The article aims to understand how changes in nurses' and physician's daily work create opportunities for distributed leadership outside formal managerial positions. The paper demonstrates ways in which nurses and physicians are engaged in distributed leadership locally at primary care centers. The study involves in-depth interviews with nurses, physicians, and managers at Primary Care centers in Sweden. The study uncovers three basic mechanisms through which nurses and physicians engage in distributed leadership. The study shows how the two groups differ in how they are able to draw benefits from engaging in distributed leadership.

Patient Empowerment (PE) allows patients to be more active in managing their own health and quality of life. The aim of this paper is to analyze how trust affects PE, in the context of healthcare information systems. An interview study was conducted concerning patients’ online access to electronic healthcare records. Results show that PE requires that patients trust the information that healthcare professionals and their electronic health record systems provide. Without trust, patients cannot control their own participation in relation to the healthcare professionals. This may result in a diminished ability to participate in the healthcare processes regarding their own care. Practical implications include acquired knowledge about and awareness of how trust influences PE, with particular emphasis on healthcare professionals. A trust model is presented that illustrates the trustor-trustee dimensions of PE. This model has both theoretical and practical implications in its illustration of how trust and PE connect.

Purpose The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work. Design/methodology/approach The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis. Findings The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work. Practical implications For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment. Originality/value The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work.

Healthcare, like society in general, is facing great changes and challenges. Rapid development and uptake of digital technologies bring about the need to change. With the COVID-19 pandemic, the amount of healthcare meetings taking place online has surged. This means, among other things, that there are more healthcare actors involved in a patient’s care, and that information relating to a patient needs to be shared across borders now more than ever need to be improved. However, this is currently not done seamlessly, and there are many hinders and obstacles to overcome. This research aims at enabling a holistic approach on how to handle patient information in order to support seamless and secure care along the whole patient process. In doing so, drivers and hinders need to be identified, and a socio-technical framework with concrete guidelines will be developed. These results will be a first step towards filling this research gap, and will connect several perspectives in order to make the results truly actionable and holistic. © 2021 Copyright for this paper by its authors.

Purpose The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden. Design/methodology/approach The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners. Findings The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups. Research limitations/implications The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction. Social implications The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction. Originality/value The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

The resilient organization has the important capability of creating high reliability. In health care, professionals deal with major challenges in terms of new working methods. The chapter describes the introduction of a standardized working method in hospitals, utilizing Lean-oriented work processes. That is different from nurses' and physicians' traditional and flexible way of working. These differences in approaches are the subject of the study. The question is: How can followership create and maintain high reliability and resilience in health care? A comparative case study was performed using interviews and steering documents. To maintain and create high reliability, social resources such as followership are important. Followers' ability to improve, cooperate, and learn turned out to be important characteristics. Organizational resilience depends on these professionals' ability to manage change.

SammanfattningNya teknologier i sjukvården skall ge effektivare informationsflöden och bidra till att behandla patienter snabbare och effektivare. Syftet är att beskriva och analysera professionernas tillit till informationen i den digitala patientjournalen. I en jämförande studie med den tidigare analoga patientjournalen besvarar en enkätundersökning till läkare (n=65) och sjuksköterskor (n=262) (svarsfrekvens 84.7%), tilliten till informationens stöd, möjligheter och utmaningar för professionernas kunskap och förmåga att tillämpa informationen. Den horisontella tilliten mellan professionerna stöder tillit till informationen i patientjournalen. Tilliten är dock låg till att informationen effektiviserar användning av informationen. Det är inte digitalisering i sig som utvecklar tillit till informationen utan tillit mellan dem som arbetar med patienterna. När tilliten mellan professionerna ökar finns möjlighet till ytterligare samarbete i sjukvården.AbstractNew technologies in health care shall provide more efficient information flows and contribute to treat patients more efficiently. The purpose describes and analyzes the professionals’ trust to the information in electronic healthcare records, compared to the former analogue. A survey of physicians’ (n = 65) and nurses’ (n = 262) (response rate of 84.7%) perceptions was performed about trust of the information regarding support, opportunities and challenges, and the professionals’ knowledge and ability to apply this information. The horizontal trust between professionals supports trust of the information. Digitized information, in itself, does not render the use of information more efficient. However, it is not digitalization that develops trust in the information without the trust between those working with the patients.

Purpose The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO). Design/methodology/approach Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n=17) nurses at two Swedish hospitals. Findings The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement. Practical implications Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned. Originality/value The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

This article studies interprofessional barriers between nurses and physicians in the context of quality improvement work. A total of 17 nurses and 10 physicians were interviewed at 2 hospitals in Sweden. The study uncovered a number of barriers relating to both the relative status of each group and their defined areas of responsibility.

Digitalization is sweeping every organization. Also in hospitals patients’ records go through a digitization process to become electronic healthcare record, (EHR).Purpose – This study describe physicians and nurses perceptions towards digitization of their work practices. The overall questions is: What are the professionals’ perceptions on how to work with digitalized information systems?Design/methodology/approach –The sample consisted of physicians (n=64) and nurses (n=261) working in a Swedish regional hospital. A standardized questionnaire was coupled with free-text options as well. The professionals’ perceptions of EHR were compared with the traditional paper-based records.Findings – The professionals reacted with resistance and need more time and more well-developed systems to exercise their new skills. Competence to document in itself is not the problem. The problem is how to perform their new EHR work in daily practise. Communication problems between different systems become obvious. The study shows that performability is important when working with digitization in every day’s practises.Practical implications – There are still shortcomings in the quality of the documentation in EHR. Redundant documentations have to be minimized. The communication between systems and information to patient have to be developed. It also important to have more and better work places for professionals’ possibility to perform their skills. Additionally, to increase their knowledge of digitization in healthcare the professionals need continuous training and time to discuss pros and cons with the digitization.

This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement—drivers. Each group's profile was then analyzed on the basis of concept of professional culture.

This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.

Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrix's usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.

Healthcare professionals are involved in development work that is always present in healthcare organisations. They are required to participate when quality methods such as Lean and Six Sigma are introduced in hospitals’ clinical practises. The purpose of this paper is to explore how development work in terms of providing reliable care are perceived by nurses and physicians when quality methods are implemented in clinical practises. The data consist from in-depth, semi-structured interviews with seventeen nurses and ten physicians at two hospitals in western Sweden. A qualitative research method was used. The interviews were analysed in the search for underlying themes that reflect their perception and evaluation of the quality methods and their possibility to increase the reliability in healthcare. The confidence between nurses and physicians was essential for creating and maintaining supportive relationships and reliable systems. Reliable care seemed to be more of the result of the dedication and professionalism than the result of the applied quality methods. Reliability in healthcare seemed to flow from work attitudes, commitment and continuous development work as much as from quality methods. In general, the professionals more emphasized the importance of teamwork and cooperation as ways to develop healthcare.

Most nurses are deeply involved in healthcare development work. Nurses are required to participate as they coordinate processes with other health professionals in the entire hospital care chain.To investigate how nurses perceive and evaluate healthcare development work when Lean and Six Sigma are introduced in clinical practises, in-depth, semi-structured interviews with seventeen nurses at two hospitals were used.The nurses mean that quality healthcare is more dependent on hospital personnel than on the use of Lean and Six Sigma. Lean can be used in some healthcare areas but not in all. Six Sigma can be used only if some precautions are taken and personnel participate in the decision-making. Furthermore nurses do stress the importance of education and training, teamwork, and cooperation as ways to improve healthcare.

Fragan ”Vad ar en hallbar kommun?” ar utgangspunkt i den studie som presenteras. Studien syftar till att belysa vad en hallbar kommun kan vara och behandlar fragan bade ur ett teoretiskt och empiri ...