Ohrling Mikael, Tolf Sara, Solberg-Carlsson Karin, Brommels Mats
SLSO, Region Stockholm, Stockholm, Sweden.
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
J Health Organ Manag. 2021 Apr 29;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-12-2020-0474.
Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.
DESIGN/METHODOLOGY/APPROACH: Data from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an logic analysis using relevant scientific literature.
The study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.
ORIGINALITY/VALUE: To the authors' knowledge this is the first logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.
医疗保健的去中心化被提议作为一种使服务更能响应当地需求从而改善患者护理的方式。本研究分析了高级管理团队如何在一个大型公共医疗保健服务组织内构思并实施去中心化管理模式。
设计/方法/途径：对高级管理团队进行深度访谈所得的数据用于定向内容分析。去中心化过程中的潜在假设和活动在逻辑模型中呈现，并使用相关科学文献进行逻辑分析。
该研究在科学文献中找到了对潜在假设的支持，即增加责任将赋予管理人员权力，因为临床主任最了解当地的先决条件，并且能够适应患者需求。高层管理人员应像空中交通管制塔一样发挥作用，信任和忠诚能提高管理能力，管理技能的提升能释放创造力和参与度，而系统视角将支持协作和学习。
原创性/价值：据作者所知，这是对初级和社区护理中医疗保健服务组织的去中心化管理模式的首次逻辑分析。它表明这些活动与潜在假设一致，有证据支持，并且及时规划能给予管理人员决策空间和使用其被授予权力的能力，同时不忽视问责制，并培养必要的组织和个人能力以避免次优情况。
