Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av f... more Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av forskningens viktigaste uppgifter är att ta reda på och presentera vad undervisningen bör handla om. I en tid där läroböcker och annan relevant publicering fortfarande tar lång tid att nå undervisningen och där det finns alternativa kanaler för kunskapsspridning skapas ett hålrum. Rapportserien är tänkt som ett instrument för att fylla nämnda hålrum. Texter som tar upp något eller några företeelser som bör presenteras för studenter och forskare med intresse för vad undervisningen bör handla om. Det forskningsfält som inkluderas här har en vid ram och har benämningen Styrning, organisering och ledning. Den vida ramen indikerar att det är en multivetenskaplig ansats som gäller. Varje rapport granskas i flera steg innan den publiceras elektroniskt. Någon eller några i redaktionen läser en inkommen text. I ett andra steg seminariebehandlas den och i ett tredje steg formaliagranskas texten ockå. Sist men inte minst går den att hämta på www.hb.se Rapportseriens redaktion består av
View related articles View Crossmark data Citing articles: 1 View citing articles Experts' contri... more View related articles View Crossmark data Citing articles: 1 View citing articles Experts' contribution to strategy when strategy is absent. A case study of quality experts in hospitals
International Journal of Public Administration, Jul 1, 2014
ABSTRACT This article examines the unintended consequences following implementation of a new publ... more ABSTRACT This article examines the unintended consequences following implementation of a new public management (NPM) reform—a performance-based salary system—in two Swedish public schools. Headmasters and central office personnel were interviewed. The expected reform results at last appeared a decade after implementation when salary-setting procedures adopted the bureaucratic framework. Despite the common view that NPM reforms, owing to unintended consequences, fail because they adapt poorly to the Weberian control regime at public organizations, this article argues that the unintended consequences of an NPM reform can drive the “bureaucratic” organization even when there is no evidence of debureaucratization.
Journal of Health Organisation and Management, Jun 1, 2011
This paper aims to describe the integrating and disintegrating effects of professional actions in... more This paper aims to describe the integrating and disintegrating effects of professional actions in customised care. Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units (CAP) charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days. The social embeddedness of action is crucial to understanding the professions' integrating/disintegrating activities. In the internal social context of CAP, the professions adapt to productivity-enhancing new public management (NPM) principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations. The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPM/customised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices. Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of de-emphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.
This study examines the cooperative work of several professions in Swedish multi-professional tea... more This study examines the cooperative work of several professions in Swedish multi-professional teams in child and adolescent psychiatric open care units in an environment of strong economic and efficiency controls resulting from the so-called New Public Management (NPM) reforms. Previous studies indicate teamwork is a network of semi-independent professionals who tend to represent their professional organisations and groups despite sharing a mutual interest in the patients. The research problem deals with finding explanations for what promotes and what hinders cooperation in a multi-professional health care team. A qualitative approach is used to study and interpret the individual professionals' actions. Data were collected in interviews and from observations of planning and treatment discussions where it was possible to witness team members' strategies and attitudes toward patients and their treatment. The main theoretical concepts are exogenous and endogenous institutions, boundary objects, standardised procedures, service ideal, discretionary power and professional dominance. Two NPM elements are applied: customised care and increased accountability. The study offers an actor perspective that complements the traditional cultural perspective. The latter perspective explains cooperation problems as the result of the professionals' confusion over their expectations of themselves in their team roles and their expectations of others in their team roles. The actor perspective shows that while norms may influence cooperation, they are not determinative. Actors are aware of the institutionalised conditions, and take them into consideration; however, their actions are not determined by these conditions, nor even primarily guided by them. The determinative factor for actors' actions is their context. Leaders and co-workers can create endogenous institutions that bridge their differences in professional norms and also bridge professional norms and NPM reforms. The institutionalised conditions are secondary factors that explain the outcome of cooperation efforts. This study offers an interpretation useful in understanding how the actors create endogenous institutions. Star and Griesemer's theory on boundary-spanning objects does not address this aspect of cooperation. Unintended consequences of NPM reforms for patients are traditionally said to imply that NPM reforms are ill conceived and unrealistic. In the light of this study the significance of such consequences may be reinterpreted to be a possible mechanism of driving the development of the public organisation. Usually NPM reforms are regarded either destructive or harmless to professional autonomy. This is scarcely a realistic description of professionals' long-term behaviour. This study offers co-optation as an alternative explanation, defined as the process by which actors absorb external strategic elements in their policy decisions. Co-optation of NPM reforms explains the gradual institutionalisation of NPM reforms. Research investigating professions has not dealt with the fact that multi-profession cooperation has the same character as mono-professional cooperation, to preserve collegiality through coexistence. Such professionals do not wish to challenge others' approaches and practices; nor do they wish to learn from them. This result challenges the general idea of professional dominance in theories on professions.
This qualitative interview study investigates managers' ongoing relationships in inter-organisati... more This qualitative interview study investigates managers' ongoing relationships in inter-organisational banks, examining how they assess trust in their counterparts and how they decide if the relationship should continue. In normal times, formal information can assess thin trustthe ability and integrity of their counterparts. In times of impending crisis, senior bank managers rely on the evaluation of thick personal trust: benevolence. To be a trustworthy party in a financial crisis, benevolence must be established between counterpart banks before the crisis. Benevolence is a redundant component of trust in normal times, but extremely important during a crisis. Lack of benevolence established in normal times may, in fact, be at least partially responsible for the fragility of interfirm agreements and alliances.
... These hypotheses were confirmed in a study of 'Policy alienation of public professional&... more ... These hypotheses were confirmed in a study of 'Policy alienation of public professional' in a similar context that emphasized measures of performance and output measurements (Tummers et al., 200959. Tummers, L., Bekkers, V. and Steijn, B. 2009. ...
Qualitative Research in Accounting & Management, Feb 27, 2018
Emerald is a global publisher linking research and practice to the benefit of society. The compan... more Emerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services. Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation.
Journal of Professions and Organization, Feb 7, 2018
Researchers working under the institutional logics perspective find the struggle between manageri... more Researchers working under the institutional logics perspective find the struggle between managerial logic and various professional logics one of the most intriguing issues in healthcare organizations. Previous research provided several explanations at both the organizational level (mediation, hybridization, and selective coupling) and the individual actor level (hierarchization, sense making, reinterpretation, and hijacking) for the coexistence of professional and managerial logics in healthcare. However, all of these explanations are based on the underlying institutional logics not changing. In this article, we show that co-optation can explain the coexistence of institutional logics, but that it also causes the underlying institutional logics to change. Co-optation means that an actor adopts a strategic element from another logic that retains the most important elements of its own logic. Empirically, this article illustrates co-optation processes through a qualitative study of outpatient units in child and adolescent psychiatric care in Sweden. Using an institutional logics framework, we describe and explain how managers co-opted elements of professional logics and professionals co-opted elements of managerial logic in their attempts to support their own interests. Even if cooptation is performed to protect the home logic, the co-opted elements ultimately change it. This study contributes to the institutional logics framework by describing and explaining how co-optation can be a dynamic response to competing logics at the individual actor level.
International Journal of Public Sector Management, May 25, 2012
PurposeThis article aims to describe and analyze the results of efforts to improve patient‐center... more PurposeThis article aims to describe and analyze the results of efforts to improve patient‐centered care (PCC) in psychiatric healthcare.Design/methodology/approachUsing the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient‐centered actions are performed. They conducted 62 interviews, made 11 half‐day observations, and shadowed employees for two days.FindingsThe article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient's medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.Practical implicationsThe article shows that accountability pressure to reduce patient risk may create new risks for patients.Originality/valueThe study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.
Qualitative Research in Organizations and Management: An International Journal, May 10, 2011
PurposeThe purpose of this paper is to investigate if a rational perspective can be used to inter... more PurposeThe purpose of this paper is to investigate if a rational perspective can be used to interpret cooperation problems in a health care organisation. This perspective is proposed as a complementary perspective to the cultural perspective that dominates as an explanation of cooperation problems. The focus of the research is multiprofessional teamwork in contemporary Swedish health care.Design/methodology/approachFour cases studies, in which the cooperation in daily work is described, are used to test the two perspectives. The cases concern the cooperative methods health care professionals use when work conditions depend upon an internal norm of mutual cooperation. Although the research is not designed to evaluate the two perspectives, it permits the rational explanations of cooperation problems to be compared with possibly cultural explanations.FindingsThe investigation concludes that health care cooperation problems may be primarily explained by the rational perspective, and only secondarily by the cultural perspective. The actors can be seen as underinstitutionalised in the sense they have not yet developed the intra‐organisational norms of cooperation needed for the provision of customised health care.Originality/valueThe paper provides a complementary explanatory framework of cooperation problems based on actors' perceptions of their self‐interests as producers. The examples of uncooperative behaviour reflect two forms of the free rider problem that Ostrom describes as a Common Pool Resource Problem. Management has to prove that cooperation is beneficial to the team members and has to promote a cooperative team spirit by instilling a common understanding of the concept of cooperation.
Constructing the patient as control strategy in psychiatry – Competing responsibilities and their... more Constructing the patient as control strategy in psychiatry – Competing responsibilities and their consequences
Scandinavian Journal of Public Administration, Mar 15, 2013
This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (N... more This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (NPM) control regime in order to develop individualistic and holistic care in healthcare in the context of two competing logics: managerialism and professionalism. In a qualitative case study, three outpatient Child and Adolescent Psychiatric (CAP) care units are investigated using interviews, observations and shadowing. The study shows that the MPT has an integrative effect on the two logics when informal alliances are formed between psychologists/psychiatrists and unit managers. We conclude that the MPT may achieve patient care in a resource-effective and professional way but not individualistic and holistic care. An explanation may be that individualistic and holistic care is neither measurable/quantifiable as required by the resource-effectiveness goal nor in focus as a consequence of the logic of professionalism. A theoretical implication is that the negative effect of NPM on the professionals' autonomy is mitigated by the MPT. Earlier studies may have underestimated the importance of "hard facts" introduced by a strong control regime, in this case, the NPM context. The control regime may take over and create collaboration; nonetheless, the outcome is not entirely the desired one. Multiprofessionella team som post NPM styrregim Kan de integrera konkurrerande styrlogiker inom hälso-och sjukvård? Denna artikel fokuserar på frågan om multiprofessionella team (MPT) kan ses som en potentiell post New Public Management (NPM) reform och uppnå både effektivitetsideal som NPM-reformer eftersträvar och intentioner om en individanpassad vård där patientens samlade behov av vård och stödinsatser beaktas. Intervjuer, observationer och skuggning har använts för att studera betydelsen av dessa logiker för samarbetet i tre enheter inom barn-och ungdomspsykiatrin (BUP). Studien visar att MPT har integrativa effekter på de två logikerna. Den negativa effekten av NPM på de professionella utövarnas autonomi underlättas av arbete i MPT. MPT kan leda till en vård som både är resurseffektivt och professionellt utförd, men intentionerna att bedriva en individualiserad och behovsanpassad vård är svåra att uppnå till följd av det ökade ansvaret för att uppfylla effektivitetskrav. Tidigare studier kan ha underskatta den styrande effekten av kvantitativa effektivitetsmått som NPM inför. En förklaring kan vara att graden av patientorienterad och holistisk vård inte kan mätas med kvantitativa mått som NPM regimen kräver och inte heller fokuseras som en konsekvens av professionslogiken. Det innebär att MPT som post NPM reform motverkas om inte de höga, kvantifierade NPM kraven på resurseffektivitet reduceras.
International Journal of Critical Accounting, 2018
This article examines senior bank managers' evaluations of other banks in the interbank marke... more This article examines senior bank managers' evaluations of other banks in the interbank market during times of financial crisis. We conclude that the fair value principle demands greater awareness of the need for reputational monitoring, evaluation by thick trust and scepticism towards numbers. Monitoring during crisis includes neither historical cost nor fair value numbers, because numbers are distrusted. Consequently, valuation principles may not explain contagion effects during crisis.
Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av f... more Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av forskningens viktigaste uppgifter är att ta reda på och presentera vad undervisningen bör handla om. I en tid där läroböcker och annan relevant publicering fortfarande tar lång tid att nå undervisningen och där det finns alternativa kanaler för kunskapsspridning skapas ett hålrum. Rapportserien är tänkt som ett instrument för att fylla nämnda hålrum. Texter som tar upp något eller några företeelser som bör presenteras för studenter och forskare med intresse för vad undervisningen bör handla om. Det forskningsfält som inkluderas här har en vid ram och har benämningen Styrning, organisering och ledning. Den vida ramen indikerar att det är en multivetenskaplig ansats som gäller. Varje rapport granskas i flera steg innan den publiceras elektroniskt. Någon eller några i redaktionen läser en inkommen text. I ett andra steg seminariebehandlas den och i ett tredje steg formaliagranskas texten ockå. Sist men inte minst går den att hämta på www.hb.se Rapportseriens redaktion består av
Unintended consequences of accountability and customer focus in healthcare : New Public Managemen... more Unintended consequences of accountability and customer focus in healthcare : New Public Management in action
Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av f... more Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av forskningens viktigaste uppgifter är att ta reda på och presentera vad undervisningen bör handla om. I en tid där läroböcker och annan relevant publicering fortfarande tar lång tid att nå undervisningen och där det finns alternativa kanaler för kunskapsspridning skapas ett hålrum. Rapportserien är tänkt som ett instrument för att fylla nämnda hålrum. Texter som tar upp något eller några företeelser som bör presenteras för studenter och forskare med intresse för vad undervisningen bör handla om. Det forskningsfält som inkluderas här har en vid ram och har benämningen Styrning, organisering och ledning. Den vida ramen indikerar att det är en multivetenskaplig ansats som gäller. Varje rapport granskas i flera steg innan den publiceras elektroniskt. Någon eller några i redaktionen läser en inkommen text. I ett andra steg seminariebehandlas den och i ett tredje steg formaliagranskas texten ockå. Sist men inte minst går den att hämta på www.hb.se Rapportseriens redaktion består av
View related articles View Crossmark data Citing articles: 1 View citing articles Experts' contri... more View related articles View Crossmark data Citing articles: 1 View citing articles Experts' contribution to strategy when strategy is absent. A case study of quality experts in hospitals
International Journal of Public Administration, Jul 1, 2014
ABSTRACT This article examines the unintended consequences following implementation of a new publ... more ABSTRACT This article examines the unintended consequences following implementation of a new public management (NPM) reform—a performance-based salary system—in two Swedish public schools. Headmasters and central office personnel were interviewed. The expected reform results at last appeared a decade after implementation when salary-setting procedures adopted the bureaucratic framework. Despite the common view that NPM reforms, owing to unintended consequences, fail because they adapt poorly to the Weberian control regime at public organizations, this article argues that the unintended consequences of an NPM reform can drive the “bureaucratic” organization even when there is no evidence of debureaucratization.
Journal of Health Organisation and Management, Jun 1, 2011
This paper aims to describe the integrating and disintegrating effects of professional actions in... more This paper aims to describe the integrating and disintegrating effects of professional actions in customised care. Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units (CAP) charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days. The social embeddedness of action is crucial to understanding the professions' integrating/disintegrating activities. In the internal social context of CAP, the professions adapt to productivity-enhancing new public management (NPM) principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations. The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPM/customised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices. Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of de-emphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.
This study examines the cooperative work of several professions in Swedish multi-professional tea... more This study examines the cooperative work of several professions in Swedish multi-professional teams in child and adolescent psychiatric open care units in an environment of strong economic and efficiency controls resulting from the so-called New Public Management (NPM) reforms. Previous studies indicate teamwork is a network of semi-independent professionals who tend to represent their professional organisations and groups despite sharing a mutual interest in the patients. The research problem deals with finding explanations for what promotes and what hinders cooperation in a multi-professional health care team. A qualitative approach is used to study and interpret the individual professionals' actions. Data were collected in interviews and from observations of planning and treatment discussions where it was possible to witness team members' strategies and attitudes toward patients and their treatment. The main theoretical concepts are exogenous and endogenous institutions, boundary objects, standardised procedures, service ideal, discretionary power and professional dominance. Two NPM elements are applied: customised care and increased accountability. The study offers an actor perspective that complements the traditional cultural perspective. The latter perspective explains cooperation problems as the result of the professionals' confusion over their expectations of themselves in their team roles and their expectations of others in their team roles. The actor perspective shows that while norms may influence cooperation, they are not determinative. Actors are aware of the institutionalised conditions, and take them into consideration; however, their actions are not determined by these conditions, nor even primarily guided by them. The determinative factor for actors' actions is their context. Leaders and co-workers can create endogenous institutions that bridge their differences in professional norms and also bridge professional norms and NPM reforms. The institutionalised conditions are secondary factors that explain the outcome of cooperation efforts. This study offers an interpretation useful in understanding how the actors create endogenous institutions. Star and Griesemer's theory on boundary-spanning objects does not address this aspect of cooperation. Unintended consequences of NPM reforms for patients are traditionally said to imply that NPM reforms are ill conceived and unrealistic. In the light of this study the significance of such consequences may be reinterpreted to be a possible mechanism of driving the development of the public organisation. Usually NPM reforms are regarded either destructive or harmless to professional autonomy. This is scarcely a realistic description of professionals' long-term behaviour. This study offers co-optation as an alternative explanation, defined as the process by which actors absorb external strategic elements in their policy decisions. Co-optation of NPM reforms explains the gradual institutionalisation of NPM reforms. Research investigating professions has not dealt with the fact that multi-profession cooperation has the same character as mono-professional cooperation, to preserve collegiality through coexistence. Such professionals do not wish to challenge others' approaches and practices; nor do they wish to learn from them. This result challenges the general idea of professional dominance in theories on professions.
This qualitative interview study investigates managers' ongoing relationships in inter-organisati... more This qualitative interview study investigates managers' ongoing relationships in inter-organisational banks, examining how they assess trust in their counterparts and how they decide if the relationship should continue. In normal times, formal information can assess thin trustthe ability and integrity of their counterparts. In times of impending crisis, senior bank managers rely on the evaluation of thick personal trust: benevolence. To be a trustworthy party in a financial crisis, benevolence must be established between counterpart banks before the crisis. Benevolence is a redundant component of trust in normal times, but extremely important during a crisis. Lack of benevolence established in normal times may, in fact, be at least partially responsible for the fragility of interfirm agreements and alliances.
... These hypotheses were confirmed in a study of 'Policy alienation of public professional&... more ... These hypotheses were confirmed in a study of 'Policy alienation of public professional' in a similar context that emphasized measures of performance and output measurements (Tummers et al., 200959. Tummers, L., Bekkers, V. and Steijn, B. 2009. ...
Qualitative Research in Accounting & Management, Feb 27, 2018
Emerald is a global publisher linking research and practice to the benefit of society. The compan... more Emerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services. Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation.
Journal of Professions and Organization, Feb 7, 2018
Researchers working under the institutional logics perspective find the struggle between manageri... more Researchers working under the institutional logics perspective find the struggle between managerial logic and various professional logics one of the most intriguing issues in healthcare organizations. Previous research provided several explanations at both the organizational level (mediation, hybridization, and selective coupling) and the individual actor level (hierarchization, sense making, reinterpretation, and hijacking) for the coexistence of professional and managerial logics in healthcare. However, all of these explanations are based on the underlying institutional logics not changing. In this article, we show that co-optation can explain the coexistence of institutional logics, but that it also causes the underlying institutional logics to change. Co-optation means that an actor adopts a strategic element from another logic that retains the most important elements of its own logic. Empirically, this article illustrates co-optation processes through a qualitative study of outpatient units in child and adolescent psychiatric care in Sweden. Using an institutional logics framework, we describe and explain how managers co-opted elements of professional logics and professionals co-opted elements of managerial logic in their attempts to support their own interests. Even if cooptation is performed to protect the home logic, the co-opted elements ultimately change it. This study contributes to the institutional logics framework by describing and explaining how co-optation can be a dynamic response to competing logics at the individual actor level.
International Journal of Public Sector Management, May 25, 2012
PurposeThis article aims to describe and analyze the results of efforts to improve patient‐center... more PurposeThis article aims to describe and analyze the results of efforts to improve patient‐centered care (PCC) in psychiatric healthcare.Design/methodology/approachUsing the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient‐centered actions are performed. They conducted 62 interviews, made 11 half‐day observations, and shadowed employees for two days.FindingsThe article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient's medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.Practical implicationsThe article shows that accountability pressure to reduce patient risk may create new risks for patients.Originality/valueThe study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.
Qualitative Research in Organizations and Management: An International Journal, May 10, 2011
PurposeThe purpose of this paper is to investigate if a rational perspective can be used to inter... more PurposeThe purpose of this paper is to investigate if a rational perspective can be used to interpret cooperation problems in a health care organisation. This perspective is proposed as a complementary perspective to the cultural perspective that dominates as an explanation of cooperation problems. The focus of the research is multiprofessional teamwork in contemporary Swedish health care.Design/methodology/approachFour cases studies, in which the cooperation in daily work is described, are used to test the two perspectives. The cases concern the cooperative methods health care professionals use when work conditions depend upon an internal norm of mutual cooperation. Although the research is not designed to evaluate the two perspectives, it permits the rational explanations of cooperation problems to be compared with possibly cultural explanations.FindingsThe investigation concludes that health care cooperation problems may be primarily explained by the rational perspective, and only secondarily by the cultural perspective. The actors can be seen as underinstitutionalised in the sense they have not yet developed the intra‐organisational norms of cooperation needed for the provision of customised health care.Originality/valueThe paper provides a complementary explanatory framework of cooperation problems based on actors' perceptions of their self‐interests as producers. The examples of uncooperative behaviour reflect two forms of the free rider problem that Ostrom describes as a Common Pool Resource Problem. Management has to prove that cooperation is beneficial to the team members and has to promote a cooperative team spirit by instilling a common understanding of the concept of cooperation.
Constructing the patient as control strategy in psychiatry – Competing responsibilities and their... more Constructing the patient as control strategy in psychiatry – Competing responsibilities and their consequences
Scandinavian Journal of Public Administration, Mar 15, 2013
This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (N... more This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (NPM) control regime in order to develop individualistic and holistic care in healthcare in the context of two competing logics: managerialism and professionalism. In a qualitative case study, three outpatient Child and Adolescent Psychiatric (CAP) care units are investigated using interviews, observations and shadowing. The study shows that the MPT has an integrative effect on the two logics when informal alliances are formed between psychologists/psychiatrists and unit managers. We conclude that the MPT may achieve patient care in a resource-effective and professional way but not individualistic and holistic care. An explanation may be that individualistic and holistic care is neither measurable/quantifiable as required by the resource-effectiveness goal nor in focus as a consequence of the logic of professionalism. A theoretical implication is that the negative effect of NPM on the professionals' autonomy is mitigated by the MPT. Earlier studies may have underestimated the importance of "hard facts" introduced by a strong control regime, in this case, the NPM context. The control regime may take over and create collaboration; nonetheless, the outcome is not entirely the desired one. Multiprofessionella team som post NPM styrregim Kan de integrera konkurrerande styrlogiker inom hälso-och sjukvård? Denna artikel fokuserar på frågan om multiprofessionella team (MPT) kan ses som en potentiell post New Public Management (NPM) reform och uppnå både effektivitetsideal som NPM-reformer eftersträvar och intentioner om en individanpassad vård där patientens samlade behov av vård och stödinsatser beaktas. Intervjuer, observationer och skuggning har använts för att studera betydelsen av dessa logiker för samarbetet i tre enheter inom barn-och ungdomspsykiatrin (BUP). Studien visar att MPT har integrativa effekter på de två logikerna. Den negativa effekten av NPM på de professionella utövarnas autonomi underlättas av arbete i MPT. MPT kan leda till en vård som både är resurseffektivt och professionellt utförd, men intentionerna att bedriva en individualiserad och behovsanpassad vård är svåra att uppnå till följd av det ökade ansvaret för att uppfylla effektivitetskrav. Tidigare studier kan ha underskatta den styrande effekten av kvantitativa effektivitetsmått som NPM inför. En förklaring kan vara att graden av patientorienterad och holistisk vård inte kan mätas med kvantitativa mått som NPM regimen kräver och inte heller fokuseras som en konsekvens av professionslogiken. Det innebär att MPT som post NPM reform motverkas om inte de höga, kvantifierade NPM kraven på resurseffektivitet reduceras.
International Journal of Critical Accounting, 2018
This article examines senior bank managers' evaluations of other banks in the interbank marke... more This article examines senior bank managers' evaluations of other banks in the interbank market during times of financial crisis. We conclude that the fair value principle demands greater awareness of the need for reputational monitoring, evaluation by thick trust and scepticism towards numbers. Monitoring during crisis includes neither historical cost nor fair value numbers, because numbers are distrusted. Consequently, valuation principles may not explain contagion effects during crisis.
Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av f... more Styrning, Organisering och Ledning Denna rapportserie tjänar flera sammanlänkande syften. En av forskningens viktigaste uppgifter är att ta reda på och presentera vad undervisningen bör handla om. I en tid där läroböcker och annan relevant publicering fortfarande tar lång tid att nå undervisningen och där det finns alternativa kanaler för kunskapsspridning skapas ett hålrum. Rapportserien är tänkt som ett instrument för att fylla nämnda hålrum. Texter som tar upp något eller några företeelser som bör presenteras för studenter och forskare med intresse för vad undervisningen bör handla om. Det forskningsfält som inkluderas här har en vid ram och har benämningen Styrning, organisering och ledning. Den vida ramen indikerar att det är en multivetenskaplig ansats som gäller. Varje rapport granskas i flera steg innan den publiceras elektroniskt. Någon eller några i redaktionen läser en inkommen text. I ett andra steg seminariebehandlas den och i ett tredje steg formaliagranskas texten ockå. Sist men inte minst går den att hämta på www.hb.se Rapportseriens redaktion består av
Unintended consequences of accountability and customer focus in healthcare : New Public Managemen... more Unintended consequences of accountability and customer focus in healthcare : New Public Management in action
Abstract
Purpose – The purpose of this paper is to enrich the theoretical understanding of the ph... more Abstract Purpose – The purpose of this paper is to enrich the theoretical understanding of the phenomenon of sensemaking where a conceptual shift was provoked by a serendipitous encounter. Design/methodology/approach – A theoretical framework consisting of three elements of reflexivity: the cognitive, the social, and the normative, all of which support the study. Semi-structured interviews were conducted in the investigation of a serendipitous Episode that occurred in a larger research project. This Episode took place at a meeting between a social welfare officer and a psychologist in which they discussed the treatment of a psychiatric patient.When the psychologist left the meeting for a brief period, the researchers, unexpectedly, were able to interview the social welfare officer alone. Findings – This interview revealed a deviation from the institutionalized patient treatment procedure that was explained to the researchers in earlier interviews. The study shows that shifts in sensemaking are possible when researchers are open to serendipitous encounters. This shift in sensemaking in this Episode was strategic because it concerned the three most important aspects of the actor’s decision making: how to make diagnosis, treatments, and cooperate around the patient. Research limitations/implications – It is recommended that researchers use the theoretical framework of reflexivity to test their sensemaking processes as well as remain open to changes in planned, traditional methodological approaches. Originality/value – The study applies a post-hoc analysis with reflections on serendipitous events that may guide researchers when they encounter unanticipated events and make anomalous discoveries. Keywords Qualitative research, Serendipity, Abduction, Sensemaking process, Serendipitous Paper type Research paper
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Papers by Roy Liff
Purpose – The purpose of this paper is to enrich the theoretical understanding of the phenomenon of
sensemaking where a conceptual shift was provoked by a serendipitous encounter.
Design/methodology/approach – A theoretical framework consisting of three elements of reflexivity:
the cognitive, the social, and the normative, all of which support the study. Semi-structured interviews
were conducted in the investigation of a serendipitous Episode that occurred in a larger research project.
This Episode took place at a meeting between a social welfare officer and a psychologist in which they
discussed the treatment of a psychiatric patient.When the psychologist left the meeting for a brief period,
the researchers, unexpectedly, were able to interview the social welfare officer alone.
Findings – This interview revealed a deviation from the institutionalized patient treatment procedure
that was explained to the researchers in earlier interviews. The study shows that shifts in sensemaking
are possible when researchers are open to serendipitous encounters. This shift in sensemaking in this
Episode was strategic because it concerned the three most important aspects of the actor’s decision
making: how to make diagnosis, treatments, and cooperate around the patient.
Research limitations/implications – It is recommended that researchers use the theoretical
framework of reflexivity to test their sensemaking processes as well as remain open to changes in
planned, traditional methodological approaches.
Originality/value – The study applies a post-hoc analysis with reflections on serendipitous events that
may guide researchers when they encounter unanticipated events and make anomalous discoveries.
Keywords Qualitative research, Serendipity, Abduction, Sensemaking process, Serendipitous
Paper type Research paper