Ohrling Mikael, Solberg Carlsson Karin, Brommels Mats
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Stockholm Healthcare Services, Region Stockholm, Box 45436, 104 31, Stockholm, Sweden.
BMC Health Serv Res. 2022 Mar 21;22(1):371. doi: 10.1186/s12913-022-07716-w.
We wanted to better understand whether and how agility can be achieved in a decentralised service delivery organisation in Sweden. The pandemic outbreak of SARS-Cov-2 (Covid-19) provided an opportunity to assess decentralisation as a strategy to improve the responsiveness of healthcare and at the same time handle an unpredictable and unexpected event.
Data from in-depth interviews with a crisis management team (n = 23) and free text answers in a weekly survey to subordinated clinical directors, i.e. unit managers, (n = 108) were scrutinised in a directed content analysis. Dynamic capabilities as a prerequisite for dynamic effectiveness, understood as reaching strategic and operative effectiveness simultaneously, were explored by using three frameworks for dynamic effectiveness, dynamic capabilities and delegated authority in a decentralised organisation.
Unpredictable events, such as the pandemic Covid-19 outbreak, demand a high grade of ability to be flexible. We find that a high degree of operational effectiveness, which is imperative in an emergency situation, also is a driver of seeking new strategic positions to even better meet new demands. The characteristics of the dynamic capabilities evolving from this process are described and discussed in relation to decentralisation, defined by decision space, organisational and individual capacity as well as accountability. We present arguments supporting that a decentralised management model can facilitate the agility required in an emergency.
This study is, to our knowledge, the first of its kind where a decentralised management model in a service delivery organisation in healthcare is studied in relation to crisis management. Although stemming from one organisation, our findings indicating the value of decentralisation in situations of crisis are corroborated by theory, suggesting that they could be relevant in other organisational settings also.
我们希望更好地了解在瑞典的一个分散式服务提供组织中，能否以及如何实现灵活性。严重急性呼吸综合征冠状病毒2（SARS-CoV-2，即新冠病毒19）的大流行爆发提供了一个机会，来评估分散化作为一种提高医疗保健响应能力并同时应对不可预测和意外事件的策略。
对一个危机管理团队（n = 23）进行深入访谈的数据，以及对下属临床主任（即科室经理，n = 108）的每周调查中的自由文本回答，在定向内容分析中进行了仔细审查。通过使用分散式组织中动态有效性、动态能力和授权的三个框架，探讨了作为动态有效性前提条件的动态能力，动态有效性被理解为同时实现战略和运营有效性。
不可预测的事件，如新冠病毒19大流行爆发，需要高度的灵活性。我们发现，在紧急情况下至关重要的高度运营有效性，也是寻求新战略地位以更好地满足新需求的驱动力。从这一过程中演变而来的动态能力的特征，与由决策空间、组织和个人能力以及问责制所定义的分散化相关进行了描述和讨论。我们提出论据支持分散式管理模式可以促进紧急情况下所需的灵活性。
据我们所知，本研究是首次对医疗保健服务提供组织中的分散式管理模式与危机管理相关进行研究。尽管源于一个组织，但我们关于分散化在危机情况下的价值的研究结果得到了理论的证实，表明它们在其他组织环境中也可能具有相关性。
