Organisational culture and change: implementing person-centred care

Leadership style, change management and job performance of health information management practitioners in tertiary hospitals in South-East, Nigeria

PURPOSE

Managing patients' health information is one of the building blocks of the health system and the adoption of health information technologies like electronic health records (EHRs) is expected to reduce the various challenges in keeping and accessing quality health-care data that aid decision-making among medical practitioners. This study aims to investigate how leadership styles and change management affected the job performance of health information management practitioners on their adoption of EHRs in tertiary hospitals in Nigeria.

DESIGN/METHODOLOGY/APPROACH

The study used primary data collected using a Likert scale questionnaire from 117 health information management officers and health information technicians in selected tertiary hospitals in South-Eastern Nigeria. The data were analysed using bivariate correlation and multiple regression techniques of inferential statistics.

FINDINGS

The analyses revealed that transformational leadership style, transactional leadership style and change management had significant positive influence on the job performance of health information management practitioners. However, laissez-faire leadership style did not show any significant positive influence. A further analysis showed that the combined effects of leadership styles and change management were also affirmed to significantly influence the adoption of EHRs for quality health-care delivery in Nigerian tertiary hospitals.

ORIGINALITY/VALUE

The study contributes to health information management and the need to understand how leadership styles and change management can influence the adoption of EHRs. However, there is no adequate research that examined the role of leadership style and change management in influencing the job performance of Nigerian HIM practitioners regarding their usage of EHRs in tertiary hospitals in Nigeria.

Surgical patients' assessment of healthcare encounters after elective surgery: A descriptive study

INTRODUCTION

A Norwegian-Danish research team identified a gap in research regarding how surgical patients felt about their post-operative care needs being met in hospitals. A study was subsequently developed to understand their subjective assessments of how they value the perceived fulfilment of their actual care needs. The study was further informed by international calls to focus on the fundamentals of care practice. Our aim was to determine the extent to which surgical patients receiving elective treatment experience the physical environment, atmosphere and collaboration with staff as supportive of their care and treatment, and what this means for them after treatment. In addition, we aimed to document the extent to which patients experienced being understood and having influence in their care.

METHODS

A descriptive observation study using a cross-sectional design. The validated Perioperative User Participation Perspectives (POUP) questionnaire was completed on the day of discharge by 194 adult (male and female) patients (mean age: 56 years) who had undergone elective surgery on gynaecological, internal medicine or orthopaedic wards. Agreement between the subjective importance of nursing care for patients and the perceived reality was determined.

RESULTS

Agreement regarding the physical environment, a clean bed and clean surroundings was between 91.7 and 96.2%, and agreement with regard to a good relational atmosphere with staff it was 94.2 to 96.7%. In terms of the relational aspects of care, being understood and having influence the agreement was calculated to be 89.4 to 94.4%. However, 42.6% of the patients reported they were involved in drawing up a care plan. For those patients who valued collaborating in their care planning the congruency was 80%.

CONCLUSION

A conducive atmosphere and a keen eye for the patients' wishes and needs is of particular importance at the time of discharge after elective surgery.

Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study

BACKGROUND

Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.

METHODS

This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach.

RESULTS

Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: 'structure', 'culture', 'education', 'emotional', and 'physical and technology'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients.

CONCLUSIONS

Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, 'politics'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations' structure, culture and practices.

Rethinking organizational culture in intersectoral coordination: the perspective of boundary work

PURPOSE

The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination.

DESIGN/METHODOLOGY/APPROACH

We used observations and qualitative interviews to develop "deep" knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of "boundary work" and "boundary objects" to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM).

FINDINGS

The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a "boundary object", being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of "lifelong health promotion" helped to transgress existing organizational and professional boundaries.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic.

PRACTICAL IMPLICATIONS

For practice this can build bridges between organizational and professional boundaries.

ORIGINALITY/VALUE

The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.

Organizational Culture as a Determinant of Outcome in Teams: Implications for the Pediatric Cardiac Specialist

Although enormous effort has focussed on how to build an effective culture in the business community, relatively little effort has addressed how to achieve this in the hospital environment, specifically related to the field of congenital heart disease teams. The examination of culture in pediatric cardiac care is particularly important for several key reasons: first, it represents high-stakes medicine, second, there are multiple stakeholders requiring collaboration between cardiologists, surgeons, anaesthesiologists, perfusionists, nursing staff, and allied health care professionals, and finally, both the patient and the family are intimately involved in the care pathway. This review article investigates some of the critical components to building an effective culture, drawing upon similarities in other disciplines, thereby fostering high performance multidisciplinary teams in congenital cardiology care. Strategies to change culture such as Kotter's model of change are also discussed. High performance teams share one common vital characteristic: psychological safety for team members to speak their minds, thereby fostering an open culture, in which creativity can flourish to facilitate major breakthroughs. Adoption of the "Flight Plan" review promotes patient centric care and champions a psychologically safe culture.

Person-centered climate from the perspective of hemodialysis patients and nurses working in hemodialysis units

Background

Person-centered care (PCC) is considered an important component of high-quality care in hemodialysis units. Hemodialysis patients and nurses may have different perceptions of person-centeredness in hemodialysis units. The present study aimed to assess the PCC from the perspective of hemodialysis patients and nurses working in the hemodialysis unit.

Methods

This cross-sectional study was performed on 200 patients and 71 nurses working in two hemodialysis units. Data were collected using a demographic questionnaire, person-centered climate questionnaire-patient version (PCQ-P), and person-centered climate questionnaire-staff version (PCQ-S). Data were analyzed by SPSS software (ver. 24) using ANOVA and independent t-tests.

Results

The mean score of person-centered climate from the patients' view was 81.49 ± 7.14 (Possible score: 17–102). Independent t-test showed that the mean total score of PCQ-P in patients undergoing hemodialysis in the Imam Reza Hospital (82.26 ± 7.09) was more than those undergoing hemodialysis in the Sina Hospital (78.60 ± 6.61) (P < 0.05). The mean score of the safety subscale showed a statistically significant difference between the two hemodialysis centers (P < 0.05). The mean total score of PCQ-S from the nurses' view was 66.86 ± 8.07 out of 84. The mean score of the everydayness subscale showed a statistically significant difference between nurses working in two hemodialysis units (P < 0.05).

Conclusion

Although the results showed an acceptable score in the person-centered climate questioner, it needs some improvements in the fields of safety and everydayness. The environment of the hemodialysis unit could limit or enhance the implementation of person-centered processes.

Change Resistance and Clinical Practice Strategies in Audiology

BACKGROUND

Audiology is experiencing pressure from market forces that may change the profession's nature. Research suggests that understanding resistance needs to change and organizational culture may provide insights that can facilitate change.

PURPOSE

This study was designed to examine audiologists' resistance to change, organizational culture, and clinical practices related to hearing aid pricing and audiology assistants.

RESEARCH DESIGN

This study utilized a cross-sectional and nonexperimental survey design.

STUDY SAMPLE

Participants were 205 U.S. audiologists, representing diversity across experience, work setting, and location.

DATA COLLECTION

This survey examined demographics and clinical practice strategies. Resistance to change (RTC) scale examined disposition toward change. Organizational culture profile (OCP) examined organizational culture perspectives.

RESULTS

The majority (52%) of respondents use bundled pricing but 42% of these repondents anticipate transitioning to unbundling. Use of hybrid pricing is increasing. Service-extender personnel were reported by 41%. Although the majority (66%) do not work with audiology assistants currently, 32% of these participants anticipate they will do so in the future. Results indicated lower RTC and greater years of experience were associated with more positive perceptions about organizational culture. Pricing structure was related to experience.

CONCLUSION

Trends indicate use of bundled pricing is decreasing, use of hybrid pricing is increasing, and employment of audiology assistants is increasing. Experienced audiologists are more likely to report unbundled and hybrid pricing compared with less experienced audiologists.

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

Historically, dualistic healthcare systems have resulted in limited mental healthcare provision within physical health settings, with service users reporting poor care specifically while attending emergency departments (EDs) in a mental health crisis. Modern approaches to healthcare recognize these inequalities and are moving towards integrating healthcare systems that allow more holistic and seamless experiences for service users. This mixed-method review examines the experiences and perceptions of service users attending EDs for a mental health crisis. Systematic searches of eight databases on two platforms (EBSCO, OVID) and grey literature databases (Open Grey, Base) were conducted. Studies were systematically screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. Ten studies consisting of qualitative and mixed-method designs were included in the review. Five overarching themes emerged from the synthesis: social constructs, service provider, service provision, effectiveness, and emotional impact. The findings from this review show that service users continue to have negative experiences in EDs due to stigmatizing attitudes and low skill in managing mental health needs, whereas more positive experiences are attributed to the availability of mental health liaison services. Tackling stigma, improving communication and staff training, providing calm environments, and addressing structural issues that promote better interagency working and reduce gaps in services are needed to improve mental health service user experience. Future research should focus on trauma-informed approaches in EDs to improve person-centred care for service users experiencing a mental health crisis.

Involvement and skepticism towards the JCI Accreditation process among hospital's four sectors employees: suggestions for cultural change

BACKGROUND

Implementing the JCI Accreditation process as an organizational culture may face resistance. However, the skepticism and involvement of different hospital sectors (medical, nursing, paramedical, and administrative/logistic) in the process may vary. Conducting organizational change needs tools to decrease resistance.

OBJECTIVES

To investigate the attitudes, cultural norms, and satisfaction of the different sectors regarding the accreditation process, and to suggest ways to integrate the process as part of the organizational culture.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 462 respondents (187 nurses, 95 physicians, 92 administrative, 88 paramedical) at Rambam Health Care Campus, a tertiary hospital in Israel. The hospital employees' attitudes, cultural norms, and satisfaction were assessed. ANOVA tests were used to examine the differences among the different sectors. The association between the satisfaction from the process and the preferred type of training was examined using Pearson's correlation coefficient.

RESULTS

Significant differences were found among the sectors in the scores related to attitude, cultural norms, and satisfaction from the accreditation process (F (3, 456) = 17.95, p < 0.001, η2 = 0.10). Gabriel post-hoc test revealed significantly lower scores between the medical and paramedical sectors. A positive correlation was found between the degree of satisfaction with the process and the satisfaction with the training type. Frontal education and video demonstrations were rated significantly higher among all 10 training types.

CONCLUSIONS

More efforts should be made to increase involvement among physicians and paramedical teams in the accreditation process. Each sector leadership involvement is essential for their involvement too. Early involvement of the Israeli Medical Association in the process might have achieved better physicians' collaboration. Frontal education and video demonstrations may help decrease skepticism and increase positive attitudes.

The Lived Experience of the Audiologist: Connections Between Past, Present, and Future

PURPOSE

The purpose of the study was to use qualitative research methods to explore connections between audiologists' lived experiences and perceptions of the future and change.

METHOD

This research was based on a constructivist grounded theory approach. A semistructured interview guide inspired 30 audiologists to share their stories via virtual interview. A theoretical framework evolved from grounded theory analysis techniques.

RESULTS

The majority of audiologists interviewed in this study entered audiology via the undergraduate-stumble pathway, usually after leaving speech-language pathology. This pathway was associated with poorer perceptions of the future compared with early-purposeful and later-purposeful pathways. Generation differences, value juxtaposition, professional identity, and student debt also influenced perspectives of the future. Participants described high value-of-self relative to patient care and joy stories associated with meaningful relationships with patients. Most participants reported responding actively to changes in the marketplace at the individual work setting level; however, change response was complex and difficult to quantify when broader issues impacting the profession were considered. Participants expressed concern about the future, including the need to address high student debt, perceived lack of unity across the profession, and value-by-others.

CONCLUSION

Grounded theory exploration of the lived experience of 30 audiologists supported a theoretical framework that connects perceptions of the future with origin story, generation perspectives, value juxtaposition, professional identity, and student debt.

Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors: findings from SWENIS, a cross-sectional study in Sweden

BACKGROUND

The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors.

METHODS

Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries' cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted.

RESULTS

Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units' staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers.

CONCLUSIONS

This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents' personal preferences and capacity are also important when striving towards person-centredness.

Becoming part of an upwards spiral: Meanings of being person-centred in nursing homes

INTRODUCTION

Previous research suggests that person-centred care is positive for people living in nursing homes, but less is known on what motivates people working in nursing homes to be person-centred. Previous research has focused on person-centred care in relation to people in need of care, which may lead to a risk of viewing person-centred care as a means to achieve quality of care, and not as a means in itself. Therefore, this study aimed to illuminate meanings of being person-centred as narrated by people working in nursing homes.

METHODS

A total of 23 persons working in a nursing home in rural Australia participated in group and individual interviews, conducted and interpreted in respect to a phenomenological hermeneutic approach.

RESULTS

The thematic structure as emerging from structural analyses of the text indicated that being person-centred involved a joint effort to think differently on what you do and why you do it interpreted as; Doing what you know and feel is the right thing to do, Being a person with and for another person, and Striving to do and be better together. The comprehensive understanding of these findings was that being person-centred means becoming part of an upwards spiral of doing person-centred actions and being person-centred to become even more person-centred and to feel a sense of belonging to a person-centred culture.

CONCLUSIONS

Denoting the importance of being more of a person in one's professional role, this study highlights health aspects of being person-centred from the perspective of people working in nursing homes, and complements previous research that describes the impact of person-centred care on people in need of care. The findings could be applied to facilitate person-centred care in nursing home contexts, and to develop prevention strategies to diminish negative impacts on person-centred doing, being, becoming and belonging.

Organizing work in local service implementation: an ethnographic study of nurses' contributions and competencies in implementing a municipal acute ward

BACKGROUND

The increased prevalence of chronic diseases and an ageing population challenge healthcare delivery, particularly hospital-based care. To address this issue, health policy aims to decentralize healthcare by transferring responsibility and introducing new services in primary healthcare. In-depth knowledge of associated implementation processes is crucial for health care managers, policymakers, and the health care personnel involved. In this article, we apply an ethnographic approach in a study of nurses' contributions to the implementation of a new inpatient service in an outpatient primary care emergency clinic and explore the competencies involved. The approach allowed us to explore the unexpressed yet significant effort, knowledge and competence of nurses that shaped the new service.

METHODS

The study combines observations (250 h) and several in situ interviews with healthcare personnel and individual in-depth interviews with nurses (n = 8) at the emergency clinic. In our analysis, we draw on a sociological perspective on healthcare work and organization that considers nursing a practice within the boundaries of clinical patient work, organizational structures, and managerial and professional requirements.

RESULTS

We describe the following three aspects of nurses' contributions to the implementation of the new service: (1) anticipating worst-case scenarios and taking responsibility for preventing them, (2) contributing coherence in patient care by ensuring that new and established procedures are interconnected, and (3) engaging in "invisible work". The nurses draw on their own experiences from their work as emergency nurses and knowledge of the local and regional contexts. They utilize their knowledge, competence, and organizing skills to influence the implementation process and ensure high-quality healthcare delivery in the extended service.

CONCLUSIONS

Our study illustrates that nurses' contributions are vital to coordinating and adjusting extended services. Organizing work, in addition to clinical work, is a crucial aspect of nursing work. It 'glues' the complex and varied components of the individual patient's services into coherent and holistic care trajectories. It is this organizing competence that nurses utilize when coordinating and adjusting extended services. We believe that nurses' organizing work is generally invaluable in implementing new services, although it has not been well emphasized in practice and research.

Associations between person-centred care and job strain, stress of conscience, and intent to leave among hospital personnel

AIM

To determine the associations between person-centred care (PCC) and job strain, stress of conscience and intent to leave among healthcare professionals in Swedish hospital departments.

BACKGROUND

Hospitals have experienced difficulty in retaining qualified healthcare personnel. Previous studies have shown that working in a person-centred environment could offset this challenge, but research is scarce.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Healthcare professionals (n = 94) in six hospital departments in Sweden completed a survey measuring perceived PCC, job strain, stress of conscience and intent to leave. Data were collected from April 2019 to April 2020. Bivariate analysis was used to describe the sample and correlations between the explanatory variables and perceived PCC and its subscales. Regression analyses were performed to explore the associations between perceived PCC and job strain, stress of conscience and intent to leave.

RESULTS

The organisational and environmental support subscale of perceived PCC showed significant correlations with all explanatory variables, while the extent of personalising care subscale only correlated with job strain and intent to leave. The regression analyses showed that higher perceived PCC was associated with higher job strain, less stress of conscience and less intent to leave.

CONCLUSION

Higher perceived PCC is associated with work-related factors in hospital departments. There is scope for further research in this area.

Organisational development to support integrated care in East London: the perspective of clinicians and social workers on the ground

PURPOSE

Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care.

DESIGN/METHODOLOGY/APPROACH

The findings presented here are based on a qualitative and participatory evaluation. The authors looked at how health and social care professionals communicated and coordinated delivery of care and evaluated the impact of current OD activities on the ground to evidence whether and to which degree they are enabling frontline staff to change their working routines towards greater coordination.

FINDINGS

Our findings highlight the limited reach and scope of a top-down approach to OD based on ad hoc coaching and staff engagement events, often delivered by external consultancies, and mostly focused at the senior management level. This approach fell short of enabling the creation of sustainable, integrated and collaborative organisations. Instead, some of the professionals that participated in our study tried to develop spaces that facilitated ongoing dialogue and mutual support among professionals on the ground.

PRACTICAL IMPLICATIONS

Initiatives of bottom-up OD such as those described in this paper have greater potential to change working routines as they enable staff to move towards more collaborative and coordinated work.

ORIGINALITY/VALUE

These findings contribute to the literature on OD in public services and highlight the benefits of a context-sensitive, pragmatic, and long-term approach to OD to help create sustainable collaborative organisations.

Person-Centered Health Promotion: Learning from 10 Years of Practice within Long Term Conditions

The utilization of person-centered care is highlighted as essential for health promotion, yet implementation has been inconsistent and multiple issues remain. There is a dearth of applied research exploring the facets of successful implementation. In this paper, a person-centered wellbeing program spanning various groups is discussed, outlining the central principles that have allowed for successful outcomes. Ten years of pragmatic pre–post service evaluation have shown consistent improvement in measures of functional capacity and wellbeing. The method for this paper is a reflective exploration of the theory and practices that can explain the continual improvement the clinics have achieved over 10 years. Core principles relate to connecting with people, connecting through groups, and connecting with self. The operationalization and theoretical explanation of these principles is outlined. The discussion of these principles posits essential factors to prioritize to advance the implementation of person-centered care in health promotion for long-term conditions.

"Care is not care if it isn't person-centred": A content analysis of how Person-Centred Care is expressed on Twitter

Background

Person‐Centred Care (PCC) has been the subject of growing interest in recent decades. Even though there is no conceptual consensus regarding PCC, many health‐care institutions have implemented elements into their care.

Objective

This study aimed to investigate the PCC topics presented by different stakeholder groups on Twitter and to explore the perceptions of PCC within the content of the tweets.

Method

Tweets with mentions of PCC in various translations were collected through a Twitter Application Programming Interface in October 2019. The tweets were analysed using quantitative and qualitative content analysis.

Results

Five stakeholder groups and ten topics were identified within 1540 tweets. The results showed that the PCC content focused on providing information and opinions rather than expressing experiences of PCC in practice. Qualitative content analysis of 428 selected tweets revealed content on a vision that all care should be person‐centred but that the realization of that vision was more complicated.

Conclusions

Twitter has shown to be a quick and non‐intrusive data collection tool for uncovering stakeholders' expressions concerning PCC. The PCC content revealed that stakeholders feel a need to 'educate' others about their perception of PCC when experiences and real‐life applications are missing. More action should be taken for the implementation of PCC rather than circulating PCC vision without operationalization in care.

Public Contribution

The public provided the data through their posts on Twitter, and it is their perception of PCC that is studied here.

Goal-Oriented Care: A Catalyst for Person-Centred System Integration

Introduction

Person-centred integrated care is often at odds with how current health care systems are structured, resulting in slower than expected uptake of the model worldwide. Adopting goal-oriented care, an approach which uses patient priorities, or goals, to drive what kinds of care are appropriate and how care is delivered, may offer a way to improve implementation.

Description

This case report presents three international cases of community-based primary health care models in Ottawa (Canada), Vermont (USA) and Flanders (Belgium) that adopted goal-oriented care to stimulate clinical, professional, organizational and system integration. The Rainbow Model of Integrated Care is used to demonstrate how goal-oriented care drove integration at all levels.

Discussion

The three cases demonstrate how goal-oriented care has the potential to catalyse integrated care. Exploration of these cases suggests that goal-oriented care can serve to activate formative and normative integration mechanisms; supporting processes that enable integrated care, while providing a framework for a shared philosophy of care.

Lessons learned

By establishing a common vision and philosophy to drive shared processes, goal-oriented care can be a powerful tool to enable integrated care delivery. Offering plenty of opportunities for training in goal-oriented care within and across teams is essential to support this shift.

Impact of financial management centralisation in a health system under austerity: a qualitative study from South Africa

INTRODUCTION

International calls for universal health coverage (UHC) have led many countries to implement health sector reforms, however, since the 2008 global recession, economic growth has slowed in many lower-income and middle-income countries. In a renewed interest in public financial management (PFM), international organisations have emphasised the importance of giving spending control to those responsible for healthcare. However, centralisation is a common response when there is a need to cut expenditure due to a reduced budget; yet failure to decentralise often hampers the achievement of important goals. This paper examines the effect of centralising financial decision-making on the functioning of the South African health system.

METHODS

We used a case study design with an ethnographic approach. Primary data collection was conducted through participant-observation and semistructured interviews, over 1 year. Member checking was conducted.

RESULTS

New management implemented centralisation due to a reduced budget, a history of financial mismanagement, the punitive regulatory environment financial managers face, and their fear of poor audit outcomes. The reform, together with an authoritarian management style to ensure compliance, created a large power distance between financial and clinical managers. District managers felt that there was poor communication about the reform and that decision-making was opaque. This lowered commitment to the reform, even for those who thought it was necessary. It also reduced communal action, creating an individualistic environment. The authoritarian management style, and the impact of centralisation on service delivery, negatively affected planning and decision making, impairing organisational functioning.

CONCLUSION

As public health systems become even more financially constrained, recognising how PFM reforms can influence organisational culture, and how the negative effects can be mitigated, is of international importance. We highlight the importance of a participatory culture that encourages shared decision making and coproduction, particularly as countries grapple with how to achieve UHC with limited funds.

Health and social care professionals' experiences of collaborative planning-Applying the person-centred practice framework

Aim

To explore how person‐centred practice framework can be applied to professionals participating in collaborative planning.

Design

An explorative, deductive approach.

Method

Eleven professionals from health care and social care participated in the study. A deductive content analysis was performed using a framework for person‐centred practice for the analysis.

Results

Practicing person‐centred care and collaborative planning is a complex process that needs to take into account system factors on both the macro‐ and the microlevel. Everyone working within the system needs to apply the same approach. Using a framework analysis offered new insights into how person‐centred care is expressed in practice during collaborative planning between the patient, and healthcare and social care professionals.

Dementia care in acute hospitals-A qualitative study on nurse managers' perceived challenges and solutions

AIM

The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges.

BACKGROUND

Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi-level factors need to be considered to promote changes in practice.

METHOD

Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorize the perceived challenges and solutions.

RESULTS

The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles.

CONCLUSION

This study highlight the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care.

The Influence of Evidence-Based Design on Staff Perceptions of a Supportive Environment for Person-Centered Care in Forensic Psychiatry

This prospective longitudinal study aimed to examine the relocation of three forensic psychiatric hospitals in Sweden into new facilities. The research focused on the effects of the physical and psychosocial environment and other staff-related parameters on the delivery of person-centered care after relocation. In forensic psychiatry, most relocations to new environments are to support a person-centered approach and to promote patients' rehabilitation and reintegration into society. Hopefully, this is undertaken in accordance with an evidence-based design strategy allowing improvement in staff satisfaction and working conditions as well as their capacity to provide individualized care. All staff members working on the wards of the facilities in question were invited to participate in the study. Data were collected prospectively between 2010 and 2014, before and after relocation of the forensic psychiatric clinics to new buildings. Structured validated questionnaires were employed. Staff members' job satisfaction and perceptions of a person-centered physical and psychosocial environment increased after relocation and provide evidence that staff perceptions of ward atmosphere in forensic psychiatric clinics are susceptible to factors in the physical and psychosocial environment. The importance of always taking the environmental factors into consideration, to achieve greater staff well-being and capacity to accomplish goals in forensic psychiatry, is emphasized.

Active Care In Practice: Long-Term Experiences From An Education Programme

Purpose

To explore whether the Active Care education programme has influenced the participants in practice over time and if so how.

Method and material

A hermeneutic explorative approach. Semi-structured focus group interviews and individual interviews with participants from the education programme from 2014 to 2015. Participants came from different areas in care and had different professional backgrounds. Systematic text condensation analysis based on Malterud.

Results

The Active Care programme has given the participants new knowledge that motivated, inspired and gave them power to change their practice. The new knowledge seems to give resonance in their basic values and strengthens their understanding of the importance of the users’ basic needs and right to be empowered.

Conclusion

Active teaching methods that appeal to participants help to understand and expand carers’ repertoire and increases professionalism across professions and positions. Structural factors need to be addressed to meet the goal of integrated person-centered services.

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Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers

AIMS AND OBJECTIVES

To explore how managers describe leading towards person-centred care in Swedish nursing homes.

BACKGROUND

Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking.

DESIGN

Descriptive interview study. COREQ guidelines have been applied.

METHODS

The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis.

RESULTS

Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures.

CONCLUSIONS

The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.

An Exploratory Study of Person-Centered Care in a Large Urban Hemodialysis Program in Canada Using a Qualitative Case-Study Methodology

Background:

Person-centered care (PCC) can benefit patients, clinical staff, and health care organizations, but has not yet been widely adopted into practice. Hemodialysis is a unique care environment in which clinical staff can be involved with patients for protracted periods of time each week and often over a number of years. While kidney care is arguably more holistic than other chronic condition management programs, most patients requiring hemodialysis do not receive care that is optimally person-centered.

Objective:

The purpose of this research was to explore how care is experienced and provided in a large urban hemodialysis program in western Canada in relation to key principles of PCC. In addition, we wanted to understand what factors at an individual, unit, and organizational level facilitate or inhibit PCC in this environment.

Methods:

We used a qualitative case-study approach to explore multiple perspectives of care provision using a number of data sources including semi-structured interviews with patients, family members, clinical staff, and administrative staff, as well as observing patterns of clinical practice in local hemodialysis units.

Findings:

In our study of a single hemodialysis program, we found limited evidence of PCC. Overall, patients reported that their care was good and they had positive relationships with their care team. However, they did not feel involved in decisions regarding their care or consider it to be individualized. In general, providers acknowledged the potential benefits of PCC but were constrained in their practice by a number of factors, including individual perceptions of their role, a prescriptive care environment, and an organizational focus on managing demand.

Conclusions:

Evidence of PCC within hemodialysis services was limited, with a number of individual, unit level, and organizational barriers mitigating against its adoption and spread.

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden

While person-centred care has gained increasing prominence in recent decades as a goal for healthcare systems, mainstream implementation remains tentative and there is a lack of knowledge about how to develop person-centred care in practice. This study therefore aimed to explore what may be required in order for person-centred care programmes to be successful. The study used an ethnographic method of data collection. This consisted of closely following an implementation programme on a medical emergency ward in a Swedish hospital. Data consisted of participant observation and informal interviews with healthcare providers and their management leaders while they were in the process of training to use person-centred care. These interlocutors were using action learning methods under the guidance of facilitators. Our findings revealed that although the programme resulted in some of the processes that are central for person-centred care being developed, organisational factors and a lack of attention to ethics in the programme counteracted these positive effects. The study highlights the importance of facilitating mechanisms to produce desired results. These include management leaders' learning about the dynamic and collective nature of learning processes and change. They also include allowing for inter-professional dialogue to enable managers and professionals to reflect deeply on professional boundaries, disciplinary knowledge and power relations in their teams. Teamwork is essential for the development of person-centred care and documentation, in accordance with this specific implementation programme, is also indispensable. The space for inter-professional dialogue should also accommodate their various perspectives on the aims of care and organizational reality.

Leadership for Innovation in Healthcare: An Exploration

Although leadership has been studied extensively, most research has focused on the political and military spheres. More recent work has also examined the role of leadership in sectors such as manufacturing and technology, both areas where it is essential to encourage and nurture innovation. Yet, in the health sector, where innovation is now high on the policy agenda in many countries, there is a paucity of research on how leadership can foster a culture of innovation. In this perspective, written for those seeking to foster innovation in the health sector, we offer a narrative synthesis approach of eight theories and concepts that have been empirically shown to support innovation through all phases of the innovation process.

Influence of Social Exchange Relationships on Affective Commitment and Innovative Behavior: Role of Perceived Organizational Support

The current study objective is to investigate how and when leader member exchange (LMX), tie strength, and innovative organizational culture influences employee innovative behavior. In particular, this study uses the social exchange theory to analyze that nurses who demonstrate high affective commitment exhibit a higher level of creativity in the workplace. Based on social exchange theory and perceived organizational support (POS) literature, the current study aims to reveal how perceived organizational support (POS) serves as an imperative mediating process between LMX, tie strength, innovative organizational culture, and employee IB. A questionnaire survey was utilized to collect the data from nurses working in public sector hospitals in Jiangsu province China. A total sample size consists of 325 nurses. Structural equation modeling through AMOS 20 was utilized to analyze the survey data. Results from the structural equation modeling (SEM) analysis indicated that LMX, tie strength, and POS are significantly related to affective commitment and employees’ IB. However, innovative organizational culture has a significant influence on POS and IB, but has no impact on affective commitment. This study covers only public sector hospitals and is limited to Jiangsu province, China. The research could be reproduced in other designated areas in different organizational setups with a bigger sample size to further enhance the understanding of the topic. The key understanding of social exchange theory (SET) is that social relationships can be used appropriately to foster an employee’s IB. It also expands research in the area of LMX, tie strength, innovative organizational culture, and POS as antecedents of affective commitment and IB. This study is a remarkable analysis of LMX, POS, organization culture, commitment, and IB in the Chinese organizational context.

Co-Producing Interprofessional Round Work: Designing Spaces for Patient Partnership

Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients' active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on “clinical microsystems,” where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine how changes in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their “double participation” (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.

Development of an instrument to measure organisational culture in community pharmacies in Great Britain

Purpose Organisational culture (OC) shapes individuals' perceptions and experiences of work. However, no instrument capable of measuring specific aspects of OC in community pharmacy exists. The purpose of this paper is to report the development and validation of an instrument to measure OC in community pharmacy in Great Britain (GB), and conduct a preliminary analysis of data collected using it. Design/methodology/approach Instrument development comprised three stages: Stage I: 12 qualitative interviews and relevant literature informed instrument design; Stage II: 30 cognitive interviews assessed content validity; and Stage III: a cross-sectional survey mailed to 1,000 community pharmacists in GB, with factor analysis for instrument validation. Statistical analysis investigated how community pharmacists perceived OC in their place of work. Findings Factor analysis produced an instrument containing 60 items across five OC dimensions - business and work configuration, social relationships, personal and professional development, skills utilisation, and environment and structures. Internal reliability for the dimensions was high (0.84 to 0.95); item-total correlations were adequate ( r=0.46 to r=0.76). Based on 209 responses, analysis suggests different OCs in community pharmacy, with some community pharmacists viewing the environment in which they worked as having a higher frequency of aspects related to patient contact and safety than others. Since these aspects are important for providing high healthcare standards, it is likely that differences in OC may be linked to different healthcare outcomes. Originality/value This newly developed and validated instrument to measure OC in community pharmacy can be used to benchmark existing OC across different pharmacies and design interventions for triggering change to improve outcomes for community pharmacists and patients.

Barriers and facilitators to the implementation of person-centred care in different healthcare contexts

BACKGROUND

To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to improve person-centred principles and address gaps in practice. Consequently, researchers at the University of Gothenburg Centre for Person-Centred Care are currently delivering person-centred interventions employing a framework that incorporates three routines. These include eliciting the patient's narrative, agreeing a partnership with shared goals between patient and professional, and safeguarding this through documentation.

AIM

To explore the barriers and facilitators to the delivery of person-centred care interventions, in different contexts.

METHOD

Qualitative interviews were conducted with a purposeful sample of 18 researchers from seven research studies across contrasting healthcare settings. Interviews were transcribed, translated and thematically analysed, adopting some basic features of grounded theory.

ETHICAL ISSUES

The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Swedish Research Council.

RESULTS

Barriers to the implementation of person-centred care covered three themes: traditional practices and structures; sceptical, stereotypical attitudes from professionals; and factors related to the development of person-centred interventions. Facilitators included organisational factors, leadership and training and an enabling attitude and approach by professionals. Trained project managers, patients taking an active role in research and adaptive strategies by researchers all helped person-centred care delivery.

CONCLUSION

At the University of Gothenburg, a model of person-centred care is being initiated and integrated into practice through research. Knowledgeable, well-trained professionals facilitate the routines of narrative elicitation and partnership. Strong leadership and adaptive strategies are important for overcoming existing practices, routines and methods of documentation. This study provides guidance for practitioners when delivering and adapting person-centred care in different contexts.

Change management through leadership: the mediating role of organizational culture

Purpose

This paper aims to examine the influence of change leadership on organizational culture and change management practices in public-sector firms in the United Arab Emirates (UAE). It also examines the mediating role of organizational culture on the interactions between leadership and change management programmes in the organization.

Design/methodology/approach

An empirical test of the hypotheses using confirmatory factor analysis and structural equation modelling were applied to data collected from 210 middle-management respondents of public-sector organizations in the UAE.

Findings

The findings suggest that change-oriented leadership has a positive and significant direct effect on planned change (ß = 0.20, p < 0.01) and a positive and significant but indirect effect on planned change (ß = 0.279, p < 0.01) and emergent change (ß = 0.262, p < 0.01) change. Furthermore, hierarchical culture was found to positively and significantly impact directly on both planned (ß = 0.480, p < 0.001) and emergent (ß = 0.245, p < 0.01) change management in the UAE public-sector service organizations.

Practical implications

Based on the study’s findings, the role of the hierarchical culture in effecting change in the UAE public-sector organizations provides new and significant insights into the research literature on organizational culture as regards change management issues and the challenges facing these organizations.

Originality/value

The study makes a significant original contribution toward knowledge on the management of organizational change in UAE public-sector service organizations. It has practical implications for managers and leaders confronting organizational change management in the UAE.

Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients

BACKGROUND

The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies.

METHODS

This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT).

RESULTS

In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication.

CONCLUSION

NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients' perceptions to evaluate outcomes.

Alignment of governance and senior executive perceptions of culture

Purpose The purpose of this paper is to examine the alignment of perceived organizational culture between Health Board chairs and Board members with that of their respective senior executive teams. It compares the degree of alignment between these two groups, and analyses them against District Health Board (DHB) performance using the New Zealand Ministry of Health's national measure "shorter stays in Emergency Departments." Design/methodology/approach Primary survey data were collected across eight DHBs using a modified version of the Organizational Culture Assessment Instrument and utilizes a sample of both higher and lower performing DHBs as defined by the "shorter stays" measure. Findings Many health organizations cite Ovseiko and Buchan's (2012) preferred culture as an ideal model. However, this study's findings indicate that most DHBs scored higher than the preferred score for "Hierarchical" and "Rational" cultures, and lower for "Clan" and "Developmental" cultures, and therefore calls into question the validity of this organizational profile as the "preferred" cultural state. Research limitations/implications This research considers perceived organizational culture from the perspective of the Board members and their respective senior executive teams. It uses a relatively small sample size and excludes potential interactions of national culture. Practical implications The findings indicate that healthcare organizations should de-emphasize the dominant "Hierarchical" and "Rational" cultures, and promote "Clan" and "Developmental" cultures within their organizations as a means of potentially improving healthcare performance. Originality/value Organizational culture has been highlighted as a major component of performance within healthcare organizations, yet very few studies examine how organizational culture is perceived by governance and executive groups. This study empirically counters prevailing knowledge regarding the most appropriate organizational cultures for healthcare organizations.

Person-centred care dialectics-Inquired in the context of palliative care

Although a widely used concept in health care, person-centred care remains somewhat ambiguous. In the field of palliative care, person-centred care is considered a historically distinct ideal and yet there continues to be a dearth of conceptual clarity. Person-centred care is also challenged by the pull of standardization that characterizes much of health service delivery. The conceptual ambiguity becomes especially problematic in contemporary pluralistic societies, particularly in the light of continued inequities in healthcare access and disparities in health outcomes. Our aim was to explicate premises and underlying assumptions regarding person-centred care in the context of palliative care with an attempt to bridge the apparently competing agendas of individualization versus standardization, and individuals versus populations. By positioning person-centredness in relation to the hermeneutics of the self according to Paul Ricœur, dialectics between individualization and standardization, and between individuals and populations were constructed. The competing agendas were related in a dialectic manner in the way that population health is of importance for the individual, and standardization is of importance for the population. The analysis suggests that person-centred care is an ethical stance, which gives prominence to both suffering and capability of the individual as a person. The dialectic analysis points towards the importance of extending person-centred care to encompass population and societal perspectives and thereby avoiding a problematic tendency of affiliating person-centred care with exclusively individualistic perspectives. Considerations for person-centred palliative care on micro-, meso- and macrolevels conclude the paper.

Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study

BACKGROUND

It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse.

AIM

To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care.

DESIGN

A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments.

SETTING/PARTICIPANTS

A Danish regional hospital with 29 department managements and one hospital management.

RESULTS

Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation.

CONCLUSION

Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.

Concept mapping to improve team work, team learning and care of the person with dementia and behavioural and psychological symptoms

The incidence of behavioural and psychological symptoms of dementia in residential aged care facilities is high. Effective team work and knowledgeable staff are cited as important facilitators of appropriate care responses to clients with these symptoms, but to achieve this within a resource-poor workplace can be challenging. In the study reported in this paper, concept mapping was trialled to enhance multifocal person-centred assessment and care planning as well as team learning. The outcomes of team concept mapping were evaluated using a quasi-experimental design with pre- and post-testing in 11 selected Australian residential aged care facilities , including two control residential aged care facilities , over a nine-month period. It was demonstrated that use of concept mapping improved team function, measured as effectiveness of care planning, as well as enhancing learning, with increased knowledge of dementia care even amongst staff who were not directly involved with the process. It is suggested that these results may be generalizable to other countries and care settings.

Advancing the Big Five of user-oriented care and accounting for its variations

Purpose

– Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

Design/methodology/approach

– Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2).

Findings

– A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level).

Originality/value

– The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Multi-Level Efficacy Evidence of a Combined Interprofessional Collaboration and Project Management Training Program for Healthcare Project Teams

Project work is essential for the improvement of healthcare organizations; yet, project management and collaboration in the project context are not taught to healthcare professionals. Three half-day training workshops integrating project management and collaboration were designed and delivered to 14 interprofessional healthcare project teams. Multivariate measures were taken over the course of 36 weeks. Individual, team, and project-level results showed high satisfaction and perceptions of utility; improved self-efficacy for project-specific task work and teamwork; increased goal clarity and coordination; and a significant impact on the functional performance of projects. This study provides initial benchmark measures regarding the pertinence of project management and interprofessional collaboration training for healthcare project teams.

Perpetuating 'New Public Management' at the expense of nurses' patient education: a discourse analysis

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could 'see' neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for 'things' such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

Experiences of person-centred care - patients' perceptions: qualitative study

BACKGROUND

Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation.

METHODS

Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients' perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model.

RESULTS

The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient's illness needed to be addressed or resolved for open listening to be perceived as a positive experience.

CONCLUSIONS

The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.

The association between subcultures and resistance to change – in a Swedish hospital clinic

Purpose

– The purpose of this paper is to explore the different subcultures and the employees’ preparedness for change at an orthopaedic clinic in a university hospital in Sweden.

Design/methodology/approach

– Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale.

Findings

– The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour.

Practical implications

– By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change.

Originality/value

– The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.

The impact of organizational culture on the outcome of hospital care: after the implementation of person-centred care

AIMS

To measure the effect of organizational culture on health outcomes of patients 3 months after discharge.

METHODS

a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively.

RESULTS

The regression analysis showed that; 16% (R(2) = 0.02) of a decreased health status, 22% (R(2) = 0.05) of pain/discomfort and 13% (R(2) = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility.

CONCLUSIONS

The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.

Elderly Men's Experience of Information Material about Melanoma-A Qualitative Study

Malignant melanoma is an aggressive disease that has been increasing worldwide. Public education is trying to focus on reducing intense sun exposure and raise awareness of signs and symptoms to prevent illness. The aim of the study was to describe and analyze elderly men's (over 65 years) experience of an information booklet regarding malignant melanoma. The study comprised of a total of 15 interviews with elderly men. The interviews were analyzed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, Security-to act, and three subcategories, Availability-to use, Clarity-to understand, and Awareness-to know, were identified to describe the men's experiences of information material about melanoma. By using person-centered care, based on a holistic approach focusing on men's need for security to act on specific risk factors and to do skin self-examination, health could be improved. The results of this study could help other health organizations to develop information material to prevent illness, such as for skin self-examination. Strategies concerning educating, preparing, and training health professionals in interpersonal communication skills should be implemented in healthcare organizations to meet patients' information needs about illness to develop continuous learning and quality improvement.

What is person-centred care in dementia? Clinical reviews into practice: the development of the VIPS practice model

The VIPS framework is a four-part definition of person-centred care for people with dementia (PCC), which arose out of an earlier review article for this journal. The definition has assisted in the practical application of person-centred care. It has been operationalized into the VIPS practice model (VPM), which has been subject to a recent randomized controlled trial within Norwegian nursing homes. The VPM provided a vehicle for the VIPS framework to be utilized during reflective practice meetings focusing on understanding care situations from the perspective of residents with moderate to severe dementia. VPM incorporated an education and coaching approach, clearly defined staff roles, and resident-focused outcomes in a cycle to support improvements in quality of care. The use of VPM in practice is discussed. VPM was built utilizing the literature from organizational change. The role of literature reviews in bringing about change in practice is highlighted.

Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.