Suchergebnisse

The rule of extended free choice of hospital, in force since 2002, provides patients with an option to choose a private hospital if the public system is unable to provide a treatment within the guaranteed waiting time of one month. In June 2008 the Government declared in their yearly budget agreement with the Danish Regions a suspension of the extended free choice until 1 July 2009. This was a consequence of a force majeure situation that arose after a two-month strike of medical personnel. Udgivelsesdato: October 2008

"Response rates were compared across a postal and a web-based survey containing the same questions about preferences for future for the design of future nursing homes which were sent to a random sample of 10.000 individuals aged 50-75 years. The 10.000 individuals were randomly allocated to receive a postal questionnaire or a letter with a web link to an online version of the same questionnaire. The web-based survey gave a significantly lower response rate than the postal survey. The web-based version improved the sample representativeness with respect to gender but worsened the representativeness with respect to age. Respondents' characteristics in the web-based survey differed significantly from those of respondents in the postal survey with respect to income, education, civil status and health status. The web-based version improved data quality by significantly lowering the number of item non-response and 'don't know' answers. Respondents found it easier to answer the web-based survey. The cost per response was significantly higher for the web-based survey because of the significantly lower response rate compared to the postal survey." (author's abstract)

Healthcare organizations are challenged by complexity in structure and knowledge, and heterogeneity in deliveries and patient demands. Reductionist managerial approaches fall short in resolving the quality issues of healthcare, but Scientific Management and New Public Management (NPM) nevertheless has a strong hold on leadership thinking in hospitals. Increasing demand for adaptive and collaborative capacity emphazises the need to rethink the way we organize and lead these organisations. We conducted semi-structured interviews, examining the organizational and leadership thinking of 14 key decision makers, hospital directors and ward leaders, holding a key role in planning and implementing new organisational structures in the Region of Southern Denmark. Informants stress the organizational complexity, and the need for better coordination and collaboration across boundaries. In contrast, they present leadership discourses that are grounded on hierarchical positions and individual agency. Hospitals are complex organisations characterised by extensive bureaucracy, struggling with quality issues, attributable to rigid organisational boundaries and the dominant SM and NPM thinking. We show that an organisational change meant to address this problem is not accompanied by a similar change in leadership constructs, and we offer ideas of complexity leadership, enhancing relational coordination, adaptability and flexibility.

Abstract
There is a growing interest in understanding when and why interprofessional collaborations are well functioning, especially within healthcare systems. However, more knowledge is needed about how professionals affect and contribute to these collaborations when they engage in them. To address this shortcoming, this study aims to contribute to professional and organizational studies of interprofessional collaboration by providing novel insights into how professionals engage in and contribute to interprofessional collaborations. It builds on a theoretical perspective of examining professionals' everyday collaboration practices through the interplay between temporal-oriented agency and institutional work. It applies this perspective to a case study of interprofessional collaboration between personal workers (PWs), nurses, and therapists in the home care sector in Denmark. Overall, the findings show that the professionals engaged in and contributed to the interprofessional collaboration by 'trying to patch a broken system'. All three professional groups did this primarily by 'adopting new practices to deal with inept institutionalized practices' to maintain collaboration. Additionally, some PWs 'failed to enact institutionalized practices' to disrupt the collaboration, and some nurses and therapists 'invented and established mechanisms' to create new arrangements for the collaboration. Based on the findings, the study demonstrates that certain dimensions of agency are associated with certain types of institutional work. Furthermore, the study suggests that the interplay between agency and institutional work varies between professional groups, influenced by their relative autonomy.

The delivery of coherent public services often depends on collaboration across organizations and organizational units, which is challenging and necessitates effective leadership. This article advances our knowledge about the value of leadership training for interorganizational collaboration. In a field experiment, 122 public healthcare managers from 68 organizational units were randomly assigned to a treatment or a control group. The treatment included a 10-month interorganizational team-based leadership training program, which focuses on establishing and sustaining shared direction, alignment, and commitment across organizational boundaries. The results from our analytic approach—including survey responses from the participating managers and more than 3,000 of their subordinates (frontline managers and employees) and 32 interviews before and after training—show that training has positive effects on relational coordination, structural coordination mechanisms, and overall collaborative quality as assessed by the participating managers and their frontline managers. We do not find significant effects among the frontline employees. We discuss our findings in relation to the literature on leadership training, nuances to existing theory, and implications for practice.