How deregulation can become overregulation: An empirical study into the growth of internal bureaucracy when governments take a step back

Størkersen, Kristine Vedal; Thorvaldsen, Trine; Kongsvik, Trond; Dekker, Sidney

doi:10.1016/j.ssci.2020.104772

Cited by 27 publications

(25 citation statements)

References 34 publications

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“…This is echoed by past research on the growth of internal bureaucracy due to governmental deregulation of safety management. 71 Hence, our study found a paradox in the systemic development of meetings, councils and committees at the administrative and management levels in hospitals to comply with regulatory requirements for quality and safety, while managers reported few changes at the sharp end; in clinic, related to implementation of quality and safety activities. It is reasonable to think that there is a disparity in hospital manager support across different hospitals.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 64%

Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

et al. 2020

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A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers’ perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities.DesignThis article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis.SettingThree hospitals retrieved from two regional health trusts in Norway.Participants20 hospital managers or quality advisers selected from different levels of hospital organisations.ResultsFour themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4).ConclusionsThis study suggests that a lack of time, competence and/or motivation, impacted hospitals’ implementation of quality improvement efforts. Hospital managers’ autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 64%

Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

et al. 2020

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“…The fact that there are currently too many procedures is consistent with the argument that it is easier to add to than to reduce safety work [ 37 ]. This is further described in Norwegian shipping and aquaculture operations [ 20 ]. For operational personnel, perceiving procedures as safety clutter also connects to gaps between “work as imagined” in documentation and “work as done” or actual practices [ 22 ], meaning the procedures are not necessarily important for the way the work is performed.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is advised that the knowledge and judgment of practitioners guide the development and implementation of safety management systems [ [34] , [35] , [36] ]. Although this might be difficult to achieve, owing to managerial and audit practices, some companies have successfully implemented and maintained practical and relevant safety management systems [ 20 ].…”

Section: Theorymentioning

confidence: 99%

“…Over a decade ago, a study found that safety management systems were not used extensively in fish farming companies and were rarely audited by the Labour Authority [ 19 ]. However, a new study argues that safety management systems have grown considerably in the industry [ 20 ]. Despite the prominent role of safety management as a risk-reducing measure, few studies have qualitatively addressed the status and practical relevance of safety management in fish farming.…”

Section: Introductionmentioning

confidence: 99%

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Safety Management in Norwegian Fish Farming: Current Status, Challenges, and Further Improvements

Thorvaldsen

Størkersen

Kongsvik

et al. 2021

Safety and Health at Work

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Background Safety management is required to ensure health and safety of personnel in Norwegian fish farming. However, few studies have addressed the status and practical relevance of this risk-reducing measure. Methods This article provides new knowledge through interviews with 35 employees at different company levels, addressing perceptions of various safety management activities according to managers and operational personnel. Results The interviews show that managers and operational personnel at fish farms agree that the quantity of measures aimed to improve safety has increased in recent years. However, some activities are perceived to have higher practical relevance than others. In general, measures that fit well with the practical reality are well received by the employees at the fish farms. Conclusion Suggested improvements include involving operational personnel in the design of procedures, considering all risk dimensions that may affect occupational health and safety, and challenging the value of specific safety activities based on a detailed knowledge of the distinctive characteristics of work practice in fish farming.

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“…It is common to add procedures after accidents or audits (Hale & Borys, 2013;Provan, Dekker, & Rae, 2017;Rae, Provan, Weber, & Dekker, 2018). Independent decision-making and improvisation are undervalued or even disparaged in audits, so even when practical procedures are created, they may be accompanied by impractical and theoretical procedures to ensure auditability (Størkersen et al, 2020).…”

Section: General Safety Management Researchmentioning

confidence: 99%

Traps and tricks of safety management at sea

Størkersen

Thorvaldsen

2021

Safety Science

Self Cite

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Safety management regulation was introduced almost twenty years earlier for Norwegian seafarers than coastal fishers, although both groups work in industries with high accident frequencies. In this study, seafarers and fishers' perspectives on safety management requirements is studied, through empirical data from interviews and observation conducted over several years, with the aim of informing the future development of safety management, especially in fishing. Results show that the fishers have practical skills and an operational orientation, while the seafarers experience ill-fitting procedures, extensive documentation, and shore management that the coastal fishers lack. The suggestions for future safety management are related to development of procedures, a safe working environment, safeguards and safety management skills.

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How deregulation can become overregulation: An empirical study into the growth of internal bureaucracy when governments take a step back

Cited by 27 publications

References 34 publications

Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

Hospital managers’ perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study

Safety Management in Norwegian Fish Farming: Current Status, Challenges, and Further Improvements

Traps and tricks of safety management at sea

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