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The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created.

Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work.

The design of the reforms and leadership are essential preconditions for work motivation.

The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.

This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.

Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.

The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory.

The purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.

The data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.

The ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.

The study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops.

The aim of this paper is to investigate the development of the quality movement in Sweden since the mid-20th century. The authors are convinced that a summary of the Swedish quality journey so far will offer important lessons for further quality improvements in Sweden and elsewhere.

The authors study how the quality movement has been included in the industrial agenda and how it has been adopted in student curricula and in research. The authors have a focus on how business leaders have learnt, adopted, adapted and innovated with respect to quality development. often in collaboration with academia.

Although the quality movement has fit well with the Swedish culture and that successful corporate leaders have successfully used the specific cultural characteristics there is still a lot to be learnt with respect to the public sector, where the ideas from the quality movement have problem to overcome institutional barriers.

The study is limited to the Swedish context.

There is a serious need to revitalize the public sector by getting leaders and politicians to understand the need for systematic quality improvement.

If future Swedish achievements with respect to healthcare and other social welfare elements are to once again become world-class, the public sector needs to be open-minded and collaborate with the industrial sector and academia to find cost-effective strategies for making quality improvements. However, the private sector must also be alert not to be overtaken by some highly active Asian countries.

Swedish large companies have been very successful in applying quality leadership – however, in the public sector, this has not been the case. Suggestions for improvement are made.

This paper aims to explore whether the principles behind improvement methods and the underlying learning orientations of ambidexterity have the potential to support the managing of ideas for implementation.

By combining improvement methods and ambidexterity, this study presents a pragmatic framework for innovative working with a scientific underpinning linked to organizational learning.

The descriptive stages in the plan-do-check-act method for improvement are instructive in their focus on progress and helpful in untangling the more explanatory nature of ambidexterity to frame innovative working.

Although the framework’s usefulness for innovative working is subject to future studies, the implementation, validation and results of the framework in pilot research may contribute to the body of knowledge.

The proposed framework can be used in teaching the key role of strategic leadership to explore and exploit over time. The framework has the potential to guide innovative working in practice by making better use of the employees’ tacit knowledge in such a way that they are empowered to explore new ways of defining problems and searching for solutions to improve organizational performance. The results of the implementation will impact the employees’ quality of life.

This study advances the current understanding of how the seemingly contradictory activities of exploration and exploitation can model an integrative learning approach.

The purpose of this study is to contribute to the knowledge base on how performance measurement drives improvements in healthcare practice.

The study is based on a single in-depth case study. The critical incident technique (CIT) has been applied in order to identify significant occurrences of performance measurement in terms of events, incidents, processes, and issues identified by respondents from the case organization. These critical incidents have been analysed and interpreted using a theoretical framework suggesting that performance measurement may be applied for exploratory or regulatory purposes as well as ad hoc or continuously in healthcare practice.

The study suggests that performance measurement may be a versatile method for driving improvement in healthcare organizations. Six types of activities directly or indirectly drive improvement in the clinical department: continuous follow-up in formal arenas and meetings; improvement work; professional efforts; goal deployment; reporting based on external demands; and creating awareness in everyday clinical work. Healthcare organizations that strive to practice performance measurement as a driver for improvement need to find infrastructures in which it is being integrated into the daily life of organizational healthcare practice.

The study provides an original account of the prerequisites and actions for driving improvement through performance measurement in a healthcare setting. Since the operations management perspective in healthcare is significantly lacking, the study offers a unique perspective which may be the basis for both practice development and further scholarly inquiry and theory development.