Elsa Kristiansen, Jarle Løwe Sørensen, Eric Carlström and Leif Inge Magnussen
This case study maps the perceived collaboration between public, private and volunteer organizations during maritime crisis work, with a substantive focus on communication…
Abstract
Purpose
This case study maps the perceived collaboration between public, private and volunteer organizations during maritime crisis work, with a substantive focus on communication, information flow and distribution of activities. The exercise studied was held in the far north in Norway. It was estimated to be Europe’s most extensive exercise in 2016. The paper aims to discuss these issues.
Design/methodology/approach
The data were collected through observations, semi-structured interviews and reviews of associated frameworks and evaluation reports. Data were collected simultaneously at five different sites.
Findings
The key findings showed an intra-organizational focus, a predominance of drills and different informal exercises instead of a cohesive exercise. This made evaluation difficult. Reasons for the fragmentation of the exercise appear to be the size of the exercise and the script.
Research limitations/implications
Generalization of findings is problematic as this study involved only one exercise. However, this study has national significance, as it involved 22 public, private and volunteer stakeholder organizations, including civil emergency response units, the military, the Norwegian Civil Defence, and major maritime volunteer organizations such as the Norwegian Society for Sea Rescue. Collaboration between actors suffered from the size of the exercise. A smaller exercise, less dependency on predetermined scripts, and more receptivity toward improvisation could improve collaboration.
Originality/value
The study shows how collaboration fails as an effect of strict agendas and scripts to accomplish an impressive but complex and oversized exercise.
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Jarle Lowe Sorensen, Eric D. Carlström, Leif Inge Magnussen, Tae-eun Kim, Atle Martin Christiansen and Glenn-Egil Torgersen
The purpose of this paper is to investigate the perceived effects of a maritime cross-sector collaboration exercise. More specifically, this study aims to examine whether past…
Abstract
Purpose
The purpose of this paper is to investigate the perceived effects of a maritime cross-sector collaboration exercise. More specifically, this study aims to examine whether past exercise experience had an impact on the operative exercise participant’s perceived levels of collaboration, learning and usefulness.
Design/methodology/approach
This was a non-experimental quantitative survey-based study. A quantitative methodology was chosen over qualitative or mixed-methods methodologies as it was considered more suitable for data extraction from larger population groups, and allowed for the measurement and testing of variables using statistical methods and procedures (McCusker and Gunaydin, 2015). Data were collected from a two-day 2017 Norwegian full-scale maritime chemical oil-spill pollution exercise with partners from Norway, Germany, Iceland, Denmark and Sweden. The exercise included international public emergency response organizations and Norwegian non-governmental organizations. The study was approved by the Norwegian Centre for Research Data (ref. 44815) and the exercise planning organization. Data were collected using the collaboration, learning and utility (CLU) scale, which is a validated instrument designed to measure exercise participant’s perceived levels of collaboration, learning and usefulness (Berlin and Carlström, 2015).
Findings
The perceived focus on collaboration, learning and usefulness changed with the number of previous exercises attended. All CLU dimensions experienced decreases and increases, but while perceived levels of collaboration and utility reached their somewhat modest peaks among those with the most exercise experience, perceived learning was at its highest among those with none or little exercise experience, and at its lowest among those with most. These findings indicated that collaboration exercises in their current form have too little focus on collaborative learning.
Research limitations/implications
Several limitations of the current study deserve to be mentioned. First, this study was limited in scope as data were collected from a limited number of participants belonging to only one organization and during one exercise. Second, demographical variables such as age and gender were not taken into consideration. Third, limitation in performing a face-to-face data collection may have resulted in missing capturing of cues, verbal and non-verbal signs, which could have resulted in a more accurate screening. Moreover, the measurements were based on the predefined CLU-items, which left room for individual interpretation and, in turn, may cause somewhat lower term validity. As the number of international and national studies on exercise effects is scarce, it is important to increase further knowledge and to learn more about the causes as to why the perceived effects of collaboration exercises are considered somewhat limited.
Practical implications
Exercise designers may be stimulated to have a stronger emphasis on collaborative learning during exercise planning, hence continuously work to develop scripts and scenarios in a way that leads to continuous participant perceived learning and utility.
Social implications
Collaboration is established as a Norwegian national emergency preparedness principle. These findings may stimulate politicians and top crisis managers to develop national collaboration exercise script guidelines that emphasize collaborative learning and development.
Originality/value
This study shows how exercise experience impacted participant’s perceived levels of collaboration, learning and usefulness. Findings indicated that collaboration exercises in their current form have too little focus on collaborative learning.
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Kristina Rosengren, Sandra C. Buttigieg, Bárbara Badanta and Eric Carlstrom
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).
Abstract
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.
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Kristina Rosengren, Petra Brannefors and Eric Carlstrom
This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge…
Abstract
Purpose
This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).
Design/methodology/approach
A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.
Findings
Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).
Practical implications
Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.
Social implications
Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.
Originality/value
Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.
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Leif Inge Magnussen, Eric Carlstrøm, Jarle Løwe Sørensen, Glenn-Egil Torgersen, Erlend Fritjof Hagenes and Elsa Kristiansen
This research investigates the perceived collaboration between public, private, and volunteer organisations during maritime crisis work, with an emphasis on learning and…
Abstract
Purpose
This research investigates the perceived collaboration between public, private, and volunteer organisations during maritime crisis work, with an emphasis on learning and collaboration. The purpose of this paper is to investigate participants’ perceived collaboration training in relation to learning and usefulness.
Design/methodology/approach
The exercise studied in this research was run in the far North in Norway. It was estimated by the participants to be Europe’s most extensive exercise in 2016. Mixed methods research approach was applied, i.e. on-site observations, photos and interviews were conducted during the exercise. After the exercise, an online survey was distributed to emergency personnel holding different positions in conjunction with this exercise.
Findings
As reported, the exercise contributed to new insights on the relationship between collaboration and learning. The study showed that collaborative elements in exercises contribute to perceived learning (R=0.86, R2=0.74), and that learning in turn had a perceived beneficial effect on actual emergency work (R=0.79, R2=0.62).
Research limitations/implications
The possible research implications from this study include more focus on collaboration and new training schemes that could increase learning and usefulness.
Practical implications
Collaboration between actors seemed to suffer from the size of the exercise. A smaller exercise, less dependency on predetermined scripts, and more receptivity towards improvisation could improve collaboration.
Social implications
Increased awareness on the outcomes of collaboration exercise might increase their learning and usefulness, providing societies with improved rescue services.
Originality/value
This research implies that increased perceived collaboration has an effect on learning and usefulness in maritime exercises.
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Eric Carlström and Lars-Eric Olsson
– 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.
Abstract
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.
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Johan M. Berlin and Eric D. Carlström
The purpose of this paper is to study why collaboration among police, fire, and ambulance services is minimised at accident scenes.
Abstract
Purpose
The purpose of this paper is to study why collaboration among police, fire, and ambulance services is minimised at accident scenes.
Design/methodology/approach
Observations and semi‐structured interviews were carried out during 2007‐2008. The data material comprises a total of 248 hours of observations on 20 occasions and 57 interviews with 80 people.
Findings
The study identifies the difference between rhetoric and practice in connection with accident work. Collaboration is seen as a rhetorical ideal rather than something that is carried out in normal practice. Asymmetry, uncertainty and lack of incentives are important explanations as to why only limited forms of collaboration are actually implemented.
Research limitations/implications
The paper shows a distinction between collaboration as rhetoric and practical collaboration at accident scenes.
Practical implications
The article proposes a multi‐faceted collaboration concept. In this way, collaboration can be developed and refined.
Originality/value
The results of the study show that police, fire, and ambulance services want to develop excellent forms of collaboration at the accident scene, but avoid this as it leads to uncertainty and asymmetries and because of a lack of incentives. However, simpler forms of collaboration may be realistic in the organisation of everyday work at accident scenes.
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Annika Andersson, Eric D. Carlstrom, Bengt Ahgren and Johan M. Berlin
– The purpose of this paper is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.
Abstract
Purpose
The purpose of this paper is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.
Design/methodology/approach
Interviews with 23 participants from four collaboration exercises in Sweden were carried out during autumn 2011. Interview data were subjected to qualitative content analysis.
Findings
Findings indicate that the exercises tend to focus on intra-organisational routines and skills, rather than developing collaboration capacities. What the participants practiced depended on roles and order of arrival at the exercise. Exercises contributed to practicing leadership roles, which was considered essential since crises are unpredictable and require inter-organisational decision making.
Originality/value
The results of this study indicate that the ability to identify boundary objects, such as injured/patients, was found to be important in order for collaboration to occur. Furthermore, lessons learned from exercises could benefit from inter-organisational evaluation. By introducing and reinforcing certain elements and distinct aims of the exercise, the proactive function of collaboration exercises can be clarified.
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Eric D. Carlström and Inger Ekman
The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had…
Abstract
Purpose
The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person‐centred care (PCC) for patients with chronic heart failure.
Design/methodology/approach
Surveys were sent out to 170 nurses. The survey included two instruments – the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC).
Findings
The results indicate that a culture with a dominating focus on social competence decreases “routine seeking behaviour”, i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well‐defined framework.
Practical implications
An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes.
Originality/value
Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units – i.e. the health workers in different hospital wards – was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.