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  • 1.
    Andersson, Thomas
    et al.
    Högskolan i Skövde, Institutionen för teknik och samhälle.
    Liff, Roy
    Gothenburg Research Institute, Göteborg, Sweden.
    Does patient-centred care mean risk aversion and risk ignoring?: Unintended consequences of NPM reforms2012Inngår i: International Journal of Public Sector Management, ISSN 0951-3558, E-ISSN 1758-6666, Vol. 25, nr 4, s. 260-271Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose – This article aims to describe and analyze the results of efforts to improve patient-centered care (PCC) in psychiatric healthcare.

    Design/methodology/approach – Using the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient-centered actions are performed. They conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days.

    Findings – The article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient’s medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.

    Practical implications – The article shows that accountability pressure to reduce patient risk may create new risks for patients.

    Originality/value – The study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.

  • 2.
    Eriksson, Nomie
    Högskolan i Skövde, Institutionen för handel och företagande. Högskolan i Skövde, Forskningsspecialiseringen Framtidens Företagande.
    Hospital management from a high reliability organizational change perspective: A Swedish case on Lean and Six Sigma2017Inngår i: International Journal of Public Sector Management, ISSN 0951-3558, E-ISSN 1758-6666, Vol. 30, nr 1, s. 67-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose – The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO).

    Design/methodology/approach – Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n 17) nurses at two Swedish hospitals.

    Findings – The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement.

    Practical implications – Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned.

    Originality/value – The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

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