Perceptions of future hospital management in Finland.

PURPOSE: The purpose of this paper is to describe how Finnish experts perceive future (year 2030) hospital management and leadership. DESIGN/METHODOLOGY/APPROACH: A total of 33 experts participated in a three-round Argument Delphi process. Opposing views of management and leadership in 2030 were analyzed using inductive content analysis. FINDINGS: The experts' perceptions were divided into two main categories: management and leadership orientation and future organization. Perceptions relating to management and leadership orientation were classified as relating to patient-centred, clinical dominance, professionally divided and management career options. Perceptions relating to future management and leadership organization were classified as representing shared, pair, team and the individual-centered leadership. The results highlighted the most distinctive issues raised by the participants. RESEARCH LIMITATIONS/IMPLICATIONS: This qualitative study was conducted in the context of Finnish healthcare according to the principles of the Argument Delphi Method. The panel consisted of high-level experts representing a diverse set of roles. However, as suggested in previous literature, these experts may not be the most astute in predicting the future development of hospital organizations. PRACTICAL IMPLICATIONS: The findings can be used to develop and renew management and leadership training and management practices in hospitals. SOCIAL IMPLICATIONS: The findings can be exploited in discussions, planning and decision making regarding future management and leadership in hospitals. ORIGINALITY/VALUE: Only a few studies have investigated perceptions of future management in hospitals. This study adopted the Argument Delphi Method to identify distinct perceptions on the future orientation and organization of management and leadership in hospitals.

Experts' perceptions of management and leadership competence in Finnish hospitals in 2030.

PURPOSE: The purpose of this study is to elicit and analyze experts' perceptions of management and leadership competence (MLC) and likely MLC developments and requirements in hospital contexts by 2030. DESIGN/METHODOLOGY/APPROACH: A three-round, web-based Argument Delphi process was used to gather critically discussed opposing perceptions of 33 Finnish experts, which were subjected to inductive content analysis to identify themes. FINDINGS: Current deficiencies in MLC and several trends (e.g. an ongoing shift towards collaborative management) and required improvements (e.g. a need to adopt more holistic approaches) were identified. However, there were some conflicting perceptions, regarding for example the desirability of fixed-term positions for managers. RESEARCH LIMITATIONS/IMPLICATIONS: The findings provide qualitative indications of a group of Finnish experts' perceptions of MLC and requirements for its development, elicited using the Argument Delphi Method. Thus, they are subject to the usual limitations of the applied methodology and should be generalized to other contexts cautiously. PRACTICAL IMPLICATIONS: The identification of current deficiencies and future requirements for MLC may facilitate the formulation of robust approaches for improving it in hospital contexts. SOCIAL IMPLICATIONS: The findings may be useful for improving MLC in hospitals, thereby enhancing efficiency, teamwork, safety and client satisfaction in healthcare settings. ORIGINALITY/VALUE: The Argument Delphi Method has been rarely used in health management science studies and healthcare context. It is intended to develop relevant arguments and reveal reasons for differing views about focal issues, thereby providing deeper understanding of experts' perceptions of MLC and its likely development.

Increasing value-adding patient care by applying a modified TCAB program.

Purpose The purpose of this study is to evaluate a development process aimed at increasing registered nurses' (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals. Design/methodology/approach Basic data for the development process were collected on RNs' working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs' working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis ( N = 64). Findings RNs' working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs' working time use. Practical implications The development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work. Originality/value Even minor changes in nurses' daily work profile can have considerable effects on RNs' work. The TCAB program was shown to be a useful method in developing RNs' work also in psychiatric units.

Collaborating with nurse leaders to develop patient safety practices.

Purpose The organisational level and leadership development are crucial elements in advancing patient safety, because patient safety weaknesses are often caused by system failures. However, little is known about how frontline leader and director teams can be supported to develop patient safety practices. The purpose of this study is to describe the patient safety development process carried out by nursing leaders and directors. The research questions were: how the chosen development areas progressed in six months' time and how nursing leaders view the participatory development process. Design/methodology/approach Participatory action research was used to engage frontline nursing leaders and directors into developing patient safety practices. Semi-structured group interviews ( N = 10) were used in data collection at the end of a six-month action cycle, and data were analysed using content analysis. Findings The participatory development process enhanced collaboration and gave leaders insights into patient safety as a part of the hospital system and their role in advancing it. The chosen development areas advanced to different extents, with the greatest improvements in those areas with simple guidelines to follow and in which the leaders were most participative. The features of high-reliability organisation were moderately identified in the nursing leaders' actions and views. For example, acting as a change agent to implement patient safety practices was challenging. Participatory methods can be used to support leaders into advancing patient safety. However, it is important that the participants are familiar with the method, and there are enough facilitators to steer development processes. Originality/value Research brings more knowledge of how leaders can increase their effectiveness in advancing patient safety and promoting high-reliability organisation features in the healthcare organisation.

Improving the quality of registered nurses' working time use data.

AIMS AND OBJECTIVES: To examine the advantages and disadvantages of external observation and self-reporting methods in investigating registered nurses' working time use in order to improve the quality of working time use data. BACKGROUND: External observation and self-reporting methods are the most widely used approaches for studying nurses' working time use in observational work sampling studies, but there is scarce information of the data collection procedures and results in the same research context and in the same study. DESIGN: A cross-sectional quantitative study with a structured data collection instrument developed for this study. The same instrument was used in both data collections. METHODS: Data were collected from six inpatient units at two Finnish tertiary hospitals in autumn 2013 over two consecutive weeks. All registered nurses (n = 95) from two internal medical units, two surgical units and two psychiatric units participated in this study. RESULTS: Statistically significantly divergent information was produced by the two data collection methods in the major nursing categories of value-adding care and non-value-adding work as well as in each of the seven nursing subcategories. CONCLUSIONS: External observation and self-reporting gave an overall picture of how registered nurses are using their working time, and both methods were useful in examining registered nurses' working time use when taking into account the advantages and disadvantages of these methods. The deviations between the results improved the quality of data because both methods address recognised shortcomings of the other. RELEVANCE TO CLINICAL PRACTICE: This research promotes awareness of the divergent study results by investigating registered nurses' working time use with these two different data collection methods. In future, it would be wise to aim for more comparable data by applying external observation and self-reporting techniques simultaneously.

Management and leadership competence in hospitals: a systematic literature review.

Purpose - The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks. Design/methodology/approach - A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis. Findings - The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general. Research limitations/implications - One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care. Originality/value - The authors' evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original.

Nursing Staff's Perceptions of Patient Safety in Psychiatric Inpatient Care.

PURPOSE: This study aims to explore nursing staff's perceptions of patient safety in psychiatric inpatient care. DESIGN AND METHODS: Nurses were asked to describe their perceptions in semi-structured interviews, and their responses were analyzed by inductive content analysis. FINDINGS: Nurses addressed two sets of factors: one related to the experiences of safety and the other related to the implementation of safe care. PRACTICE IMPLICATIONS: The views of the nurses contribute to formalization of organizational policies and strategies. In particular, they highlight the importance of continual training for the staff and management, considering patients' views, and treating patients as collaborators in their care.

Nurses' working time use - how value adding it is?

AIM: To investigate registered nurses' (RN) and licensed practical nurses' (LPN) working time use in adult inpatient units. BACKGROUND: There is only scarce information about value-adding patient care. Nursing care can be divided into three major categories: value-adding care (direct care, indirect care, patient documentation), necessary activities (indirect work, unit-related work) and non-value-adding work (personal time, miscellaneous work). METHOD: A cross-sectional quantitative work sampling study. Total of 11,029 nursing activities were collected from two Finnish tertiary hospitals using registered nurses' (n = 66) and licensed practical nurses' (n = 12) self-reporting. RESULTS: Nearly three-quarters of nurses' work was value-adding care (71%). The working time division was almost identical for necessary activities and non-value-adding work. Registered nurses spent more time carrying out unit-related work, while licensed practical nurses' spent more time on direct care. Nurses' working time use was divided nearly identically in somatic units but there were differences when compared with psychiatric units. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' work seemed to concentrate on value-adding care. The results of working time use studies can be used when developing nursing work for more value-adding care for the patients.

The success of a management information system in health care - a case study from Finland.

PURPOSE: The purpose of this article is to describe perspectives on information availability and information use among users of a management information system in one specialized health care organization. The management information system (MIS) is defined as the information system that provides management with information about financial and operational aspects of hospital management. METHODS: The material for this qualitative case study was gathered by semi-structured interviews. The interviewees were purposefully selected from one specialized health care organization. The organization has developed its management information system in recent years. Altogether 13 front-line, middle and top-level managers were interviewed. The two themes discussed were information availability and information use. The data were analyzed using inductive content analysis using ATLAS.ti computer program. RESULTS: The main category "usage of management information system" consisted of four sub-categories: (1) system quality, (2) information quality, (3) use and user satisfaction and (4) development of information culture. CONCLUSIONS: There were many organizational and cultural aspects which influence the use of MIS in addition to factors concerning system usability and users. The connection between information culture and information use was recognized and the managers proposed numerous ways to increase the use of information in management work. The implementation and use of management information system did not seem to be planned as an essential tool in strategic information management in the health care organization studied.

Managers' perspectives on recruitment and human resource development practices in primary health care.

OBJECTIVES: The aim of this study is to describe primary health care managers' attitudes and views on recruitment and human resource development in general and to ascertain whether there are any differences in the views of managers in the southern and northern regions of Finland. STUDY DESIGN: A postal questionnaire was sent to 315 primary health care managers, of whom 55% responded. METHODS: The data were analysed using descriptive statistics and cross-tabulation according to the location of the health centre. RESULTS: There were few differences in managers' attitudes and views on recruitment and human resource development. In the southern region, managers estimated that their organization would be less attractive to employees in the future and they were more positive about recruiting employees abroad. Furthermore, managers in the northern region were more positive regarding human resource development and its various practices. CONCLUSIONS: Although the results are preliminary in nature, it seems that managers in different regions have adopted different strategies in order to cope with the shrinking pool of new recruits. In the southern region, managers were looking abroad to find new employees, while in the northern region, managers put effort into retaining the employees in the organization with different human resource development practices.

Experiences of the fairness of recruitment from unsuccessful applicants in the field of nursing.

AIM: The purpose of this study was to describe the experiences of unsuccessful applicants for permanent nursing positions with regard to the fairness of the recruitment process. BACKGROUND: The international shortage of recruits in nursing and the rapidly increasing number of nurses retiring implies new challenges for recruitment. The nurses' experiences of fairness affect the availability of nurses and the attractiveness of the organization. The recruitment process is approached through traditional organizational justice theories. METHODS: The material was gathered from thematic interviews with 12 nurses who had applied for a permanent nursing position but were not selected. The material was analysed using theory-driven content analysis. RESULTS: The nurses felt differently about the result of the recruitment process. The experience of distributive justice alone was not significant in terms of the general sense of justice, since other dimensions of justice compensated for it. The effect of applicants' experiences of fair treatment in the recruitment process affected their future behaviour positively, negatively or not at all. CONCLUSIONS: and implications for nursing management It is crucial to recognize applicants' experiences of the fairness of the recruitment process, because unsuccessful applicants constitute a pool of potential new employees. Furthermore, applicants with different experiences cannot be seen as a homogenous group. For example, internal applicants with negative experiences pose challenges for nursing management with regard to retaining them in the organization.

Use of electronic information systems in nursing management.

PURPOSE: The purpose of this study is to describe nurse managers' perceptions of the use of electronic information systems in their daily work. Several kinds of software are used for administrative and information management purposes in health care organizations, but the issue has been studied less from nurse managers' perspective. METHODS: The material for this qualitative study was acquired according to the principles of focus group interview. Altogether eight focus groups were held with 48 nurse managers from both primary and specialized health care organizations. The nurse managers were asked in focus groups to describe the use of information systems in their daily work in addition to some other themes. The material was analyzed by inductive content analysis using ATLAS.ti computer program. RESULTS: The main category "pros and cons of using information systems in nursing management" summarized the nurse managers' perceptions of using electronic information systems. The main category consisted of three sub-categories: (1) nurse managers' perceptions of the use of information technology; (2) usability of management information systems; (3) development of personnel competencies and work processes. CONCLUSIONS: The nurse managers made several comments on the implementation of immature electronic information systems which caused inefficiencies in working processes. However, they considered electronic information systems to be essential elements of their daily work. Furthermore, the nurse managers' descriptions of the pros and cons of using information systems reflected partly the shortcomings of strategic management and lack of coordination in health care organizations.

Strategic management of health care information systems: nurse managers' perceptions.

The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

Human resource development in nursing: views of nurse managers and nursing staff.

AIM: This study describes the views of nurse managers and staff members on human resource development (HRD) in health care. Our interest here is whether there are any differences between these two groups. BACKGROUND: The need for HRD in order to cope with an ageing workforce and a diminishing number of younger nurses. METHODS: A postal questionnaire was sent to a random sample of nursing staff (n = 653) and all nurse managers (n = 302) in six Finnish hospital districts in spring 2005. The data were analysed by statistical methods. RESULTS: The nurse managers placed more emphasis on human resource development than did staff members. In general, both the nurse managers and nursing staff held positive views on human resource development, but they reported that HRD practices were quite under-developed. Some differences emerged between the groups. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: These findings underline the importance of human resource development and its practices in health care. Nurse managers need to implement strategically steered HRD in order to maintain high quality of care in the future.

External failures as descriptor of quality in clinical microbiology laboratory services.

This study employed customer feedback surveys to assess the quality of the laboratory services provided by an accredited clinical microbiology laboratory. The purpose of the study was to classify external failures and determine the quantity of such errors, and to establish how much time was spent processing and correcting these errors, together with the costs arising. The study indicates that the quality of laboratory test results can be regarded as good based on the accuracy of the result. Customer needs were also well taken into account in practice because of the good quality of the service. However, improvements are required in providing customers with test results without delay. The cost of processing and correcting such errors was negligible. The use of a customer feedback system allows systematic monitoring of external failures. In the accredited laboratory under study, it is unnecessary to monitor continually the costs and working time involved in processing and correcting external failures. The most essential point is to monitor the effects of the quality measures taken to reduce the number of failures.

The digital portfolio: a tool for human resource management in health care?

This article discusses the current situation of human resource management (HRM) in Finnish health care and charts the views of nurse directors (ward sisters and clinical nurse managers, n = 47) on the digital portfolio as a tool of HRM. The study is part of an evaluation research project; this article reports on the findings from nurse directors' perspective. The data were collected from three organizations in eastern Finland: a University Hospital, a Central Hospital and a Social and Health Centre. The nurse directors indicated a need for information on their staff's skills and competencies, but the area on which they had most information was on staff's formal education. They did not have access to systematic tools and methods for monitoring the continuous education of staff members. The digital portfolio can be used as a tool for HRM in health care, although the nurse directors did not realize it could provide a tool for sharing expertise through the units or wards.