Elg Mattias, Stenberg Jesper, Kammerlind Peter, Tullberg Sofia, Olsson Jesper
Division of Quality Management and Technology, HELIX Research Centre, Linköping University, Linkõing, Sweden.
Int J Health Care Qual Assur. 2011;24(2):101-23. doi: 10.1108/09526861111105077.
The purpose of this paper is to empirically examine developmental trends in healthcare organisation management practice and improvement work.
DESIGN/METHODOLOGY/APPROACH: Primary healthcare centre (n = 1,031) and clinical hospital department (n = 1,542) managers were surveyed in spring 2007 (response rate 46 per cent). This article compares results from this survey with a study in 2003. A theoretical framework based on organisational inner context, organisational outer context, external environment and outcomes form the analytical base. Comparisons were made using independent two-sample t-tests.
A general aspect, identified empirically, is the tendency toward increased external pressure on leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers increasingly influence and shape the choices made by healthcare managers about where to focus improvement efforts. Three different trends are empirically identified and elaborated: take-control logic; practice-based improvement; and patient-centeredness.
RESEARCH LIMITATIONS/IMPLICATIONS: Healthcare leaders should carefully design new management control systems that support healthcare micro systems. Findings support the general assumption that staff increasingly tend to focus organisational changes on management control.
ORIGINALITY/VALUE: This study extends management research with a unique survey. Through two measurements made in 2003 and 2007, several important trends about how healthcare organisations are managed and developed are identified.
本文旨在实证研究医疗保健组织管理实践和改进工作的发展趋势。
设计/方法/途径：2007年春季对基层医疗中心（n = 1031）和临床医院科室（n = 1542）的管理人员进行了调查（回复率为46%）。本文将此次调查结果与2003年的一项研究结果进行了比较。一个基于组织内部环境、组织外部环境、外部环境和结果的理论框架构成了分析基础。使用独立样本t检验进行比较。
通过实证确定的一个总体情况是，领导者在改进工作中面临的外部压力有增加的趋势。高层管理决策、患者压力和政策制定者做出的决策越来越多地影响并塑造了医疗保健管理者在确定改进工作重点方面所做的选择。通过实证确定并阐述了三种不同的趋势：控制逻辑；基于实践的改进；以及以患者为中心。
研究局限性/启示：医疗保健领导者应精心设计支持医疗微观系统的新管理控制系统。研究结果支持了一个普遍的假设，即员工越来越倾向于将组织变革聚焦于管理控制。
原创性/价值：本研究通过一项独特的调查扩展了管理研究。通过2003年和2007年进行的两次测量，确定了有关医疗保健组织如何管理和发展的几个重要趋势。
