Erlingsdottir Gudbjörg, Ersson Anders, Borell Jonas, Rydenfält Christofer
Department of Design Sciences, Lund University , Sweden.
Department of Intensive Care Medicine, Skåne University Hospital , Malmö, Sweden.
J Health Organ Manag. 2018 Mar 19;32(1):69-84. doi: 10.1108/JHOM-02-2017-0027. Epub 2018 Jan 4.
Purpose The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often characterized by problems and solutions that have been formulated by higher levels of management. This top-down management approach has not been well received by the professional community. As a result, improvement processes are frequently abandoned, resulting in disrupted and dysfunctional organizations. This paper presents two successful change processes where managerial leadership was used to coach the change processes by distributing mandates and resources. After being managerially initiated, both processes were driven by local agency, decisions, planning and engagement. Design/methodology/approach The data in the paper derive from two qualitative case studies. Data were collected through in-depth interviews, observations and document studies. The cases are presented as process descriptions covering the different phases of the change processes. The focus in the studies is on the roles and interactions of the actors involved, the type of leadership and the distribution of agency. Findings Five factors emerged as paramount to the successful change processes in the two cases: local ownership of problems; a coached process where management initiates the change process and the problem recognition, and then lets the staff define the problems, formulate solutions and drive necessary changes; distributed leadership directed at enabling and supporting the staff's intentions and long-term self-leadership; mutually formulated norms and values that serve as a unifying force for the staff; and generous time allocation and planning, which allows the process to take time, and creates room for reevaluation. The authors also noted that in both cases, reorganization into multi-professional teams lent stability and endurance to the completed changes. Originality/value The research shows how management can initiate and support successful change processes that are staff driven and characterized by local agency, decisions, planning and engagement. Empirical descriptions of successful change processes are rare, which is why the description of such processes in this research increases the value of the paper.
目的 本文旨在描述在医疗保健领域两个成功的变革过程中出现的五个显著因素。医疗保健领域的组织变革往往具有由高层管理人员制定的问题和解决方案的特点。这种自上而下的管理方法并未得到专业群体的广泛认可。因此，改进过程经常被放弃，导致组织混乱和功能失调。本文介绍了两个成功的变革过程，在这些过程中，管理领导力通过分配任务和资源来指导变革过程。在由管理层发起后，这两个过程都由地方机构、决策、规划和参与推动。 设计/方法/途径 本文的数据来自两个定性案例研究。数据通过深入访谈、观察和文献研究收集。案例以涵盖变革过程不同阶段的过程描述呈现。研究的重点是所涉及的行动者的角色和互动、领导类型以及机构的分布。 发现 五个因素在这两个案例的成功变革过程中至关重要：对问题的地方所有权；一个由管理层发起变革过程和问题识别，然后让员工定义问题、制定解决方案并推动必要变革的指导过程；旨在促进和支持员工意图及长期自我领导的分布式领导；作为员工统一力量的共同制定的规范和价值观；以及慷慨的时间分配和规划，这使得过程有时间进行，并为重新评估创造空间。作者还指出，在这两个案例中，重组为多专业团队为完成的变革带来了稳定性和持久性。 原创性/价值 该研究展示了管理层如何发起并支持由员工驱动、以地方机构、决策、规划和参与为特征的成功变革过程。成功变革过程的实证描述很少见，这就是为什么本研究中对此类过程的描述增加了本文的价值。
