Fredrik Bååthe, Gunnar Ahlborg Jr, Lars Edgren, Annica Lagström and Kerstin Nilsson
The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.
Abstract
Purpose
The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department.
Design/methodology/approach
Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings.
Findings
This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered.
Practical implications
For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure.
Originality/value
This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
Details
Keywords
C. Grill, G. Ahlborg Jr and E. Wikström
Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic…
Abstract
Purpose
Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates’ dialogue training.
Design/methodology/approach
A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used.
Findings
Managers’ experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers – such as acting democratically and pedagogically – and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors.
Research limitations/implications
Only eight managers participated in the intervention, but data afforded a basis for further research.
Practical implications
Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work.
Originality/value
Studies focusing on health care managers’ communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.
Details
Keywords
Mats Eklof and Gunnar Ahlborg Jr
This paper aims to test the effects on aspects of workplace communication relevant to teamwork, and social support, in hospital units, of a dialog training (DT) intervention based…
Abstract
Purpose
This paper aims to test the effects on aspects of workplace communication relevant to teamwork, and social support, in hospital units, of a dialog training (DT) intervention based on knowledge of key quality aspects related to interpersonal work-related communication among healthcare workers.
Design/methodology/approach
A cluster randomized controlled study conducted among approximately 300 Swedish healthcare workers employed at ten hospital units. Workplace communication was measured in the form of participative safety, trust/openness, and social support. Effects were tested at three-month and six-month follow-ups. Repeated measurements were made.
Findings
The results indicated that DT had a positive influence on participative safety and social support from managers. A positive tendency was observed for trust/openness.
Originality/value
Developing and practicing good staff communication in hospital units is an important area for interventions designed to improve job performance and health.
Details
Keywords
Christina Grill, Gunnar Ahlborg Jr, Ewa Wikström and Eva-Carin Lindgren
This paper aims to illuminate and analyse the participants’ experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning…
Abstract
Purpose
This paper aims to illuminate and analyse the participants’ experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning of dialogically oriented communication to prevent stress and ill health and to promote health, well-being, learning and efficiency in the organisation.
Design/methodology/approach
An intervention method based on dialogue theory, with Socratic provocations and concrete workplace examples enhanced authenticity of conversations. A qualitative study, using qualitative content analysis, entailed interviews with 24 nurses, assistant nurses and paramedics, strategically selected from 156 intervention participants.
Findings
Two themes emerged, dialogue-learning processes and dialogue-promoting communicative actions. The first includes risk-taking to overcome resistance and fear of dialogue, expressing openly thoughts and feelings on concrete issues and taboo subjects, listening to and reflecting on one’s own and others’ perspectives and problematising norms and values. The second comprises voicing opinions, and regarding one’s own limits; requesting support and room for manoeuvre; and restraining negative emotions and comments in the interest of well-being. Findings depict strengthened awareness and readiness regarding dialogue and multiple balancing of dialogue at work.
Research limitations/implications
This study implies further observing and examining of communicative patterns during workplace dialogue.
Practical implications
A useful approach to communication development for occupational health and personnel in health care and other workplace contexts.
Originality/value
Previously, arenas have been created for dialogue, but close-process studies of dialogue in health-care work are scarce. This study provides insights into how workplace communication can develop towards dialogue.
Details
Keywords
John M. Violanti and Michael E. Andrew
Policing requires atypical work hours. The present study examined associations between shiftwork and pregnancy loss among female police officers.
Abstract
Purpose
Policing requires atypical work hours. The present study examined associations between shiftwork and pregnancy loss among female police officers.
Design/methodology/approach
Participants were 91 female officers with a prior history of at least one pregnancy. Shiftwork information was assessed using daily electronic payroll work records. Any prior pregnancy loss (due to miscarriage) was self-reported. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for main associations.
Findings
On average, the officers were 42 years old, had 14 years of service, and 56% reported a prior pregnancy loss. Officers who worked dominantly on the afternoon or night shift during their career had 96% greater odds of pregnancy loss compared to those on day shift (OR = 1.96, 95% CI:0.71–5.42), but the result was not statistically significant. A 25% increase in percent of hours worked on night shift was associated with 87% increased odds of pregnancy loss (OR = 1.87, 95% CI:1.01–3.47). Associations were adjusted for demographic and lifestyle factors. Objective assessment of shiftwork via electronic records strengthened the study. Limitations include small sample size, cross-sectional design and lack of details on pregnancy loss or the timing of pregnancy loss with regard to shiftwork.
Research limitations/implications
The present study is preliminary and cross-sectional.
Practical implications
With considerable further inquiry and findings into this topic, results may have an impact on police policy affecting shift work and pregnant police officers.
Social implications
Implication on the health and welfare of police officers.
Originality/value
To our knowledge, there are no empirical studies which associate shiftwork and pregnancy loss among police officers. This preliminary study suggested an association between shiftwork and increased odds of pregnancy loss and points out the need for further study.
Details
Keywords
Christin Mellner, Walter Osika and Maria Niemi
Contemporary workplaces undergo frequent reorganizations in order to stay competitive in a working life characterized by globalization, digitalization, economic uncertainty, and…
Abstract
Purpose
Contemporary workplaces undergo frequent reorganizations in order to stay competitive in a working life characterized by globalization, digitalization, economic uncertainty, and ever-increased complexity. Managers are in the frontline of these challenges, leading themselves, organizations and their employees in high stress environments. This raises questions on how to support managers’ work-life sustainability, which is crucial for organizational sustainability. Mindfulness has been related to enhanced capacities to cope with challenges that are associated with organizational change. The authors evaluated short- and long-term effects of an eight-week mindfulness-based intervention in a company setting, which was going through reorganization.
Design/methodology/approach
Forty managers (42.5% males), mean age 54.53 (SD 5.13), were randomized to the mindfulness intervention or a non-active wait-list control. Self-report data were provided on individual sustainability factors in a work context: job demands and resources, psychological detachment, i.e. possibilities for letting go of work-related thoughts during leisure, control over work-nonwork boundaries, work-life balance, and mindfulness at baseline, postintervention, and at 6-month follow-up.
Findings
Linear mixed models (LMMs) analysis (all ps < 0.005 to 0.05) showed that the intervention group had a larger decrease in job demands and a smaller decrease in job resources, a larger increase in psychological detachment, work-nonwork boundary control, work-life balance, and mindfulness from baseline to postintervention when compared with the reference group. These initial effects were sustained at 6-month follow-up.
Originality/value
The study provides evidence that mindfulness practice can enhance managers’ long-term capacity to cope with challenging working conditions, and increase their work-life sustainability in times of organizational change and disruption.
Details
Keywords
Ellinor Tengelin, Rebecka Arman, Ewa Wikström and Lotta Dellve
The purpose of this paper is to explore managers' boundary setting in order to better understand their handling of time commitment to work activities, stress, and recovery during…
Abstract
Purpose
The purpose of this paper is to explore managers' boundary setting in order to better understand their handling of time commitment to work activities, stress, and recovery during everyday work and at home.
Design/methodology/approach
The paper has qualitatively‐driven, mixed method design including observational data, individual interviews, and focus group discussions. Data were analyzed according to Charmaz' view on constructivist grounded theory.
Findings
A first step in boundary setting was to recognize areas with conflicting expectations and inexhaustible needs. Second, strategies were formed through negotiating the handling of managerial time commitment, resulting in boundary‐setting, but also boundary‐dissolving, approaches. The continuous process of individual recognition and negotiation could work as a form of proactive coping, provided that it was acknowledged and questioned.
Research limitations/implications
These findings suggest that recognition of perceived boundary challenges can affect stress and coping. It would therefore be interesting to more accurately assess stress, coping, and health status among managers by means of other methodologies (e.g. physiological assessments).
Practical implications
In regulating managers' work assignments, work‐related stress and recovery, it seems important to: acknowledge boundary work as an ever‐present dilemma requiring continuous negotiation; and encourage individuals and organizations to recognize conflicting perspectives inherent in the leadership assignment, in order to decrease harmful negotiations between them. Such awareness would benefit more sustainable management of healthcare practice.
Originality/value
This paper highlights how managers can handle ever‐present boundary dilemmas in the healthcare sector by regulating their time commitments in various ways.
Details
Keywords
Iain Snelling, Lawrence Adrian Benson and Naomi Chambers
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Abstract
Purpose
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Design/methodology/approach
This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.
Findings
Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.
Research limitations/implications
The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.
Practical implications
Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.
Originality/value
This paper adds some detail to the general understanding of learning leadership in practice.
Details
Keywords
Emma Hagqvist, Stig Vinberg, Bodil J. Landstad and Mikael Nordenmark
The purpose of this paper is to explore the gaps between experienced working conditions (WCs) and the perceived importance of these conditions in relation to subjective health in…
Abstract
Purpose
The purpose of this paper is to explore the gaps between experienced working conditions (WCs) and the perceived importance of these conditions in relation to subjective health in Swedish public sector workplaces.
Design/methodology/approach
In total, 379 employees answered questions concerning WCs and health. Nine WC areas were created to measure the gap between the experienced WCs and the perceived importance of each condition. These WC areas were: physical work environment, social relationships, communication, leadership, job control, recognition, self-development, workplace culture and work/life satisfaction. Subjective health was measured using mental ill health, well-being and general health.
Findings
The results indicated relatively large gaps in all nine WC areas. Leadership, physical work environment and work/life satisfaction in particular seemed to be problematic areas with relatively large gaps, meaning that employees have negative experiences of these areas while perceiving these areas as very important. Additionally, all WC areas were significantly related to subjective health, especially regarding mental ill health and well-being; the larger the gaps, the worse the subjective health. The WC areas of work/life satisfaction, self-development, social relationships, communication and recognition had the highest relationships and model fits. This indicates that it is most problematic from an employee’s point of view if there are large gaps within these WC areas.
Originality/value
This study improves the understanding of workplace health by exploring the gap between experienced WCs and the perceived importance of these conditions.
Details
Keywords
Aizzat Mohd Nasurdin, Cheng Ling Tan and Sabrina Naseer Khan
This paper aims to examine the effects of high-performance work practices (HPWPs) (participation, training and compensation) on nurses’ job performance (task and contextual…
Abstract
Purpose
This paper aims to examine the effects of high-performance work practices (HPWPs) (participation, training and compensation) on nurses’ job performance (task and contextual) through the mediating role of job satisfaction. As nurses form the bulk of health-care professionals, their performance at work is crucial in determining patient satisfaction regarding care quality. HPWPs have been recognized as having the ability to affect employees’ work attitudes and behaviours positively. Specifically, these practices foster job performance.
Design/methodology/approach
Self-administered questionnaires were used to collect the survey data on 639 staff nurses working in large private hospitals in Malaysia. Data were subsequently analysed using the partial least squares method.
Findings
The findings indicate that job satisfaction serves to mediate the relationships between the three HPWPs (participation, training and compensation) and the two dimensions of job performance (task performance and contextual performance).
Research limitations/implications
First, as all variables were measured using self-reports, a common-method bias could exist (Podsakoff et al., 2003). Hence, future researchers may want to combine self-assessments and supervisory or peer assessment to improve the validity of the outcomes. Second, the cross-sectional nature of this study limits our ability to make causal inferences. Bias could happen because the study examined both exogenous and endogenous variables at the same time. Thus, a longitudinal approach taken in the future could cross-validate the current findings and provide additional support regarding the causality of the HPWPs-job performance relationship. Third, the data were collected from staff nurses working in large private hospitals in Peninsular Malaysia. Thus, one should be careful to generalize the findings to different health-care professional groups and organizations.
Practical implications
From the practical perspective, it is evident from the findings that as job satisfaction is able to enhance job performance and given the need for nurses to provide quality health-care services, private hospital authorities concerned with encouraging greater job performance among their nursing workforce need to provide adequate support to their employees. This could be achieved through the implementation of HPWPs. Perceptions of the extent of a hospital’s HPWPs in terms of participation, training and compensation, have significant and positive effects on nurses’ level of job satisfaction. Therefore, it would be worthwhile for private hospitals to encourage more opportunities for nurses to participate in decision-making regarding their work. In addition, frequent training activities will be able to enhance nurses’ knowledge, skills and abilities, resulting in greater satisfaction
Originality/value
To the best of the authors’ knowledge, this is the first attempt to investigate the effects of HPWPs on nurses’ job performance in the Malaysian private health-care context. As studies using Eastern samples are relatively limited, the findings from this study would serve to expand the extant literature from a cross-cultural perspective.