Socially induced motivation in learning: coping with digital interaction in higher education under the pandemic.

The COVID-19 pandemic resulted in a total digital disruption of all activities at universities. New digital tools and arenas replaced the daily physical interactions between students and professors. How did this affect motivation and learning outcomes? This article uses the pandemic as a prism to understand how and why social relations and interaction are important in the educational system. Data were obtained from 26 informants in two case studies (study programs). A total of 12 in-depth interviews with employees and 4 group interviews with 14 students were performed at Oslo University during the pandemic (2020-2021). We explore an alternative understanding of social ties in relation to the educational process and the importance of social interaction in sensemaking and self-determination theory concepts. As digital disruption creates a social disconnect for most actors, it becomes prevalent that social activity, both formal and informal, seems to be an important source of motivation for both students and faculty members at the university. We introduce the concept of socially induced motivation as an important aspect of learning. The tendencies in the informants' accounts of the social interaction are perceived in this context as sensemaking the university as an organization and how it solves its missions and assignments. Socially induced motivation is an important concept, both in relation to work in general and specifically to work in higher education. Our study shows why universities should strive to facilitate socially induced motivation in the future.

Work-related moderators of the relationship between organizational change and sickness absence: a longitudinal multilevel study.

BACKGROUND: A sizeable body of research has demonstrated a relationship between organizational change and increased sickness absence. However, fewer studies have investigated what factors might mitigate this relationship. The aim of this study was to examine if and how the relationship between unit-level downsizing and sickness absence is moderated by three salient work factors: temporary contracts at the individual-level, and control and organizational commitment at the work-unit level. METHODS: We investigated the association between unit-level downsizing, each moderator and both short- and long-term sickness absence in a large Norwegian hospital (n = 21,085) from 2011 to 2016. Data pertaining to unit-level downsizing and employee sickness absence were retrieved from objective hospital registers, and moderator variables were drawn from hospital registers (temporary contracts) and the annual work environment survey (control and organizational commitment). We conducted a longitudinal multilevel random effects regression analysis to estimate the odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee. RESULTS: The results showed a decreased risk of short-term sickness absence in the quarter before and an increased risk of short-term sickness absence in the quarter after unit-level downsizing. Temporary contracts and organizational commitment significantly moderated the relationship between unit-level downsizing in the next quarter and short-term sickness absence, demonstrating a steeper decline in short-term sickness absence for employees on temporary contracts and employees in high-commitment units. Additionally, control and organizational commitment moderated the relationship between unit-level downsizing and long-term sickness absence. Whereas employees in high-control work-units had a greater increase in long-term sickness absence in the change quarter, employees in low-commitment work-units had a higher risk of long-term sickness absence in the quarter after unit-level downsizing. CONCLUSIONS: The results from this study suggest that the relationship between unit-level downsizing and sickness absence varies according to the stage of change, and that work-related factors moderate this relationship, albeit in different directions. The identification of specific work-factors that moderate the adverse effects of change represents a hands-on foundation for managers and policy-makers to pursue healthy organizational change.

Organizational change and the risk of sickness absence: a longitudinal multilevel analysis of organizational unit-level change in hospitals.

BACKGROUND: Organizational change is often associated with reduced employee health and increased sickness absence. However, most studies in the field accentuate major organizational change and often do not distinguish between and compare types of change. The aim of this study was to examine the different relationships between six unit-level changes (upsizing, downsizing, merger, spin-off, outsourcing and insourcing) and sickness absence among hospital employees. METHODS: The study population included employees working in a large Norwegian hospital (n = 26,252). Data on unit-level changes and employee sickness absence were retrieved from objective hospital registers for the period January 2011 to December 2016. The odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee were estimated in a longitudinal multilevel random effects logistic regression model. RESULTS: Unit-level organizational change was associated with both increasing and decreasing odds of short-term sickness absence compared to stability, but the direction depended on the type and stages of change. The odds of long-term sickness absence significantly decreased in relation to unit-level upsizing and unit-level outsourcing. CONCLUSIONS: The results from this study suggested that certain types of change, such as unit-level downsizing, may produce greater strain and concerns among employees, possibly contributing to an increased risk of sickness absence at certain stages of the change. By contrast, changes such as unit-level insourcing and unit-level upsizing were related to decreased odds of sickness absence, possibly due to positive change characteristics.

Professional identity and role transitions in clinical managers.

PURPOSE: The purpose of this paper is to investigate how clinicians' professional background influences their transition into the managerial role and identity as clinical managers. DESIGN/METHODOLOGY/APPROACH: The authors interviewed and observed 30 clinicians in managerial positions in Norwegian hospitals. FINDINGS: A central finding was that doctors experienced difficulties in reconciling the role as health professional with the role as manager. They maintained a health professional identity and reported to find meaning and satisfaction from clinical work. Doctors also emphasized clinical work as a way of gaining legitimacy and respect from medical colleagues. Nurses recounted a faster and more positive transition into the manager role, and were more fully engaged in the managerial aspects of the role. PRACTICAL IMPLICATIONS: The authors advance that health care organizations need to focus on role, identity and need satisfaction when recruiting and developing clinicians to become clinical managers. ORIGINALITY/VALUE: The study suggests that the inclusion of aspects from identity and need satisfaction literature expands on and enriches the study of clinical managers.

Survival of the project: a case study of ICT innovation in health care.

From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology.

Effect of organisational change type and frequency on long-term sickness absence in hospitals.

AIM: The present study was conducted to investigate how the frequency of structural change and patient care-related change is related to employees' long-term sickness absence. BACKGROUND: Although a growing body of research is investigating the potentially harmful effects of organisational change on employee health, most studies have focused on single episodes of organisational change and do not differentiate among the types and frequencies of change. METHOD: National registry data were collected from 2005 and 2007. A total of 34 712 health professionals from 56 hospitals were included (76% nurses, 18% physicians and 6% other health professionals) and the data were analysed using multilevel logistic regression. RESULT: The research findings reveal a significantly higher probability of long-term sickness absence among employees who experienced more frequent structural changes (OR = 1.03; CI: 1.00-1.06; P < 0.05), but not among employees who experienced more frequent patient care-related changes. CONCLUSIONS: A higher frequency of organisational change may lead to more sickness-related absence among employees, with the effect depending on the type of change. IMPLICATIONS FOR NURSING MANAGEMENT: These findings highlight the need for managers who are contemplating or are in the process of implementing organisational change to become more aware of the potentially harmful effects of frequent organisational change on employee health.

Clinicians in management: a qualitative study of managers' use of influence strategies in hospitals.

BACKGROUND: Combining a professional and managerial role can be challenging for doctors and nurses. We aimed to explore influence strategies used by doctors and nurses who are managers in hospitals with a model of unitary and profession neutral management at all levels. METHODS: We did a study based on data from interviews and observations of 30 managers with a clinical background in Norwegian hospitals. RESULTS: Managers with a nursing background argued that medical doctors could more easily gain support for their views. Nurses reported deliberately not disclosing their professional background, and could use a doctor as their agent to achieve a strategic advantage. Doctors believed that they had to use their power as experts to influence peers. Doctors attempted to be medical role models, while nurses spoke of being a role model in more general terms. Managers who were not able to influence the system directly found informal workarounds. We did not identify horizontal strategies in the observations and accounts given by the managers in our study. CONCLUSIONS: Managers' professional background may be both a resource and constraint, and also determine the influence strategies they use. Professional roles and influence strategies should be a theme in leadership development programs for health professionals.

The effect of hospital mergers on long-term sickness absence among hospital employees: a fixed effects multivariate regression analysis using panel data.

BACKGROUND: Hospitals are merging to become more cost-effective. Mergers are often complex and difficult processes with variable outcomes. The aim of this study was to analyze the effect of mergers on long-term sickness absence among hospital employees. METHODS: Long-term sickness absence was analyzed among hospital employees (N = 107 209) in 57 hospitals involved in 23 mergers in Norway between 2000 and 2009. Variation in long-term sickness absence was explained through a fixed effects multivariate regression analysis using panel data with years-since-merger as the independent variable. RESULTS: We found a significant but modest effect of mergers on long-term sickness absence in the year of the merger, and in years 2, 3 and 4; analyzed by gender there was a significant effect for women, also for these years, but only in year 4 for men. However, men are less represented among the hospital workforce; this could explain the lack of significance. CONCLUSIONS: Mergers has a significant effect on employee health that should be taken into consideration when deciding to merge hospitals. This study illustrates the importance of analyzing the effects of mergers over several years and the need for more detailed analyses of merger processes and of the changes that may occur as a result of such mergers.

Clinicians' experiences of becoming a clinical manager: a qualitative study.

BACKGROUND: There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. METHODS: We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. RESULTS: We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. CONCLUSIONS: Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.

Leading during change: the effects of leader behavior on sickness absence in a Norwegian health trust.

BACKGROUND: Organizational change often leads to negative employee outcomes such as increased absence. Because change is also often inevitable, it is important to know how these negative outcomes could be reduced. This study investigates how the line manager's behavior relates to sickness absence in a Norwegian health trust during major restructuring. METHODS: Leader behavior was measured by questionnaire, where employees assessed their line manager's behavior (N = 1008; response rate 40%). Data on sickness absence were provided at department level (N = 35) and were measured at two times. Analyses were primarily conducted using linear regression; leader behavior was aggregated and weighted by department size. RESULTS: The results show a relationship between several leader behaviors and sickness absence. The line managers' display of loyalty to their superiors was related to higher sickness absence; whereas task monitoring was related to lower absence. Social support was related to higher sickness absence. However, the effect of social support was no longer significant when the line manager also displayed high levels of problem confrontation. CONCLUSIONS: The findings clearly support the line manager's importance for employee sickness absence during organizational change. We conclude that more awareness concerning the manager's role in change processes is needed.

Leadership, staffing and quality of care in nursing homes.

BACKGROUND: Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. METHODS: A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. RESULTS: Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r=0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. CONCLUSIONS: Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care.

[Development of organizations in Norwegian hospitals]. / Organisasjonsutvikling ved norske sykehus.

BACKGROUND: Hospitals in Norway are changing as a result of altered hospital environments and the constraints they are placed under. This article describes the organizational development in Norwegian hospitals from 1999 to 2005 and discusses whether the developments observed can be interpreted as a modernization of the Norwegian hospital system. MATERIAL AND METHODS: The article is based on a survey sent to all public hospitals in 2001, 2003 and 2005. In 2001 the hospitals were asked retrospectively about 1999. In 2005, 60 of 63 hospitals responded to the survey. RESULTS: Results indicate a consistent pattern of organizational development from 1999 to 2005. Some areas change to a greater degree than others; the most noticeable is decentralization in terms of financial routines and personnel responsibilities. Other major organizational developments include ring fencing of elective surgery, co-localization of hospital reception rooms and emergency wards, and increased use of computerized routines, both for patient management and treatment. INTERPRETATION: It has been demonstrated that Norwegian hospitals are able to change and adapt. Several standardized organizational and leadership structures recommended by official reviews are increasingly being adopted into practice. Hospitals are being modernized.

[Consultations with specialists in private practice in a Norwegian district]. / Konsultasjoner hos spesialister med avtale med Helse Øst.

BACKGROUND: After the Norwegian hospital reform of 2002, there has been increased acceptance of private-sector health-care providers. Still, the use of specialist services in private practice is less well documented. This article explores the use of private specialist health care in the south-east of Norway. MATERIAL AND METHODS: The article is based on several sources of data, including data from the Norwegian Patient Register and from the National Insurance Administration on reimbursements. Also a survey was sent out to a sample of general practitioner; in-depth interviews were carried out with a sample of hospital physicians and private specialists. RESULTS: The article shows that private specialists with contract with Helse Øst provided 151 consultations per 1000 inhabitants over the period September to November 2003, while the public outpatient clinics provided 186 consultations. The service provision varies geographically and between specialties. In one county the use of private specialists is 174 consultations per 1000 inhabitants; in another it is 80 per 1000 inhabitants. Private-sector specialists within the fields of eye, ear-nose-throat and skin provided two thirds of all outpatient services in their respective fields. INTERPRETATION: The results indicate that the services of specialists in private practice should be more focused on and discussed in relation to integrated healthcare and the relationship between specialised hospital services and primary healthcare.

Ring fencing of elective surgery: does it affect hospital efficiency?

Ring fencing (RF) is defined as separating elective from emergency operations in parallel hospital production lines. This study examines the effects of RF of elective surgery on hospital efficiency. The analysis is performed on two levels. First, an intensive three-month study at the departmental level of three hospitals was performed. Second, a panel data analysis of the organizational population of Norwegian hospitals over the period from 1992 to 2000 was conducted, using a 'fixed effect' regression model to analyse the effect of RF on hospitals' cost and technical efficiency. The intensive study indicates that RF could have positive effects both on cost and technical efficiency under certain conditions of case-mix and the demand for elective surgery, while the panel analyses of the effects of RF in the hospital population do not produce stable results. We cannot conclude that RF has unconditional positive effects on hospitals' efficiency. However, in certain situations of case-mix and demand for services, RF could be a valuable tool for managers to increase hospitals' efficiency.

Primary health care and hospital interactions: effects for hospital length of stay.

AIMS: Norwegian healthcare services are divided between primary and secondary care providers. A growing problem is that every third patient of 75 years of age or more experiences an extended stay in a somatic hospital while waiting to be sent to primary healthcare services. The interaction between these two levels of healthcare services is analysed to examine the effect on a patient's length of stay in hospital. METHODS: Recent studies have asserted that research on length of stay in hospital should include influential factors such as system variation and system characteristics, in addition to standardizing for case-mix. New organizational routines are identified in 50 Norwegian somatic hospitals. A multivariate linear regression is used in both a static and a dynamic model to explain variations in hospital length of stay and in additional length of stay (5% of stays are defined as outliers). RESULTS: The study shows that newly specialized structures constructed to enhance the interaction between the two levels have had no effect. Length of stay is dependent on the capacity of the primary healthcare provider and on the share of elderly in the hospital catchment area, the type of patients, the procedure performed, and the characteristics of the hospital. CONCLUSION: Variation in length of stay between hospitals is primarily explained by the capacity of primary healthcare providers. However, some support is found in the dynamic model that introduces the proposition that a hospital-owned hotel would decrease the length of stay of patients in hospital.