What is strategic management?

Social and health care top managers' perceptions and aims of strategic work ability management in the midst of change

BACKGROUND

Existing research has mostly focused on themes related to returning to or staying at work and studied organizations' operational rather than strategic level actions to support work ability. Top managers' understanding of work ability management (WAM) may influence how work ability support processes are implemented in organizations.

OBJECTIVE

To find out how top managers define WAM, what the aims of WAM were and whether the aims were on a strategic level.

METHODS

Altogether 28 semi-structured interviews among Finnish social and health care top managers were conducted during the years 2019-2021 and analyzed inductively using qualitative thematic analysis.

RESULTS

Top managers' definition of WAM was mainly multidimensional. Two main aims were identified, i.e., to support work ability 1) at the individual and 2) at the organizational level. The aims of the former were to anticipate the decrease of health and functional capacity, to support workers already decrease in these, to develop competence, and to manage the effects of changes on work ability. The aims at the organizational level were to improve labor availability and personnel retention, to ensure the flow of work, and to increase trust and create shared values. Top managers described the aims as being at a strategic level, but this was not yet realized in their organizations because the actions were reactive rather than proactive.

CONCLUSION

Top managers' multidimensional perception of WAM, emphasizing proactive actions, and strategic level aims are crucial and require the commitment of the top managers for strategic WAM, especially during constant changes.

Framework of care: communicating the structure and processes of care

AIM

This article attempts to present a 'macro view' of the role and nature of an organization's Framework of Care (FrOC). This 'view' arises from a critical reflection on the available literature and the combined professional experience of the authors, who have worked in a variety of healthcare systems and settings in Australia, North America, United Kingdom, and the Middle East.

BACKGROUND

FrOC can be defined as the systems and processes within an organization that structure the delivery of care. These systems and processes are made evident in a series of documents, such as the Mission and Vision statement, Policies and Procedures, Standards of Care, Clinical Practice Guidelines, Clinical Pathways, and Protocols. These frameworks can provide structure for important organizational activities such as clinical audits, quality management and clinical information system (CIS) 'decision support', thereby supporting clinicians in their efforts to deliver high-quality, evidence-based care. How a healthcare organization structures its systems and processes of care directly impacts the patient and caregiver experience - made evident in patient and staff satisfaction with the services provided.

RECOMMENDATIONS

Mapping out and understanding an organization's FrOC is a critical first step for interprofessional teams attempting to implement evidence into practice and/or accreditation teams and expert consultants critiquing the performance of an organization.

Leadership and management competencies of head nurses and directors of nursing in Finnish social and health care

This paper describes the leadership and management competencies of head nurses and directors of nursing in social and health care. In the nursing profession, studies have tended to describe the role of the nurse manager, or to provide lists of competencies, talents and traits which can be found in successful managers. However, nursing managers’ leadership and management competencies lack any depth of research knowledge. Data were gathered by electronic questionnaire. Respondents ( n = 1025) were head nurses and directors of nursing. The data were statistically analysed. Both groups evaluated their leadership and management competencies to be quite good and their general competence to be better than their special competence. Overall, directors of nursing rated their general competence and special competence better than head nurses. However, the head nurses had a stronger expertise in general competence areas, professional competence and credibility, and also in the special competence areas of substance knowledge than the directors of nursing. While the overall leadership and management competencies were good for both groups, each has identified areas which can be further developed.

Exploring senior nurses' experiences of leading organizational change

Purpose - The aim of this paper is to explore Senior nurses' experiences of leading organizational change. There is a substantial literature reporting middle-level nurse managers' experiences of change; however, there is less evidence concerning senior nurses' perspectives. In view of this, interview data collected from senior nurses, as part of a study of major organizational change, were analysed to redress this imbalance. Design/methodology/approach - In-depth semi-structured interviews (n = 14) were conducted with senior nurses (between 2009 and 2012). Findings - Senior nurses' activity centred on leadership and workforce issues, internal influences and external pressures. In periods of change, appropriate leadership was vital, and "weak" leaders were considered to have an adverse effect on teams. Concerns were expressed about financial strictures and their impact on patient care and service provision. The senior nurses were striving to provide the best quality of service delivery with the limited resources available. Concentration on operational matters was necessary to maintain stability in periods of change. However, this prevented senior nurses from influencing strategic decision-making in their organizations. Practical implications - If senior nurses are to realise their potential to operate at a strategic level, they need to be given time and support to lead, rather than just react to change. This research emphasises the importance of a "nursing voice" to inform board-level decisions and maintain a focus on patient care. Originality/value - This research sheds light on the work of a key group of staff in health-care organizations. Understanding senior nurses' experience of and contribution to change is a useful contribution to health services research.

The development and pilot of an instrument for measuring nurse managers’ leadership and management competencies

This paper describes the development and piloting of an instrument for measuring nurse managers’ leadership and management competencies. No previous instruments exist that comprehensively measure these dimensions. The instrument was developed in three phases. Following a literature review, the items of the instrument were created. Second, the face and content validity of the instrument were evaluated by an expert panel. Finally, the developed instrument was pilot-tested with a test survey of 22 nurse managers in two organisations. The validity and reliability of the scale was analysed using statistical methods. The resulting Nurse Managers Leadership and Management Competencies scale is a web-based self-assessment test consisting of 194 five-point Likert scale items. Competence is divided into general competence and special competence. The instrument makes it possible to evaluate nurse managers’ leadership and management competencies in public healthcare, and to obtain information for the further development of these attributes and factors.

Gaps in governance: protective mechanisms used by nurse leaders when policy and practice are misaligned

BACKGROUND

Due to large geographical distances, the telephone is central to enabling rural Australian communities to access care from their local health service. While there is a history of rural nurses providing care via the telephone, it has been a highly controversial practice that is not routinely documented and little is known about how the practice is governed. The lack of knowledge regarding governance extends to the role of Directors of Nursing as clinical leaders charged with the responsibility of ensuring practice safety, quality, regulation and risk management. The purpose of this study was to identify clinical governance processes related to managing telephone presentations, and to explore Directors of Nursing perceptions of processes and clinical practices related to the management of telephone presentations to health services in rural Victoria, Australia.

METHODS

Qualitative documentary analysis and semi structured interviews were used in the study to examine the content of health service policies and explore the perceptions of Directors of Nursing in eight rural health services regarding policy content and enactment when people telephone rural health services for care. Participants were purposively selected for their knowledge and leadership role in governance processes and clinical practice. Data from the interviews were analysed using framework analysis. The process of analysis resulted in the identification of five themes.

RESULTS

The majority of policies reviewed provided little guidance for managing telephone presentations. The Directors of Nursing perceived policy content and enactment to be largely inadequate. When organisational structures failed to provide appropriate governance for the context, the Directors of Nursing engaged in protective mechanisms to support rural nurses who manage telephone presentations.

CONCLUSIONS

Rural Directors of Nursing employed intuitive behaviours to protect rural nurses practicing within a clinical governance context that is inadequate for the complexities of the environment. Protective mechanisms provided indicators of clinical leadership and governance effectiveness, which may assist rural nurse leaders to strengthen quality and safe care by unlocking the potential of intuitive behaviours. Kanter's theory of structural power provides a way of conceptualising these protective mechanisms, illustrating how rural nurse leaders enact power.