Suchergebnisse

Brugerinddragelse i det danske sundhedsvæsen står højt på den politiske dagsorden, men det er stadig en udfordring at implementere visionen i klinisk praksis. Ledelse af brugerinddragelse bliver aktuelt udpeget som en central nøgle til at føre visionen ud i livet. Samtidig er der kun relativt lidt forskning om ledelse af brugerinddragelse i sundhedsvæsenet og på det empiriske plan er det uklart, hvad det er lederne skal implementere. Artiklen identificerer syv forskellige italesatte mål med brugerinddragelse, hvoraf nogle potentielt kan være i konflikt med hinanden. Herudover peges der på, at brugerinddragelse skal implementeres i en verden, hvor der allerede er en række andre mål tilstede. En central ledelsesudfordring er derfor, at nogle af målene med brugerinddragelse forudsætter nye måder at organisere ikke bare arbejdet og kompetencer på, men også relationer til patienter og pårørende. En væsentlig opgave i ledelse af brugerinddragelse vil derfor være at fremme en gentænkning af de etablerede roller og identiteter i sundhedsvæsenet. Artiklen opstiller tre forskellige inddragelsesmodeller, der hver organiserer relationer mellem sundhedsprofessionelle og sundhedsvæsenets brugere på forskellige måder.Artiklen bygger dels på en gennemgang af dansk og international litteratur og policy dokumenter, dels på en empirisk best practice undersøgelse af ledelse af brugerinddragelse, som i perioden 2012-2013 blev gennemført på tre danske hospitalsafdelinger.

AbstractPractice-based studies have demonstrated how institutional logics function as repertoires of cultural resources that actors may use strategically for professional (re-)positioning. This article focuses on the concept of hijacking based on a qualitative study of the implementation of a randomized controlled trial (RCT) in specialized cancer palliation. Using the logics-as-resources perspective as theoretical framing, we describe the negotiations and hijacking of logics that followed the introduction of the RCT and the temporary reversal of home logics between professional subgroups in cancer treatment and care. The analysis shows how hijacking unfolds in a highly institutionalized and complex professional healthcare setting characterized by intra-institutional heterogeneity. We contribute to the literature by highlighting how hijacking is related to power differentials and identity work and may contribute to obscuring underlying conflicts, in this case between science and care logics. The article develops our understanding of hijacking as a theoretical concept and an empirical phenomenon.

Les leaders transformationnels s'emploient à préciser une vision, à la partager avec leurs personnels et à la faire vivre à long terme, en vue d'améliorer la motivation de service public (MSP) des salariés, autrement dit d'accroître leur inclination à œuvrer pour le bien des autres et de la société dans son ensemble. En se fondant sur 48 entretiens approfondis menés avec 16 responsables et 32 membres du personnel d'établissements d'accueil de la petite enfance ainsi que sur des travaux d'observation effectués pendant 16 jours au sein de ces établissements, le présent article examine les liens existant entre leadership transformationnel et MSP. Lorsque les leaders précisent, partagent et font vivre une vision organisationnelle, les salariés sont davantage motivés pour œuvrer pour le bien des autres et de la société et cette motivation tend à être moins paternaliste et quelque peu plus axée sur la société. Il est donc pertinent de se demander si le leadership transformationnel améliore la MSP et de s'interroger sur la façon dont il influe sur les types de MSP. Remarques à l'intention des praticiens Les leaders pratiquent le leadership transformationnel lorsqu'ils s'attachent à élaborer une vision pour l'organisation, à la partager avec les personnels et à faire en sorte qu'elle suscite chez eux un intérêt durable. Il semblerait que le leadership transformationnel renforce la motivation de service public et rende les personnels moins paternalistes et plus enclins à apporter leur contribution à la société.

Professional quality is an important performance criterion in the public sector, but professionals can have very different understandings of what constitutes professional quality. Leadership is often emphasized as a key element in giving direction to employees, thus enabling the promotion of shared understandings of what professional quality is. Although several studies show a positive relationship between transformational leadership and performance, professional quality is seldom investigated, and too little is known about how transformational leadership is linked to shared understandings among employees and leaders. This article applies a qualitative multilevel comparative case design to investigate the transformational leadership–professional quality relationship for child care centers. We find that transformational leadership is positively associated with the degree of shared understanding of professional quality among professionals and that a shared understanding of quality is positively associated with high levels of professional quality. Moreover, transformational leadership seems to be more prevalent in medium-sized spans of control.

Transformational leaders work to clarify a vision, share it with their employees and sustain it in the long run, and this is expected to result in increased employee public service motivation (PSM), that is, orientation towards doing good for others and society. Based on 48 in-depth interviews with 16 childcare leaders and 32 of their employees combined with 16 days of observation in these childcare centers, this article investigates the association between transformational leadership and PSM. When the leaders clarify, share and maintain an organizational vision, their employees are more motivated to do good for society and others, and this motivation tends to be less paternalistic and slightly more society-oriented. This implies that it is relevant to ask not only whether transformational leadership increases PSM, but also how it affects the type of PSM.Points for practitionersTransformational leadership happens when leaders strive to develop a vision for the organization, share the vision with the employees and sustain the employees' attention to the vision. Transformational leadership seems to increase PSM and make employees less paternalistic and more focused on contributing to society.

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.