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The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work.

The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis.

The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work.

For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment.

The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work.

The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO).

Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n=17) nurses at two Swedish hospitals.

The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement.

Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned.

The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery Spirits, as institutional entrepreneurs can, working in a team, implement sustained change in hospital clinical practice.

This paper describes two case studies, conducted at two Swedish hospitals over a period of two years, in which changes in clinical practice were implemented. In both cases, key-actors, termed Fiery Spirits, played critical roles in these changes. The authors use a qualitative approach and take an intra-organizational perspective with semi-structured in-depth interviews and document analysis.

The new clinical practices were successfully implemented with a considerable influence of the Fiery Spirits who played a pivotal role in the change efforts. The Fiery Spirits persuasively, based on their structural and normative legitimacy and the adoption of learning processes, advocated, and supported change.

Fiery Spirits, given flexibility and opportunity, can be powerful forces for change outside the trajectory of management-inspired and management-directed change. Team members, when inspired and encouraged by Fiery Spirits, are less resistant to change and more willing to test new clinical practices.

The paper complements literature on how the Fiery Spirit concept aligns with concepts of clinical governance and leadership and how change can be achieved. Additionally, the findings show the effects of legitimacy and learning processes on change in clinical practice.

The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records.

A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix.

Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized.

A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas.

The trust matrix’s usefulness as a tool for organizations to analyze trust problems and issues is demonstrated.

Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.

Regardless of who or where we are and when we get sick, we expect healthcare to make us well and to handle us and our information with care and respect. Today, most healthcare institutions work separately, making the flow of patient information sub‐optimal and the use of common standards practically unheard of. The purpose of this paper is to emphasise the use for standards to improve information security in process‐oriented distributed healthcare.

The paper introduces a real‐life case which is analysed to highlight how and where standards can and should be used in order to improve information security in process‐oriented distributed healthcare.

In total, 11 flaws or problems in information security and process‐orientation are identified. From these, six changes are suggested which address how information is handled, and how organizational routines should be standardized.

The case setting is Swedish healthcare, but problems can be shared across international borders. The purpose is to highlight the issues at hand.

If suggested changes are implemented, healthcare processes will be more streamlined and focused on patients. Routines will be standardized and uncertainties thus removed in terms of how to act in certain situations.

Healthcare and academia has yet to address both document and process issues concerning standardization in distributed healthcare. There are also few actual cases from a patient perspective. This paper provides lessons learned from a real‐life case, where results may impact how standardization is addressed in healthcare organizations.

The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers.

The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers.

The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians’ trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role.

This paper’s findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers.

The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities.

The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.