BackgroundHealthcare middle managers (HMMs) have, as the leaders closest to clinical practice, a crucial position in healthcare today. There is broad knowledge about the demands on HMMs’ capacity, their situation in general, and the challenges this presents for the improvement of healthcare quality. There is less knowledge about how to facilitate HMMs` capacity and capability with regard to their leadership and how to handle this in a complex context. The purpose of this study was to identify and discuss the facilitation of HMMs’ development of capacity and capability for leadership.MethodA critical hermeneutic design was chosen. Data were collected through three focus group interviews with Norwegian HMMs who participated in a learning network. A user representative (from among the recipients of public healthcare), involved in the same learning network, participated in all three interviews. A qualitative interpretive approach guided the analysis.ResultsThe results show two main themes: 1. Trusted interaction despite organizational and structural frames and 2. Knowledgeable understanding of a complex context.ConclusionThis learning network facilitated HMMs` development of capacity and capability for leadership. The development included a combination of understanding the complex context, knowledge, trust, and confidence. The approaches in the learning network were based on transformative learning, coherence, reflection, discussion, repetition, knowledge sharing, and short lectures. These approaches can be recommended for the facilitation and support of HMMs.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3259-7) contains supplementary material, which is available to authorized users.
Background Healthcare middle managers play a central role in reducing harm, improving patient safety, and strengthening the quality of healthcare. The aim of this systematic review was to identify the present knowledge and critically discuss how healthcare middle managers experienced to develop the capacity and capability for leadership in a healthcare system characterized by high complexity. Methods This comprehensive systematic review provided evidence of healthcare middle managers’ experiences in developing the capacity and capability for leadership in public healthcare. The three-step literature search was based on six databases and led by a PICo question. The review had a critical hermeneutic perspective and was based on an a priori published, protocol. The methods were inspired by the Joanna Briggs Institute and techniques from Kvale and Brinkmann. The results were illustrated by effect size, inspired by Sandelowski and Barroso. Results Twenty-three studies from four continents and multiple contexts (hospitals and municipal healthcare) published from January 2005–February 2019 were included. Based on experiences from 482 healthcare middle managers, 2 main themes, each with 2 subthemes, were identified, and from these, a meta-synthesis was developed: Healthcare middle managers develop capacity and capability through personal development processes empowered by context. The main themes included the following: 1. personal development of capacity and capability and 2. a need for contextual support. From a critical hermeneutic perspective, contrasts were revealed between how healthcare middle managers experienced the development of their capacity and capability and what they experienced as their typical work situation. Conclusions This review provides evidence of the need for a changed approach in healthcare in relation to criticisms of present organizational structures and management methods and suggestions for how to strengthen healthcare middle managers’ capacity and capability for leadership in a healthcare system characterized by high complexity. Evidence of how leadership development affected the clinical context and, thus, the quality of healthcare was found to be a field requiring further research. PROSPERO registration number CRD42018084670
Background: First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers' own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers' experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. Methods: An interpretive approach was chosen following Graneheim and Lundman's qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. Results: "Navigation to prioritizing the patient" emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. Conclusions: A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers' own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.
The objective of this review is to explore the experiences of healthcare middle managers in developing capacity and capability to manage in a leadership role characterized by high complexity.
Purpose The purpose of this study was to identify and critically discuss how healthcare middle managers’ (HMMs) development of the capacity and capability for leadership are experienced to influence quality improvement (QI) in nursing homes. Design/methodology/approach This study had a critical hermeneutic perspective with data gathered using focus groups, one individual interview and participative observations. Analysis was guided by a qualitative interpretive approach. Findings The results show how HMMs’ development of the capacity and capability for leadership are experienced to influence QI in nursing homes through grasping complexity in a conflicting practice. This involves continuous knowledge development and compensating contrasted by resource shortages, role conflicts and the lack of trust and cooperation. Originality/value HMMs have a key role in implementing QIs in healthcare. There are few studies on how HMMs develop the capacity and capability for leadership and it is unclear how clinical contexts are influenced by HMMs’ development. This study provides new knowledge supporting a change facilitating HMMs’ developmental processes targeting practical influence; it emphasizes continuity, coherence, presence and trust.
Background Dignity, in the care of older nursing home residents, has been an increasingly part of the public discourse the recent years. Despite a growing body of knowledge about dignity and indignity in nursing homes, we have less knowledge of how relatives experience their role in this context. This study is a follow-up to a previous study in nursing homes, which gave rise to concern about the relatives’ descriptions of residents’ dignity. The aim of this current study is to critically discuss relatives’ experiences of influencing the dignified care of residents of nursing homes. Methods Methodologically, the study is informed by a critical hermeneutic stance, where the analysis is guided by a qualitative interpretive approach and a humanizing framework. This is a secondary analysis that includes data from five semi-structured focus groups from a previous study. The participants were 18 relatives of 16 residents living in two nursing homes in rural northern Norway. Results The main theme in this study, preventing missed care when dignity is at stake, is identified when relatives of nursing homes experience that they are able to influence dignified care by (a) pinpointing to prevent missed care and (b) compensating when dignity is threatened. Conclusions Despite their stated good intentions to safeguard dignity, relatives of nursing homes experience being alienated in their attempts to change what they describe as undignified and unacceptable practice into dignified care. The relatives’ observations of dignity and indignity are, contrary to what national and international regulations require, not mapped and/or used in any form of systematic quality improvement work. This indicates that knowledge-based practice in nursing homes, including the active application of user and relative knowledge, has untapped potential to contribute to quality improvement towards dignified care.
Background Dignity, in the care of older nursing home residents, has been an increasingly part of the public discourse the recent years. Despite a growing body of knowledge about dignity and indignity in nursing homes, we have less knowledge of how relatives experience their role in this context. This study is a follow-up of a previous study in nursing homes, which gave rise to a concern about the relatives’ descriptions of residents’ dignity. The aim of this current study is to critically discuss relatives’ experiences of influencing dignified care among residents in nursing homes. Methods Methodologically, the study is informed by a critical hermeneutic stance, where the analysis is guided by a qualitative interpretive approach and a humanizing framework. This is a secondary analysis that includes data from five semi-structured focus groups. The participants are 18 relatives of 16 residents living in two nursing homes in rural northern Norway. Results The main theme in this study, Temporarily preventing missed care when dignity is at stake, is identified when relatives in nursing homes experience they influence dignified care by (a) Pinpointing to prevent missed care and (b) Compensating when dignity is threatened. Conclusions Despite their stated good intentions to safeguard dignity, relatives in nursing homes experience being alienated in their attempts to change what they describe as an undignified and unacceptable practice into dignified care. The relatives’ observations of dignity and indignity are, contrary to what national and international regulations require, not mapped and/or used in any form of systematic quality improvement work. This indicates that knowledge-based practice in nursing homes, including the active application of user and relative knowledge, has untapped potential to contribute to quality improvement towards dignified care.
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