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  • 1.
    Carlström, Eric
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Middle managers on the slide2012In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 25, no 2, p. 90-105Article in journal (Refereed)
    Abstract [en]

    Purpose

    – This article aims to examine middle managers in health care and how their role has changed in times of fiscal constraints. It seeks to focus particularly on how cost savings influence the position of middle managers in the organisation between governance and advocacy pressure.

    Design/methodology/approach

    – A total of 25 Swedish middle managers from public health care organisations during fiscal constraints were interviewed about what contributes to their positioning in the organisation.

    Findings

    – The loyalty of middle managers is tested in the "in between" role. Excessive loyalty, in any direction, can distance a middle manager from their expected position. In times of a weakening economy, middle managers are expected to be a tool that is used by the management to communicate savings, personnel reductions, redundancies and closures. This contributes to middle managers sliding out of their role in between.

    Practical implications

    – Middle managers' skills are within care itself. In times of cost savings, demands are placed on their ability to handle advanced management tasks. They need to gain a clearer insight into management control, understanding conflict management and leadership.

    Originality/value

    – The article explains not only why middle managers slide up (take on governance roles) and down (take on advocacy roles) in the organisation, which has been described previously. It also explains why middle managers slide out (abdicate responsibility) of the role between governance and advocacy during times of fiscal limitations.

  • 2.
    Kajonius, Petri
    et al.
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies. Department of Psychology, University of Gothenburg, Göteborg, Sweden and School of Health and Education, University of Skövde, Skövde, Sweden.
    Kazemi, Ali
    University of Skövde.
    Tengblad, Stefan
    School of Business, University of Skövde, Skövde, Sweden.
    Organizing Principles and Management Climate in High-Performing Municipal Elderly Care2016In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 29, no 1, p. 82-94Article in journal (Refereed)
    Abstract [en]

    Purpose – Previous research has shown that user-oriented care predicts older persons’ satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The present study set out to investigate the organizing principles and management climate characterizing successful elderly care organizations.

    Design – The care organization in one highly ranked municipality was selected and compared with a more average municipality. On-site semi-structured in-depth interviews with managers as well as participatory observations at managers’ meetings were conducted in both municipalities.

    Findings – The results revealed three key principles for successful elderly care: 1) organizing care from the viewpoint of the older service user, 2) recruiting and training competent and autonomous employees, 3) instilling a vision for the mission which guides operations at all levels in the organization. Furthermore, using climate theory to interpret the material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing things right characterizing the more average municipality.

    Value – We suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the upper management, i.e., the views of the older persons, the co-workers, and the mission. The results can guide future care quality developments and increase the understanding of the importance of organizational climate at the senior management level.

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