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

Music-based environmental therapy and training programme: a qualitative evaluation study, Norway

Various authors have emphasized music's value as beneficial intervention, with few or hardly any side effects. Further studies are called for on how music-based environmental treatment in nursing homes works in practice. The aims of the study are first to explore the subjective experiences, opinions and attitudes of health personnel from nursing homes participating in the 'music-based environmental therapy programme (MB programme); and second, to examine why and how this programme impacts on patients and staff, and how it works in practice. It is the first qualitative study to evaluate the impact of the programme on health personnel's daily practice in nursing homes. The sample was strategically selected by means of convenience sampling, and consisted of 26 (n = 26) nurses, managers, physiotherapists, social workers and carers from 11 nursing homes in the south-east of Norway. Data were collected in autumn 2019 using a methodological triangulation of in-depth interviews, focus groups and passive observation, and the data were analyzed using systematic text condensation. With systematic use of music in daily activities in the nursing homes, users became calmer and less outspoken, and the use of psychotropic drugs was greatly reduced. The MB programme seems to be a successful intervention that provides a unique opportunity to improve patients' health and well-being with minimal adverse effects. This new focus on non-pharmacological approaches makes investigation of alternatives to medication vital.

Diffusion of person-centred care within 27 European countries – interviews with managers, officials, and researchers at the micro, meso, and macro levels

Purpose

This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC).

Design/methodology/approach

A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective.

Findings

Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system.

Research limitations/implications

The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited.

Practical implications

Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

Originality/value

Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

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.

The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

BACKGROUND

Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit.

METHODS

The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics.

RESULTS

The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time.

CONCLUSION

It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren't enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change.

Preconditions to implementation of an integrated care process programme

Purpose

The purpose of this study was to investigate the preconditions of a full-scale implementation of an integrated care process programme for frail older people from the staff's understanding, commitment and ability to change their work procedures with comparisons over time and between organisations.

Design/methodology/approach

A repeated cross-sectional study was conducted in a hospital, municipal health and social care setting.

Findings

Staff commitment decreased to the importance of a permanent municipal contact from baseline compared to the 12-months follow-up (p = 0.02) and the six- and 12-months follow-up (p = 0.05), to the information transfer from emergency department from the six- to the 12-months follow-up (p = 0.04), to discharge planning at the hospital at six- and 12-months follow-up (p = 0.04) and towards discharge planning at home from baseline to the six-month follow-up (p = 0.04). Significant differences occurred between the organisations about information transfer from the emergency department (p = 0.01) and discharge planning at home (p = 0.03). The hospital staff were the most committed.

Practical implications

The results can guide the implementation of complex interventions in organisations with high-employee turnover and heavy workload.

Originality/value

The study design, allowing the comparison of implementation results over time and between organisations in a later phase, gives this study a unique perspective.

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.

Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study

BACKGROUND

Effective interprofessional collaboration (IPC) is essential for the delivery of chronic care. Interprofessional education (IPE) can help support IPC skills. This makes IPE interesting for GP practices where chronic care is delivered by GPs together with practice nurses, especially for GP trainees who have to learn to collaborate with practice nurses during their training. The aim of this study is to gain insights in how IPE and IPC occur between GP trainees and practice nurses during the delivery of chronic care in GP training practices.

METHODS

We conducted a qualitative research using semi structured focus groups and interviews with GP trainees, practice nurses and GP supervisors. All respondents were primed to the subject of IPE as they had followed an interprofessional training on patient-centred communication. The verbatim transcripts of the focus groups and interviews were analysed using thematic analysis.

RESULTS

Despite the overall positive attitude displayed by respondents towards IPE and IPC, the occurrence of IPE and IPC in GP training practices was limited. Possible explanations for this are impeding factors such as limited knowledge, prejudice, lack of role models and a hierarchical organisational structure. Contributing to IPE and IPC use was the integration of IPE in daily practice, e.g. via recurring scheduled meetings.

CONCLUSION

We found a limited occurrence of IPE and IPC in GP training practices. Our results show a discrepancy between respondents enthusiasm for IPE and IPC and their actual behaviour. IPE activities have to be initiated in GP training practices, otherwise, despite good intentions, IPE and IPC will be ineffective.

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.

Change Management in Health Care and Mental Health Nursing

Since Nightingale implied that progress was inherent in good nursing, change has slowly but surely accelerated to a frenetic pace in health care and to a degree in nursing. However, the healthy progress and implications associated with change in the nursing profession are not as readily embraced as this pace may imply. Rather, embracing change at the core of nursing and health care is a challenge as this is a group who it is suggested are not only resistant but also adept at reinforcing the status quo. Using mental health nursing as an example this position paper addresses the concept of change management, explores the facilitators and inhibitors to explain why change is not effectively managed at times. Further, case studies provided exemplify how change in mental health nursing has occurred and demonstrate how the concept of change management effectively has been achieved. Key strategies for change management are outlined in this article, noting the need to be sensitive to the culture and specifics of that organisation, because change takes place within people rather than within the organisation itself. Part of the challenges and strategies faced in the profession are related to the movement of information and knowledge from the point of research to implementation of evidence-based best practice. Leaders, therefore, should adopt change management principles and strategies, to further drive the developments which have changed mental health nursing over a relatively short period.

Resistance to change: an empirical investigation of its antecedents

Purpose

Resistance to change (RtC) is widely recognized as the main reason of failure, when it comes to change initiatives. Despite its importance, there is still a rather limited knowledge concerning the factors that trigger this behavior at the workplace. The purpose of this paper is to identify the factors affecting RtC in healthcare organizations (namely, hospitals) and specifically, in emergency departments (EDs).

Design/methodology/approach

An original conceptual framework (research model) has been developed and empirically tested using primary data collected from EDs of six Greek hospitals. In total, the actual sample incorporates the responses of 158 ED health professionals who completed a structured questionnaire.

Findings

The findings verified the initial assumption that “disposition towards change (DtC),” “anticipated impact of change (AIC)” and “attitude towards change (AtC)” mediate the impact of various personal and behavioral characteristics on “RtC.” The results suggested that “RtC” is (indirectly) influenced by four main factors (“employee-management relationship,” “personality traits,” “employee participation in the decision-making process” and “job security”).

Originality/value

This study investigates how several factors affect, both directly or indirectly, employee reactions toward “RtC.” It also examines the mediating effect of three factors (“DtC,” “AtC,” “AIC”) that capture three different dimensions of individual evaluation toward change, something that goes beyond previous work. In addition, the present study examines a wide range of antecedents of RtC, including both personality-related and job-related factors.

Person-centred care - An approach that improves the discharge process

BACKGROUND

Discharge planning is important to bridge the gap between hospital and home. Many patients with chronic heart failure are often fragile elderly with co-morbidities and functional decline due to increased symptom burden. A structured Gothenburg person-centred care (gPCC) approach may promote better discharge-planning.

AIMS

To evaluate whether proactive care-planning based on the gPCC model leads to improved efficiency in discharge procedures compared with usual care in patients hospitalized for worsening chronic heart failure.

METHODS

In a controlled before-and-after design, patients hospitalized for worsening chronic heart failure were assigned to either a usual care group or a gPCC intervention group. The patients' social situation, their discharge destination and the number of days until the discharge were recorded. The time interval (in days) between notification and start of coordination of care was recorded.

RESULTS

In total, 248 patients were included, 123 in the usual care group and 125 in the gPCC intervention. During hospitalization, notifications to the community home help service and/or round-the-clock home nursing care services were more frequent in the gPCC-group (33.8%) compared with patients in the usual care group (12.1%). A confirmed discharge planning conference started within the first five days in the gPCC group whereas the usual care group ranged from one to 28 days. Compared with the usual care group, the gPCC group had fewer days in hospital (11 versus 35) ready for discharge.

CONCLUSION

gPCC improves discharge processes because patients are viewed as competent to be involved in planning their subsequent care.

Organisational culture and post-merger integration in an academic health centre: a mixed-methods study

BACKGROUND

Around the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres. However, many mergers fail to bring the anticipated benefits, and successful post-merger integration in university hospitals and academic health centres is even harder to achieve. An increasing body of literature suggests that organisational culture affects the success of post-merger integration and academic-clinical collaboration.

METHODS

This paper reports findings from a mixed-methods single-site study to examine 1) the perceptions of organisational culture in academic and clinical enterprises at one National Health Service (NHS) trust, and 2) the major cultural issues for its post-merger integration with another NHS trust and strategic partnership with a university. From the entire population of 72 clinician-scientists at one of the legacy NHS trusts, 38 (53%) completed a quantitative Competing Values Framework survey and 24 (33%) also provided qualitative responses. The survey was followed up by semi-structured interviews with six clinician-scientists and a group discussion including five senior managers.

RESULTS

The cultures of two legacy NHS trusts differed and were primarily distinct from the culture of the academic enterprise. Major cultural issues were related to the relative size, influence, and history of the legacy NHS trusts, and the implications of these for respective identities, clinical services, and finances. Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger. However, some aspects of university entrepreneurial culture are difficult to reconcile with the NHS service delivery model and may create tension.

CONCLUSIONS

There are challenges in preserving a more desirable culture at one of the legacy NHS trusts, enhancing cultures in both legacy NHS trusts during their post-merger integration, and in aligning academic and clinical cultures following strategic partnership with a university. The seeds of success may be found in current best practice, good will, and a near identical ideal of the future preferred culture. Strong, fair leadership will be required both nationally and locally for the success of mergers and post-merger integration in university hospitals and academic health centres.

Person-centred care compared with standardized care for patients undergoing total hip arthroplasty--a quasi-experimental study

Background

A common approach to decrease length of stay has been to standardize patient care, for example, by implementing clinical care pathways or creating fast-track organizations. In a recent national report, it was found that Sweden’s healthcare system often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. We compared a standardized care approach to one of person-centred care for patients undergoing total hip replacement surgery.

Methods

A control group (n =138) was consecutively recruited between 20th September 2010 and 1st March 2011 and an intervention group (n =128) between 12th December 2011 and 12th November 2012, both scheduled for total hip replacement. The primary outcome measures were length of stay and physical function at both discharge and 3 months later.

Results

The mean length of stay in the control group was 7 days (SD 5.0) compared to 5.3 days in the intervention group (SD 2.2). Physical functional performance, as assessed using activities of daily living, was similar at baseline for both groups. At discharge, 84% in the control group had regained activities of daily living level A vs. 72% in the intervention group. At 3 months after surgery, 88% in the control group had regained their independence vs. 92.5% in the person-centred care group.

Conclusions

Focusing attention on patients as people and including them as partners in healthcare decision-making can result in shorter length of stay. The present study shows that the patients should be the focus and they should be involved as partners.