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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.

The study was based on a discursive approach. Group discussions with three groups of Finnish middle managers (n = 39) were analyzed using discourse analysis.

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.

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.

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.

This study aims to make visible the dynamic nature of leader–member exchange (LMX) in the changing realm of health-care leadership.

The qualitative study used an open questionnaire, which was distributed amongst nursing staff and managers at a Finnish public university hospital.

The participants described partly LMX theory, but the leader-member relationship was also influenced by the organizational culture and the existing management practices. Nursing staff were found to have a more variable and dynamic role in the LMX relationship than has previously been reported. The research therefore provided novel information for the field of health-care research.

The presented research was limited by the content of the data, as the collected single narratives were rather short; however, the fact that a large number of narratives were collected from diverse participants strengthened the ability to reliably answer the research questions.

Although the participants described partly LMX theory, the leader–member relationship is also influenced by the organizational culture and existing management practices; the finding that nurses have more variable roles in LMX relationships in the health-care context was new insight in this field. Therefore, the presented findings can help decision-makers change the current, perhaps antiquated, leadership practices at health-care organizations.

This study provides new insight into the field of LMX research in terms of the important role of nursing staff, the organizational factors that influence the LMX relationship and the dynamic nature of LMX relationships.

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.

Ten health care professionals (five leaders and five members) were interviewed to subject to qualitative thematic analysis.

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.

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.

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.

The novelty of the study relates to the identification of the collective, emotional and multidimensional nature of LMX relationships.

The purpose of the paper is to investigate ambiguous language use in health-care project plans in a manner that accounts for the wider, institutional, public health-care context.

The article deployed a case study approach and drew from Fairclough's critical discourse analysis (CDA) as well as a keyword analysis to investigate two time-sequenced versions of the same project planning document for a health-care project in Finland.

In the project plans investigated, the study identified patient as a keyword possessing various meanings within the public health-care context. By examining the discursive practices around the keyword patient, the study demonstrated their role in constituting the institutional context as well as the function of this context in constraining these practices.

By looking at the potential of the CDA to investigate discursive practices of the keyword in two sequential versions of a project plan within the broader context of public health care, the study adds to the scant existing literature on critically oriented health-care project communication studies.

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.

Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue.

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.

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.

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.

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.

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.

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.

The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups.

By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

The purpose of this paper is to analyse the impact of reforms designed to address economic and demographic challenges in England with reference to the authors’ own empirical work providing a critique of their impact and suggesting a way to improve the quality of social care for older people.

The research was a qualitative study conducted in a participatory manner in which older people were positioned as co-creators of the research study. This involved setting the scope of the study and identifying and refining the themes used in the analysis of an inquiry board and interviews.

The research findings highlight the threat of recent moves that emphasise “independence” and “self-management” particularly as they risk marginalising some groups of older people and reducing the quality of care. An alternative approach drawn from the ethics of care is suggested.

The research study focused on a narrow selection of older people and future work will wish to explore concepts of “care” and “independence” in additional contexts and of reforms in other geographies.

The researchers argue that the current reform agenda threatens the quality of care services and suggest improvements to the way in which services might be organised and presented.

It is intended that the research will contribute to social policy debates and particularly those that focus on social care. The study also looks to contribute to current work in the fields of critical gerontology, feminist ethics and the management of public services more generally.

The paper presents a novel and critical viewpoint of current social care policy in England and will therefore be of interest to policy-makers and to professionals.

The purpose of this paper is to analyse how accounts of collaboration practice were made and used to construct accountability in the empirical context of coordination associations, a Swedish form of collaboration between four authorities in health and social care. They feature pooled budgets, joint leadership and joint reporting systems, intended to facilitate both collaboration and (shared) accountability.

Empirical data were collected in field observations in local, regional and national settings. In addition, the study is based on analysis of local association documents such as evaluations and annual reports, and analysis of national agency reports.

Accountability is constructed hierarchically with a narrow focus on performance, and horizontal (shared) accountability as well as outcomes are de-emphasised. Through this narrow construction of accountability the coordination associations are re-created as hierarchical and accountability is delegated rather than shared.

Features such as pooled budgets, joint leadership and joint reporting systems can support collaboration but do not necessarily translate into shared accountability if accountability is interpreted and constructed hierarchically.

When practice conforms to what is counted and accounted for, using the hierarchical and narrow construction of accountability, the result may be that the associations become an additional authority. That would increase rather than decrease fragmentation in the field.

This research derives from first-hand observations of actor-to-actor episodes complemented with the analysis of documents and reports. It provides critical analysis of the construction and evaluation of accounts and accountability related to practice and performance in collaboration. The main contribution is the finding that despite the conditions intended to facilitate inter-organisational collaboration and horizontal accountability, the hierarchical accountability persisted.

Finland represents one of the Nordic welfare states where the role of the public sector as the organiser and provider of health and social care is strong. However, the amount of voluntary work in social and health care services is surprisingly big. The strongest advocates for keeping the volunteers outside are hospitals and health centres while at the same time they are suffering from shortages of staff and staff is reporting lack of time to provide needed care for their patients. The purpose of this paper is to report the results of a study of the attitudes of professionals towards voluntary work in hospitals.

The paper is based on an exploratory study done in three hospitals, two from an urban area and one in a rural area. The interviewees represent nursing and care staff (n=21). The main questions were how staff members see options, constraints and drawbacks of volunteering regarding professional roles, work division, coordination and management.

Attitudes of staff varied from positive to conditional. The approaches towards voluntary work varied from holistic to task-centred or patient-centred and were linked with organisational approach, professional approach or considerations of patients’ well-being. Critical views were expressed related to managerial issues, patients’ safety and quality of care. Increasing the amount of voluntary work done in hospitals would require a considered strategy and a specifically designed process for coordination, management and rules on the division of labour.

The research raised themes for further quantitative studies to elaborate the findings on the similarities and differences of the opinions of different staff categories and to be able to develop further the heuristic model of volunteer management triangle suggested in the paper.

The study raises questions of the need and promotion of volunteers in general and especially in health care services. It also raises critical views related to voluntary work in hospitals.

The study is a new initiative to discuss voluntary work and how to manage volunteers in hospitals. It provides valuable knowledge for practitioners in health care involved in volunteer management and coordination.

The purpose of this paper is to explore the process of evolution of medical autonomy as an analytic and historical aspect of the medical work organization in a public bureaucracy.

The authors draw on the analytic concept of organizational contradictions (Heydebrand, 1977) to inform a dialectical approach in organizational analysis. Semi-structured interviews with 20 doctors of a Greek general public hospital were conducted and archival data were collected.

The findings suggest that the historical development of two contradictions characterize the process of medical autonomy evolution. The first contradiction tends to develop between medical autonomy, as a self-control relation, and the established division of labour through which bureaucratic control is exercised over the allocation of resources and over the distribution of healthcare service. The second contradiction tends to develop between those reified aspects of the medical work organization and the ongoing organizing activity, i.e. activity towards extending, intensifying and centralizing organizational control over labour, resources and the distribution of healthcare services. These contradictions indicate a pressure towards constraining health professionals’ power to self-define their relationship with patients and towards curtailing their discretionary domain over the use of resources.

This paper offers an empirical approach to materialist dialectics for organizational analysis towards conceptualizing change as a historical process.