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Experience is lost during reorganisation of health and medical care

Within health and medical care the merger of hospitals and privatisation of activities have become popular solutions in the hunt for increased efficiency and more care for less money.

"There is much mention of efficiency without further definition of the concept, but it influences and is influenced by the organisation's structure, leadership as well as employeeship," says Agneta Kullén Engström who is studying for a doctor's degree in the subject at the Nordic School of Public Health, NHV.

"Structural changes, such as mergers and privatisation, can be compared to fashion trends," says Agneta Kullén Engström, who, on 16 October will be defending her thesis "Leadership and employeeship during structural changes within health and medical care.

The experiences of key players and employees" at the Nordic School of Public Health.

Whilst structural changes are happening within health and medical care, changes are also taking place in the population structure and a development of knowledge involving increased demands on availability and quality, which can lead to conflicts of objectives.

"Furthermore, if there is a lack of trust in the organisation and its management, neither managers nor employees can be expected to act rationally in a process of change," says Agneta Kullén Engström.

She works with strategic personnel and educational issues at Skaraborg's Hospital.

Processes of change double spiral
"The management, communication, culture and employees' participation accompanied by words and deeds are thought to be some of the keys to the success of organisations in times of change," says Agneta Kullén Engström, who interviewed a large number of managers and employees in connection with structural changes within health and medical care.

The processes of change can be described as a double spiral, with two different intertwined sides. One side is characterised by commitment, security and positive feelings whilst the other is characterised by negative feelings, lack of commitment and security.

At the same time, according to Agneta Kullén Engström, there is a tendency for the lessons learned from previously implemented structural changes to be ignored, which means that mistakes already made tend to be repeated. Structural changes within health and medical care should instead build upon previous experiences and be deeply rooted among the employees in order to be successful and sustainable.

Title of thesis: Leadership and employeeship during structural changes in health and medical care The experiences of key players and employees
Author: Agneta Kullén Engström, (+46) 502 230 33 (home), (+46) 500 432964 (work), (+46) 73 3521299 (mobile), e-mail:
Main supervisor: Runo Axelsson, Professor, the Nordic School of Public Health, (+46) 31 693924
Opponent: Terese Bondas, Professor, Bodø, University College, Norway
Time and place of disputation: Friday, 16 October 2009, at 13.30 Aulan (the Lecture Hall), the Nordic School of Public Health
Address: Fredrik Bloms väg 25, Nya Varvet, Göteborg, Sweden
The thesis can be ordered for SEK 150.00 exclusive of postage and packing:

Monica Bengtsson | idw
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