Högskolan i Skövde

Previous research has made three parallel but incompatible observations on the contemporary development of welfare professions: loss of professional autonomy, hybridization, and maintained autonomy.  Yet,  research  providing  contextual  understanding  of  the  simultaneous  occurrence  of  these three observations is lacking. The aim of this theoretical paper is to identify and explain seemingly  contradictory  coexisting  features  of  modern  welfare  professions  through  a  compre-hensive reading of current literature on the health care and teaching professions in Sweden. The literature  has  demonstrated  entangled  institutional  logics,  in  which  simultaneous  but  differing  effects occur, thereby developing a new professional landscape.

Genom att ge medarbetarna förtroende och uppmuntra ansvars- och initiativtagande är det möjligt att bryta den passivitet som detaljerade regler och standardisering ofta medför.

Barley & Kunda (1992) state that the development of managerial discourse is best understood as the result of different dominating ideologies. The argument is that the managerial discourse has developed in waves that have alternated between rational and normative rhetoric. According to the ideology of rational control the manager should manage on basis of expertise. Centralised ecision-making and specialization are therefore desirable. In the ideology of normative control influencing the subordinate's attitudes, satisfaction and beliefs are given preference. The manager should be a leader who sets the goals, which the subordinates are responsible for reaching. During the period 1955 - 1980 the ideology that dominated management was rational control and from 1980 management has been dominated by an ideology of normative control. As management control is a management activity, it is assumable that management control discourse would develop in a similar way. This pilot study shows a change from rhetoric of rationalism to normative rhetoric. Furthermore, as management control is based on rational assumptions, the concept have rhetorically been broadened to include organization culture and HRM, perhaps as a means "to survive" in a dominating managerial ideology of normative control

Waitzberg and colleagues identified strategies that managers and physicians in hospitals apply to reconcile dilemmas between clinical and economic considerations. Contributions that actually acknowledge the institutional complexity of hospitals and describe how to deal with it are rare. This comment explains the reason behind the institutional complexity in healthcare organizations and argues that institutional complexity is a good foundation for a well-functioning and sustainable healthcare, as long as we are able to deal with this complexity. This point underscores the importance of their contribution. However, even if the identified strategies on how to reconcile and balance different, competing demands are important, they are not easy to apply in practice. First, the strategies require frequent and high-quality interaction between different actors adhering to different institutional logics. Second, even when the strategies are applied successfully, it is difficult to make them sustainable since they rest on a fragile balance between competing logics. However, these are important avenues for future research for researchers who want to follow the route of Waitzberg and colleagues.

This chapter addresses how intentionality and agency can be understood in relation to values and values work. How different degrees of intentionality relate to different dimensions of agency is something we need to understand empirically rather than as a point of departure. A connected challenge is to what extent people are aware of values that influence their actions and the values work they are involved in, but also to what extent they are aware of relations/conflicts between values that are imposed on them (e.g., from an employer) and personal values. This is also something we need to understand empirically. This chapter describes how different qualitative data collection methods have different strengths and weaknesses in relation to the above challenges and how a design of mixing them may enable a true empirical investigation of intentionality and agency in values work research.

The study takes its point of departure in the complex relation between “being yourself” and being manager, i.e. the struggle between what one ought to do as a representative of an organizations and what one want to do as a person. Introspective management training constitutes one extreme of focusing on the person in this matter, i.e. managers should develop their own unique leadership style upon “who they are”. The influences on managers from this type of management training are not self-evident considering the complex relation mentioned in the beginning. The study therefore aims at describing how introspective management training influences practicing managers. To reach that aim six managers representing three different organizations were followed during and after their participation in an eight month long introspective management training. For the managers in the study, the introspective training was mainly an arena for identity work. Identity work meant dealing with conflicting identities, elaborating and developing identities, roles and role transitions, and struggling to fit into different discourses, rather than finding the “true self”. The identity process is complex and is influenced both by direct interaction with others “here-and-now” and by the “generalized other”, which goes beyond “here-and-now”. Identity work and role transitions are important parts of management considering the relational aspect of both identity and role. The introspective management training seems to have a potential on the personal level for the managers, but the organizational gain is more doubtful. There is a need of reciprocity during the process to enable an organizational enhancement together with the manager’s personal

Purpose – The article aims to analyze how personal development training influences managers’ identity processes.

Design/methodology/approach – The article, taking an interpretive-critical approach, is based on a qualitative, longitudinal study of five participants (managers) in a personal development training program. During the two years of research, 62 interviews (with the managers and related personnel) were conducted and 13 observations were made.

Findings – Personal development training provokes identity regulation by prescribing a normative identity process that claims managers should engage in a process of reflection in order to gain self-awareness. Such training constitutes a local management discourse that may influence different levels of identity work and identity regulation processes depending on the participants’ expectations, their organizations and professional situations, their level of insecurity, as well as their previous experience with management discourse.

Practical implications – Since management training influences participants’ identity processes, program organizers, purchasers and participants should be wary of the expectation that management training will deliver content as “a package” of managerial skills.

Originality/value – The study challenges the traditional view of management training as a provider of skills and solutions for managers by focusing instead on its influence on managers’ processes of identity work and identity regulation. Management training in general is claimed to regulate identities and direct identity work by providing inspirational identities. However, this study finds that personal development training regulates identities by prescribing the identity process in itself.

Purpose – to compare the introduction of, and associated contemporary research into, two management fashions. Design/methodology/approach – names the two fashions as “personal growth” and “sensitivity training”, states that sensitivity training was popular in the 1960s-1970s, and that personal growth, incorporating aspects of sensitivity training, was widely used in 1990s-2000s, focuses on the relationship between management fashions and management research fashions, suggests that fashions follow wave patterns, and discusses the role of consultants in the development, diffusion and translation of a fashion. Draws on the author’s own doctoral thesis to illustrate how individuals can be influenced by a fashion, identifies similarities between sensitivity training and personal development, sees the former as a first-wave fashion and the latter as a second-wave, and profiles the techniques, methods and goals of the two fashions, pinpointing self-knowledge, and the belief that in order to understand others one must understand one’s self, as key concepts in both fashions. Analyses two doctoral theses, the first published in 1979 studying sensitivity training, the second published by the author in 2005 studying personal development, reports the author’s interviews with the first paper’s author, likens managers’ identity work in managing to researchers’ identity work in a dissertation, and concludes that both managers and researchers surf on the same or parallel, fashion waves. Originality/value – highlights the cyclic pattern of fashions, and shows how both researchers and practitioners are subject to fashions

Tillitsdelegationens arbete har varit viktigt genom att det har fört upp tillit på agendan i offentliga organisationer. Men tillit är ingen styrform. Däremot är tillit en av många viktiga aspekter att ta hänsyn till när det gäller styrning och ledning av offentliga verksamheter. Det här kapitlet är ett försök att ta tillbaka tillit som begrepp och visa hur vi kan förstå tillit som fenomen.

Den inledande delen av kapitlet beskriver vikten av att inte använda etiketten New Public Management (NPM) svepande för att beskriva de problem som tillit ska vara lösningen på, utan i stället se NPM som en institutionaliserad del av offentlig verksamhet som vi behöver förstå för att också bättre förstå förutsättningarna för tillit i offentliga organisationer. Kapitlet går sedan vidare med att beskriva en viktig aspekt av många offentliga organisationer – dess professioner. Tillitsdelegationens texter präglas av en stor tillit till just professionerna, den bilden nyanseras här. Avslutningsvis beskrivs två möjliga vägar framåt. Den ena bygger på en mer relationsorienterad professionalism och den andra bygger på ett utvecklat medarbetarskap. Gemensamt för dem är att de fokuserar på vad som kan skapa goda förutsättningar för tillit i offentliga verksamheter, där tonvikten ligger på samarbetsorienterade relationer snarare än stort handlingsutrymme och självstyre.

Purpose – The purpose of this paper is to investigate the struggles of managerial identity in relation to the process of becoming/being a manager, and the personal conflicts involved within this process.

Design/methodology/approach – In a qualitative, longitudinal project, five managers were studied for two years using interviews and observations. This was undertaken before, during, and after their participation in personal development training. In total, 62 interviews and eight half-day observations were conducted.

Findings – The study puts emphasis on the role of management training in providing templates for “how to be a manager”, but it also illustrates the double-edged and complex role played by context in managerial being and becoming. On the one hand context shapes managerial identity; on the other hand, context might operate to dilute the identity an individual manager wishes to assume.

Research limitations/implications – The study focuses on only five managers in two organizations. This small sample limits the generalisabilty of the research.

Practical implications – Management training tends to be based on the idea that management concerns the acquisition of competencies, techniques and personal awareness, while managerial practice is more fluid and contextually based. There is a challenge for organizers of all types of management training to bridge the gap between a fixed idea of what it is to be a manager and how management is actually practised.

Originality/value  – The longitudinal and in-depth qualitative approach facilitates an important contribution to understanding issues in developing a managerial identity.

Purpose– The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face.

Design/methodology/approach– Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action.

Findings– This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians.

Research limitations/implications– The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership.

Practical implications– Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership.

Originality/value– Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

This paper describes and explains how balancing organizational structures can build traits for organizational resilience. Organizational resilience is a holistic and complex concept. In this paper, we move beyond focusing on sudden and disruptive events in favour of anticipating the unexpected in daily organizing. Organizational resilience is understood here as building traits of risk awareness, preference for cooperation, agility and improvisation and is analysed by means of a longitudinal qualitative case study. The paper contributes to the field by showing how balancing organizational structures can foster organizational resilience traits. We show that power distribution and normative control can create preparedness for unexpected events and foster action orientation at the same time as supporting organizational alignment. 

Purpose: The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work. Design/methodology/approach: The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis. Findings: The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work. Practical implications: For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment. Originality/value: The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work. 

PURPOSE: The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

DESIGN/METHODOLOGY/APPROACH: The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

FINDINGS: The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

RESEARCH LIMITATIONS/IMPLICATIONS: The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

SOCIAL IMPLICATIONS: The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

ORIGINALITY/VALUE: The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

Previously, improvement work in healthcare has mainly been medically related and driven by medical research, but NPM implies that management-initiated improvement work targeting organizing, productivity, efficiency, work flow etc. has become more and more common. Management-initiated improvement work has a high failure rate, and in general it seems difficult to motivate co-workers to actively participate. In all processes of organizational change, trust in the initiator of a change project is an important prerequisite to enable change take place. In this article, our purpose is to investigate how trust in management influences management-initiated improvement work. In a qualitative study we investigate improvement work at three Swedish hospitals. Our theoretical framework is based on a view of management as being both the people who manage and the system of management. This distinction is important since we can trust people and we can have confidence in a system, but these processes are different. Consequently, it is possible to trust individual managers, but as long as we do not trust management as a system, management-initiated improvement work will face considerable problems.  To analyze trust we use a model that identifies three important antecedents for one person (the trustor) to consider another person (the trustee) as trustworthy: ability, benevolence and integrity. Using social system theory, we extend this model to on the one hand describe trust in specific persons (specific managers), and on the other hand describe confidence in a system (management in general, which the system-specific managers are parts of). The results indicate that there in general is a lack of trust between healthcare personnel and healthcare management.

We were able to find certain managers who were found trustworthy by the personnel, but despite these trust-relations the personnel did still not have confidence in management as a system. To the contrary, these managers were perceived as exceptions, and did not change the perception of management in general. The consequences for management-initiated improvement work were that most personnel at best were ignorant to it, and at worst resisted it openly. However, there were examples when trusted enthusiastic managers succeeded in initiating improvement work, but then the continuation and success was directly connected to this person, and if s/he left, the improvement work stopped. Furthermore, some work groups seemed to very clearly separate “real” improvement work, which they initiated themselves, from “phony” improvement work initiated by management, which only stole time from more important tasks.

I denna artikel fokuserar vi på användandet av industriellt baserade produktionssynsätt (IBP) inom vården i avsikt att arbeta systematiskt med förbättringsarbete. Tidigare forskning har visat att det är svårt att få nya arbetsmetoder att få genomslag i den dagliga praktiken. I denna artikel fokuserar vi på om det går att se indirekta effekter såsom hur förbättringsarbetet organiseras beroende på vilka IBP olika sjukhus väljer att arbeta med. Undersökning är genomförd genom fallstudier på tre sjukhus som har valt att arbeta med tre olika metoder: six sigma, processorientering och mikrosystem.

Studien visar att de olika logikerna bakom de olika metoderna ger fundamentalt olika sätt att organisera förbättringsarbetet vid de tre sjukhusen. Six sigma-sjukhuset valde ett centraliserat förbättringsarbete i hög grad drivet av experter på förbättringsmetoder, processsjukhuset

hade en expertavdelning som var mer av bollplank och utbildare för verksamhetens förbättringsarbete och mikrosystem-sjukhuset valde ett decentraliserat förbättringsarbete där förbättringsarbetet var både lokalt initierat och drivet.

This study examines how interactions between individual actors can form institutional work in a highly institutionalized setting. Recent progress within the institutional logics perspective has directed focus to the roles of individual actors, their strategic actions, and how institutional logics may be interpreted and rebalanced. However, these contributions are founded on individual actors’ identity processes, but not on how institutional work can be performed through interactions among individual actors adhering to different institutional logics. We performed a qualitative case study, based on observations and interviews, with a focus on quality-improvement work performed in a hospital. The study affirmed that institutional work primarily maintains and upholds the rigidity of healthcare organizations, by interactions that either preserve the distance between different institutional logics or prevent their mutual influence on each other. However, when institutional work transcends maintaining – towards creating or disrupting – the interaction is characterized both by acts of claiming influence and acts of granting influence between actors adhering to different institutional logics. Nonetheless, these interactions are dependent upon the approaches of the physicians; such interactions start with the physicians either being granted influence or granting influence – influence that can later be claimed by the other actor. As such, although the coexistence of different institutional logics is currently an established phenomenon in healthcare, we illustrate how institutional work is contingent upon the dominating professional logic of physicians.

The present study describes and analyses how social interactions between individual actors form institutionalwork in the highly institutionalized setting of healthcare organizations. Based on a qualitative case study, weaffirm that social interactions mainly form maintaining institutional work, thus primarily upholding the rigidityof healthcare organizations. Social interactions either preserve distance between different actors or prevent theirmutual influence, which decreases the effects of institutional complexity. However, when institutional work goesbeyond maintaining, social interaction is characterized by processes of claiming influence and granting influencebetween individual actors who adhere to different institutional logics, which allows effects of institutionalcomplexity. Such institutional work is contingent upon physicians’ strong power position, and granting influenceis likely to precede claiming influence.

The retail sector in Sweden has an outstanding productivity ratio in comparison to retailsectors in other countries. In this paper we claim that the main reason to this is the HRMpractice on store level in Sweden. International research presents a grim picture of the retailworkplace. Because of fierce price competition personnel are subjected to high demands forflexibility in working hours and suffer from low salaries, poor working conditions and little orno employer provided education and training resulting in a low level of employee workmotivation, responsibility and productivity. Our research constrasts this picture and showsthat the workplace in Swedish retailing is characterized by mutually trusting and cooperativerelationships between managers and co-workers, leading to employee commitment andacceptance of responsibility. We mainly explain our conclusions that differ from those ofinternational retailing research by the principal fact that standards and values from otherSwedish work sectors are also found in the Swedish retail sector.

Vad innebär det att arbeta med ledaruppdrag inom handeln och hur kan man nå framgång som butikschef? Detta är två centrala frågor i boken Uppdrag butikschef – att leda i butik som tar ett helhetsgrepp om följande centrala aspekter på butikschefsarbete: 

• ledarskap och medarbetarskap 

• motivation och kommunikation 

• personalarbete och arbetsrätt 

• kompetensutveckling och etik

Boken är skriven av forskare inom företagsekonomi och socialpsykologi, verksamma vid Högskolan i Skövde, och den bygger delvis på ett aktuellt forskningsprojekt om ledarskap och medarbetarskap inom svensk handel.