Suchergebnisse

Avhandlingen undersøker team ledelse i psykiatriske sykehusavdelinger. Avdelingsledelse i norske sykehus har vært et omstridt tema de siste tiårene. Det tidligere regionssykehuset i Tromsø (RiTø nå UNN) introduserte teamledelse på avdelingsnivå i 1988, noe som representerte et brudd med hvordan avdelingsledelse hadde blitt praktisert i sykehus frem til da. Selv om praktikere og offentlige utredninger melder at denne ledelsesformen har vært suksessfull i praksis, hadde det ikke vært gjennomført studier av denne ledelsesmodellen og hvordan den påvirket resultater i forhold til andre måter å organisere ledelse på i sykehus. På bakgrunn av dette lød forskningsspørsmålet i studien: spiller teamledelse noen rolle i forhold til lederes og ansattes jobbtilfredshet og forpliktelse til organisasjonen sammenlignet med hvordan hierarkisk ledelse påvirker disse dimensjonene? Og videre, hvis teamledelse påvirker ledere og ansattes jobbtilfredshet og forpliktelse til organisasjonen, hvordan påvirker teamledelse lederes og ansattes jobbtilfredshet og forpliktlese til organisasjonen? Teamledelse er studert ved hjelp av modernistisk og konstruktivistisk tilnærming, representert ved instrumentelle og institusjonelle teorier. Ved hjelp av instrumentell teori fanges det opp hvordan teamledelse materialiserer seg i den formelle organisasjonsstrukturen og tar form som et instrument. Mens den institusjonelle tilnærmingen fanger inn hvordan teamledelse også manifesterer seg i uformelle strukturer og får meningsdannende og symbolsk betydning i organisasjonen. Kvalitative og kvantitative data er samlet inn for å besvare forskningsspørsmålet for å gjennomføre en "most similar" case sammenligning. Analyser av disse dataene viser at teamledelse spiller en rolle i forhold til både lederes og ansattes jobbtilfredshet. Men det skal bemerkes at lederes tilfredshet er sterkere påvirket enn ansattes tilfredshet, noe som viser at teamledelse har både instrumentell og symbolsk påvirkningskraft. Lederes og ansattes forpliktelse til organisasjonen blir ikke påvirket av hvorvidt avdelingsledelse er organisert i team. ; This dissertation examines team management in mental hospital departments. Management has for decades been a disputed subject in Norwegian hospital departments. The former Regional hospital of Tromsø (now UNN) introduced team management at department level at the hospital in 1988, which represented a fundamental break with how management had been carried out in hospitals until then. Although practitioners in UNN and governmental reports reported that this management model was successful in practice, there had not been conducted studies of the team management model and how it affected outcomes in contrast to other ways of conducting management in hospitals. On this basis I worked out the research questions: does team management make a difference on subjective outcome dimensions of managers and employees compared to how hierarchical management impacts these subjective outcome dimensions? Furthermore, if team management affects subjective outcome dimensions, the next research question regards: how does team management affect subjective outcome dimensions of managers and employees? Team management is approached by modernism and instrumental theory in which formal structure is regarded as a means to affect behavior. Team management is according to these analytical lenses viewed as an instrument to achieve organizational goals more efficiently. Contrarily, constructivism and institutional theory regards team management as a socially constructed phenomenon which is infused with meaning and values dependent on how organizational members interpret the idea of team management. According to this view, analytical priority is given to informal and symbolic structures when understanding how individuals' attitudes and behaviors are shaped. Qualitative and quantitative data are collected by interviews and questionnaire, and the study is designed due to a "most similar case design". Analyses of these data imply that team management makes a difference on both managers' and employees' job satisfactions. Still managers' satisfaction is more strongly affected than employees' satisfaction, which I argue illustrates that team management has both instrumental and symbolic impacts. The organizational commitment of managers and employees is not affected by team management

Objective To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods Data collected by ICCONIC partners. Principal findings Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.