This paper describes and explains how balancing organizational structures can build traits for organizational resilience. Organizational resilience is a holistic and complex concept. In this paper, we move beyond focusing on sudden and disruptive events in favour of anticipating the unexpected in daily organizing. Organizational resilience is understood here as building traits of risk awareness, preference for cooperation, agility and improvisation and is analysed by means of a longitudinal qualitative case study. The paper contributes to the field by showing how balancing organizational structures can foster organizational resilience traits. We show that power distribution and normative control can create preparedness for unexpected events and foster action orientation at the same time as supporting organizational alignment.

Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

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Drawing from collaborative public management, this article seeks to contribute to public service logic by focusing on what precedes the public service user's realization of value: the value proposition. A new care model for elderly people with multiple chronic diseases shows that coordinators with an inter-organizational mission, vertical and horizontal supporting structures, trust established through relationships, and recognition of service systems' embeddedness in social systems are pivotal for the ability of public service organizations to develop coordinated value propositions. The contribution to policy and practice is an increased understanding of a coherent, rather than fragmented, welfare system for users/citizens.

Strong professionals who influence the development of healthcare services have dominated healthcare organizations for many years. However, this dominance has been challenged recently through patient involvement. One method of achieving patient involvement is experience-based co-design (EBCD), in which patients and healthcare professionals work together to improve care. Patient involvement has considerable potential, but also presents certain challenges. This article addresses these challenges using experiences from patients and healthcare professionals who participated in two action research projects that aimed to improve patient experienced quality using EBCD in pediatric care. The paper shows that patient involvement in quality improvements can challenge the traditional roles of professionals and patients by new roles as co-designers. The role as co-designer embraces new perspectives for healthcare professionals that force them to step out of their comfort zone. Accordingly, healthcare professionals are able to view patients as equal partners in improvement work. Reflecting dialogues during the projects offered eye-opening stories for patients and healthcare professionals that enabled them to construct a common picture of care. The contribution of this study is strengthening earlier research that argues that an action research approach can strengthen important values for successful EBCD projects: equal partnerships, new roles, and dialogue. The findings show that the combination of EBCD and action research is a promising approach to address the challenges of patient involvement in healthcare improvement.

PurposeThe article aims to analyze how personal development training influences managers' identity processes.Design/methodology/approachThe article, taking an interpretive‐critical approach, is based on a qualitative, longitudinal study of five participants (managers) in a personal development training program. During the two years of research, 62 interviews (with the managers and related personnel) were conducted and 13 observations were made.FindingsPersonal development training provokes identity regulation by prescribing a normative identity process that claims managers should engage in a process of reflection in order to gain self‐awareness. Such training constitutes a local management discourse that may influence different levels of identity work and identity regulation processes depending on the participants' expectations, their organizations and professional situations, their level of insecurity, as well as their previous experience with management discourse.Practical implicationsSince management training influences participants' identity processes, program organizers, purchasers and participants should be wary of the expectation that management training will deliver content as “a package” of managerial skills.Originality/valueThe study challenges the traditional view of management training as a provider of skills and solutions for managers by focusing instead on its influence on managers' processes of identity work and identity regulation. Management training in general is claimed to regulate identities and direct identity work by providing inspirational identities. However, this study finds that personal development training regulates identities by prescribing the identity process in itself.

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

PurposeProcurement is increasingly used as a strategic tool to mitigate societal issues such as social exclusion and unemployment of marginalized groups. By conducting social procurement and imposing so-called employment requirements, organizations can create job opportunities for marginalized people. Such practices are becoming increasingly popular in the construction sector, but remain scattered, which hinders the effective creation, use and dissemination of cohesive and commonly shared social procurement practices. Accordingly, this paper analyzes the creation, use and dissemination of social procurement practices in the Swedish construction sector.Design/methodology/approachThe theory of proto-institutions, which refers to institutions under development, is applied to analyze 46 interviews with construction practitioners.FindingsThere is currently little convergence of social procurement practices, due to practices not being fully internalized across organizations and projects; interns hired through employment requirements not having strong enough incentives to engage with their internships; actors working strategically and operatively having different possibilities to create social procurement practices; and the development of maintenance mechanisms for the formalization of sustainable practices being weak.Originality/valueThis paper contextualizes efforts to increase equality, diversity and inclusion of marginalized groups in the construction sector. The adoption of an institutional perspective of practice development elucidates the institutional constellation of existing institutional logics that impact on this practice development. This paper also indicates how the work with social procurement can become more effective and efficient and maximize the social value output for marginalized people living in social exclusion. For institutional theory, it illustrates how proto-institutions can be driven by both top-down and bottom-up perspectives.