Anneli Hujala, Helena Taskinen, Sanna Laulainen, Charlotte Klinga and Sandra Schruijer
In the implementation of integrated care, the role of managers is important and their mutual collaboration should be addressed more visibly. The purpose of this study was to…
Abstract
Purpose
In the implementation of integrated care, the role of managers is important and their mutual collaboration should be addressed more visibly. The purpose of this study was to investigate how cross-boundary collaboration is constructed in the discourse of middle-level managers in health and social care.
Design/methodology/approach
The study was based on a discursive approach. Group discussions with three groups of Finnish middle managers (n = 39) were analyzed using discourse analysis.
Findings
Five ways of talking about cross-boundary collaboration were identified, labeled “ideal”, “structure”, “defence”, “money” and “support” discourses. In the ideal discourse, cross-boundary collaboration appeared as a “good thing” and is self-evident. Structural discourse defined managers as passive actors in self-sustaining entities. Defensive discourse highlighted the problems of cross-boundary collaboration and the hierarchy within the health and social sectors. Financial discourse constituted the ultimate obstacle to successful cross-boundary collaboration, and both strengthened and explained defensive discourse. Supportive discourse portrayed other managers as partners and as an important resource.
Research limitations/implications
Cross-boundary collaboration can be experienced as a resource, helping managers cope with their workload. However, identification of and continuous attention to challenges at macro, meso and micro levels of integrated care is crucial for successful collaboration. Thus, critical discussion of collaboration needs to be given space.
Originality/value
The study design and discursive approach highlights the power of language and give voice to middle managers who are key actors when implementing integrated care.
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Keywords
Sari Kristiina Hirvi, Sanna Laulainen and Helena Taskinen
The purpose of this study is to address the construction of trust in leader member exchange (LMX) relationships as a multidimensional phenomenon and identify the importance of…
Abstract
Purpose
The purpose of this study is to address the construction of trust in leader member exchange (LMX) relationships as a multidimensional phenomenon and identify the importance of emotional and collective factors contributing to this phenomenon.
Design/methodology/approach
Ten health care professionals (five leaders and five members) were interviewed to subject to qualitative thematic analysis.
Findings
Four main themes in the data were identified (work roles, collectivity, interaction and participation) and linked to two main elements of LMX trust relations: core and contextual. The results extend understanding of the construction and maintenance of trust in LMX relationships, indicating that it is a more complex and socially constructed phenomenon than previously described.
Research limitations/implications
Despite identified limitations of the study (the small amount of empirical material, interpretive research method and purposive sampling of participants), the findings reveal that constructing trust in LMX relationships is more multidimensional than generally portrayed in traditional LMX theory and its three-stage continuum. This study suggests that a broader perspective should be adopted in LMX research, treating it not only as a collective phenomenon but also considering leaders and members as emotional individuals.
Practical implications
Understanding the multidimensional nature of LMX relationships is helpful for developing interpersonal relationships in organizations and leadership practices through recognition of the importance of the transparency, practices and adequacy of mutual interaction. The results presented here may contribute to such understanding and help leaders to relate to members as both subjective individuals and parts of a complex social network. The results may also increase members' awareness of possible ways that they can promote the development of good LMX relationships in organizations.
Originality/value
The novelty of the study relates to the identification of the collective, emotional and multidimensional nature of LMX relationships.
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Anneli Hujala, Mieke Rijken, Sanna Laulainen, Helena Taskinen and Sari Rissanen
The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of…
Abstract
Purpose
The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions.
Design/methodology/approach
The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies.
Findings
Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients’ active agency. The potential restrictions and consequences of a “business-like” orientation must be paid careful attention when dealing with patients with multimorbidity.
Research limitations/implications
The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed.
Social implications
The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.
Originality/value
By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.
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Anneli Hujala, Sanna Laulainen and Kajsa Lindberg
– The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management.
Abstract
Purpose
The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management.
Design/methodology/approach
Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue.
Findings
In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management.
Originality/value
The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.