User-oriented care
National Category
Business Administration
Identifiers
URN: urn:nbn:se:his:diva-11679DOI: 10.1108/LHS-06-2015-0018ISI: 000379697000006PubMedID: 26764962ScopusID: 2-s2.0-84954416079OAI: oai:DiVA.org:his-11679DiVA: diva2:869046
Available from: 2015-11-12 Created: 2015-11-12 Last updated: 2016-08-09Bibliographically approved
In thesis
1. An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
Open this publication in new window or tab >>An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The foundation for this thesis is an ongoing discussion about quality in Swedish elderly care: Which are the most important factors that contribute to elderly care in terms of satisfaction among older persons, and what are the primary reasons for their differences?

Aims. The principal aim was to examine what determines satisfaction with elderly care in home care and nursing homes, using the perspective of older persons (Studies I and II). The secondary aim was to analyze why these determinants differ, using the perspective of care workers, managers, and observers (Studies III and IV).

Methods. Study I analyzed aggregated statistical data from the level of municipalities and districts (N = 324) based on the Swedish elderly care quality reports “Open Comparisons”, while Study II analyzed individual data based on the original ratings in the annual, nationwide elderly surveys (N = 95,000). Study III describes field observations and interviews with care workers and managers in two municipalities, one with a high rating for user satisfaction and one with an average rating. Study IV describes investigations in these two municipalities concerning their organizing principles and departmental‑level management climate.

Results. The results relating to the principal aim showed that process factors (such as respect, information, and influence) are related considerably more closely than structural factors (such as budget, staffing levels, and training levels) to satisfaction with care. Other process factors (such as treatment, safeness, staff and time availability) were also able to alleviate person factors (such as health, anxiety, and loneliness). Moreover, the results relating to the secondary aim showed that differences in user-oriented elderly care are mainly due to interpersonal factors between the caregiver and the older person. Care workers, however, reported that other factors (such as organizing principles and leadership support) influence the quality of the care process. Overall, older persons who receive home care generally report higher satisfaction with care than those in nursing homes, and feeling less safe. It may be that differences in the process of aging explain this.

Value. This thesis shows that satisfaction with elderly care can be largely explained by psychological quality at the individual level. The sizes of structural resources and organizing principles at the municipal level have minimal effect (< 5%). The thesis also presents a theoretical multiple-level Quality Agents Model to explain the sources of differences in satisfaction with care, and it presents recommendations for elderly care practices. A renewed focus on the psychology of satisfaction may contribute to the development of quality in elderly care.  

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2015. 77 p.
Series
Doktorsavhandlingar vid Göteborgs universitet, ISSN 1101-718X
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:his:diva-11684 (URN)978-91-982353-9-5 (ISBN)
Public defence
2015-12-11, F1, Haraldsgatan 1, Göteborg, 18:21
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1200
Available from: 2015-11-23 Created: 2015-11-12 Last updated: 2016-12-15Bibliographically approved

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