No description available.

Internationally, health systems have been undergoing an extended period of endemic change, where one effort at health system reform inevitably seems to lead to further attempts to make adjustments, re-direct the focus of the reform effort, or bring about further, sometimes very different changes. This phenomenon is described as churning in this thesis. Churning is a result of continual efforts to adjust and �improve� health systems to address intractable �wicked� problems, often through applying solutions based on neo-liberal reform agendas that have influenced public sector reform in developed countries since the early 1980s. Consistent with this, the South Australian health system has been caught up in a cycle of change and restructuring for almost thirty years. This qualitative study explores a case study of unsuccessful organisational change initiated by a group of health care agencies in the southern metropolitan area of Adelaide, South Australia, which took place between 1996 and 2001. The agencies sought to develop and establish a regional health service through a process they called �Designing Better Health Care in the South� which aimed to improve the way that services were provided in the area, and to enable the agencies to manage the increasing budgetary and workload pressures that they were all experiencing. A significant policy shift at the state government level meant that this initiative was no longer supported by the central bureaucracy and could not proceed. The agencies reverted from a focus on regional planning and service delivery to an institutional focus. The changes that are described within the scope of the case study are universally recognisable, including centralisation, decentralisation, managerialism and integration. The experience of Designing Better Health Care in the South as an unsuccessful attempt to implement change that was overtaken by other changes is also a universal phenomenon within health systems. This study locates the case study within its historical and policy contexts. It then analyses the key themes that emerge from consideration of the case study in order to understand the reasons for constant change, and the structural and systemic impediments to successful reform within the South Australian health system as an example of health systems in developed countries. As a case study of organisational change, Designing Better Health Care in the South was a story of frustration and disappointment, rather than of successful change. The case study of Designing Better Health Care in the South demonstrates the tensions between the differing priorities of central bureaucracy and health care agencies, and the pendulum swing between the aims of centralisation and regionalisation. The study uses the theory of negotiated order to understand the roles of the key themes of trust, partnership and collaboration, and power and control within the health system, and to consider how these themes affect the potential for the successful implementation of health care reform. Through analysis of the case study, this thesis contributes to an understanding of the difficulties of achieving effective reform within health systems in advanced economies, such as the South Australian health system, because of the complex power and trust relations that contribute to the functioning of the health system as a negotiated order. The study is multidisciplinary and qualitative, incorporating a number of social science disciplines including sociology, political science, historical analysis and organisational theory. Data collection methods for the study included interviews, focus groups, document analysis and a survey.

For decades, union membership and activity has been declining in North America; employers have demanded greater flexibility and have successfully weakened workplace and worker protections. Modern workers increasingly use alternative strategies to negotiate conditions of employment with managers who have limited their discretionary power. Negotiated order theory provides a useful tool for analyzing the mesostructural arrangements of bargaining parties during labor disputes. This thesis applies negotiated order theory to explore how and why the National Football League (NFL) players have twice decertified their union and sought court intervention to challenge the legitimacy of the League's highly restrictive reserve system. An outcome-focused content analysis was designed as a preliminary investigation to ascertain why an alternative strategy was sought and if the strategy proved more effective in securing the players' preferred ends than conventional collective bargaining. The NFL case offers a fixed market from which to formulate a negotiation context of the interorganizational structures and bargaining interactions of its members.

Yes / Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant's role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not redistribute work in a uniform way; contextual factors of individual experience and team relationships shape changes to the division of labour. For instance, in some situations, scrub practitioners take on the role of supporting inexperienced surgical assistants. These changes in the division of labour do not persist when team members return to operations that are not robot-assisted. This study contributes to wider literature on divisions of labour in healthcare and how this is impacted by the introduction of new technologies. In particular, we emphasise the need to pay attention to often neglected micro-level contextual factors. This can highlight behaviours that can be promoted to benefit patient care.

This thesis is a case study of the Swedish Rehabilitation Reform of 1992. Vocational rehabilitation is described as an organizational activity which takes place in the interaction between social policy regulations and organizational execution. The analytical point of departure is made up of two complementary theoretical perspectives (Chapter 3): New institutional theory and the concept of 'negotiated order'. New institutional theory can aid inter-organizational analysis as it assumes that organizations are not only influenced, but also permeated by institutional and technical frameworks. The 'negotiated order' perspective can provide an understanding of actors' motives when they work together. This perspective also acknowledges that actors are able to exercise 'episodic power', and that this differs from 'formal power'. The first empirical study (Chapter 4) analyses the political motives behind the Rehabilitation Reform of 1992. It shows that at the time of the Rehabilitation Reform economical and political interests were pushing for a tighter regulations in Swedish social policy. The following three empirical studies focus on the 'organizational field' in which rehabilitation is practised. This field consists of the social insurance office, employment agencies, primary health care centres and occupational health service centres. Chapter 5 deals with the regulations and environmental factors influencing the various organizations and their representatives. It points to five external forces that influence the performance of the four type of actors. The social insurance office is influenced by a judicial social insurance logic, the employment agencies by a holistic labour market policy logic, and the physicians in primary health care centres and in occupational health centres by a 'holistic' medical frame of reference, which contrasts with that often found in other medical sub-specialities. Finally, employers are influenced first, by a logic of profit which has a technical and institutional dimension and second, by an institutional welfare state logic. Chapter six shows that the largest 'domain conflict' in the initial phase of the rehabilitation trajectory has to do with defining 'capacity to work'. Domain conflicts are seen as resulting from different institutional logics, implying different views on illness and capacity to work. Numerous and frequent personal interaction make it possible for physicians and rehabilitation officials to avoid conflict. The operative phase is associated with two major domain conflicts. The first is related to negotiations between the social insurance office and the employers about transferring employees to other duties. Both sides avoid exercising power that may damage clients and future trust. Episodic power resources are used to exercise the strategy of 'the golden middle path'. The other domain conflict is related to the judgement of work capacity. The labour market officials' view of work capacity differs from that of the officials at the social insurance office. Chapter seven compares cooperative rehabilitation projects with regular rehabilitation activity. The results show that actors in cooperative projects break the sequential work order used in regular rehabilitation activity and thereby projects quickly collect comprehensive information about individuals. Cooperative projects can also achieve flexible solutions tailored to an individual clients needs. Further, cooperative projects allow time for unconventional initiatives, which regular activity do not. The process of 'returning to work' poses a challenge both kinds of work organizations. Individuals who are disabled in some way are required to meet the same labour market demands as healthy and well educated are expected to meet. Finally, regular rehabilitation work tends uses standardize clients while cooperative projects tend to treat them as individuals. / digitalisering@umu

Ambitionen med denna studie har varit bidra med ny kunskap över hur olika kommuner organiserar sitt arbete med Kommunernas aktivitetsansvar (KAA), hur verksamheterna utformas samt vilka faktorer som får betydelse för utformningen. Syftet har även varit att beskriva vilka framgångsfaktorer och utmaningar yrkesverksamma kan identifiera i sitt arbete med ungdomen och hur den relationsskapande processen ser ut. Ytterligare avsåg studien att undersöka hur KAA-verksamheter samverkar med andra offentliga serviceorgan, som skola och socialtjänst. Studiens teoretiska referensramar har varit Organisationsteorin ‘Förhandlad ordning’ och ‘Relation- och kommunikationsteorin’. Empirin samlades in genom kvalitativa, semistrukturerade intervjuer med nio yrkesverksamma inom KAA-verksamheter från sju svenska kommuner. Resultatet av denna studie visar att KAA-verksamhetens operativa förutsättningar påverkas av vilken kommunal förvaltning som insatsen placeras inom. KAA-verksamheten styrs till stor del underifrån, och yrkesverksammas yrkesbakgrund, handlingsutrymme och engagemang får betydelse för verksamhetens utformning. Samverkan med andra verksamheter och organisationer sker antingen genom standardiserade möten eller personliga kontakter. En bra samverkan med både grund- och gymnasieskolan är en framgångsfaktor som fungerar olika bra i olika kommuner. Vårt resultat har även visat att socialtjänstens sekretessbestämmelser försvårar KAA-verksamhetens uppsökande arbete. Detta leder till att kommuner upprättar lokala rutiner för hur sekretessbelagda uppgifter ska hanteras. / The ambition of this study has been to contribute new knowledge about how different municipalities organize their work with The Municipalities' Activity Responsibility (Kommunens Aktivitetsansvar; KAA), how the operations are designed and which factors are important for the design. The purpose has also been to describe which success factors and challenges professionals can identify in their work with young people and what the relationship building process looks like. The study also aimed to investigate how KAA operations interact with other public service providers, such as schools and social services. The study's theoretical framework has been the Organizational Theory ‘Negotiated Order’ and the ‘Relationship and Communication Theory’. The empirics were collected through qualitative, semi-structured interviews with nine professionals in KAA operations from seven Swedish municipalities. The result of this study has shown that the KAA operation’s operational conditions are affected by the municipal administration in which the intervention is placed. KAA operations are often controlled from below, and professionals' own professional background, commitment and space of action have an impact on the design of the operations. Collaboration with other authorities and organizations takes place either through standardized meetings or personal contacts. A good collaboration with both primary and secondary school is a success factor that works differently in different municipalities. The result of this study has also shown that the social services' secrecy regulations make it difficult for the KAA operations to fulfill their duty. This leads to municipalities establishing local routines for how classified information is to be handled.

No description available.

Throughout their existence, organizations face endless change. Organizational change programs, despite often being initiated by top management, inevitably involve employees at multiple levels in the organization, including middle managers, which could be argued to play an especially important role as they are both receivers and implementers of the change. The middle managers try to make sense of the changes initiated by top management while they simultaneously are expected to sell it down the organizational line, meaning that the middle managers are forced to balance multiple and sometimes competing roles during change. Moreover, negotiations arise during the unstable times of change for the new social order to be determined and for organizational work to take place. To better understand these phenomena, this study applies a change recipient perspective, specifically that of middle managers. The phenomena were explored through a case study, which included qualitative interviews with managers in an organization that during the study was undergoing multiple changes, with the aim to gain a better understanding of these complex social processes by recognizing the impact from contextual and cultural factors. The findings of the study illustrate that while the middle managers negotiated within themselves to make sense of the change, they did not get the same opportunity to negotiate with their superiors. Further, the middle managers made sense of the change in ways that were unique to them, depending on their individual experiences and backgrounds. Hence, there was no single “best way” to facilitate all middle managers’ sensemaking processes, rather, the middle managers needed differing support at differing points in time. The study concludes that the contextual factors, such as the organizational culture and subcultures, power relations and social dynamics, were what affected the middle manager's sensemaking processes and their room for negotiation. Therefore, these factors could be further addressed in theory and in practice before initiating change. / Organisationer står inför oändlig förändring under hela sin existens. Organisatoriska förändringsprogram, trots att de ofta initierats av högsta ledningen, involverar oundvikligen anställda på flera nivåer i organisationen, inklusive mellanchefer, vilka skulle kunna hävdas spela en särskilt viktig roll eftersom de är både mottagare och implementerare av förändringen. Mellancheferna försöker förstå den uppifrån initierade förändringen samtidigt som de förväntas sälja den längs organisationslinjen, vilket innebär att mellancheferna tvingas balansera flera, ibland konkurrerande, roller under förändring. Dessutom uppstår förhandlingar under den instabila tid som förändringar medför för att den nya sociala ordningen ska kunna bestämmas och för att organisationsarbete ska kunna äga rum. För att bättre förstå dessa fenomen tillämpar denna studie ett “förändringsmottagarperspektiv”, särskilt det av mellancheferna. Dessa fenomen utforskades genom en fallstudie, som innehöll kvalitativa intervjuer med chefer i en organisation som under studien genomgick flera förändringar, med syftet att få en bättre förståelse för dessa komplexa sociala processer genom att vidkänna påverkan från kontextuella och kulturella faktorer. Resultaten av studien illustrerar att medan mellancheferna förhandlade inom sig själva för att förstå förändringen, fick de inte samma möjlighet att förhandla med sina överordnade. Vidare skapade mellancheferna mening av förändringen på sätt som var unika för dem, beroende på deras individuella erfarenheter och bakgrunder. Därför fanns det inget enskilt "bästa sätt" att underlätta alla mellanchefers meningsskapande processer, snarare behövde mellancheferna olika stöd vid olika tidpunkter. Studien drar slutsatsen att de kontextuella faktorerna, såsom organisationskulturen och subkulturer, maktrelationer och social dynamik, var det som påverkade mellanchefens förhandlingsmöjligheter och förmåga att förstå förändringen. Därför kan dessa faktorer uppmärksammas ytterligare i teorin samt i praktiken innan förändringar initieras.

Cette recherche tente de répondre à la problématique suivante : dans quelle mesure la mise en place d’un manager-hybride et d’une équipe pluridisciplinaire, peut- elle permettre la gestion de la concurrence entre des logiques institutionnelles au sein d’une organisation hybride ? Nous avons alors établi un cadre théorique développant d’abord la notion d’organisation hybride. Ensuite, nous investiguons la notion de manager-hybride en la rapprochant de celle de l’acteur-frontière. Enfin, nous nous intéressons à l’équipe pluridisciplinaire qui apparaît alors comme un espace favorable à la collaboration interprofessionnelle. Concernant notre démarche empirique, celle-ci, dans le cadre d’une étude de cas unique, s’est déroulée au sein du pôle Femme-Enfant d’un centre hospitalier intercommunal de grande taille que nous considérons comme un cas extrême et révélateur. Plus particulièrement nous avons endossé une méthodologie qualitative (entretiens semi-directifs avec analyse de contenu). Quant à nos résultats, nous avons constaté que les contextes institutionnel et organisationnel apparaissent comme empreints de tensions entre les différents groupes d'acteurs. Pour autant, le chef du pôle Femme-Enfant et le trio gestionnaire parviennent, via différents mécanismes, à agir en faveur d’une compréhension mutuelle des différents groupes et d’une hybridité équilibrée. Nous émettons alors deux principaux axes de discussion : l’un traitant des différentes habiletés du manager-hybride à soutenir la conciliation entre des logiques institutionnelles concurrentes ; et l’autre, de l’équipe pluridisciplinaire comme espace favorable à la diffusion d’une hybridité équilibrée et durable / The particular purpose of the research is to answer the following question : to what extent is the implementation of a hybrid-manager and a multidisciplinary team enables the management of competing institutional logics within a hybrid organization ? To this end, we propose a theoretical framework that develops, firstly, the concepts of hybrid organization. Next, we focus on the concept of hybrid-manager to put it closer to the boundary-actor one. Lastly, we focus on the concept of multidisciplinary team. Multidisciplinary team that appears as a favorable space for interprofessional collaboration. Our empirical approach is based on a single case study, which references a particular department in a hospital located in southern France (i.e. the « child-woman pole ») that we consider as an extreme and revelatory case. More specifically, we applied a qualitative methodology (i.e. semi-structured interviews with content analysis). Concerning our results, the data analysis shows an institutional and organizational context marked by tensions between individuals. But, the the head of the child-woman pole and the trio foster a mutual understanding between groups, and in so doing, balances competing logics. Finally, these results lead us to put foward two main themes for discussion : one centred on the skills and competencies of the hybrid-manager to support reconciliation and to balance coexistence of competing logics ; and the second one, centred on the multidisciplinary team as favorable space for the emergence of a hybrid institutional logic and for the dissemination of balanced and sustainable hybridity

Une des caractéristiques des entreprises multinationales est leur implantation dans des pays divers géographiquement et culturellement. Les services de communication interne sont représentés majoritairement comme la solution pour susciter l’adhésion à la culture d’entreprise et pour développer une synergie autour de celle-ci en dehors des considérations culturelles de chacun.Le discours dominant veut que la culture d’entreprise soit acceptée de la même façon par l’ensemble des salariés, notamment grâce à la communication interne qui y est définie comme un acteur stratégique jouant un rôle dynamique dans le quotidien de l’entreprise. L’objectif de cette thèse est de contraster les discours sur la communication interne avec les conclusions tirées de l’observation des tâches assurées par ses responsables dans trois filiales d’entreprises multinationales, en particulier pour constater à quel point les questions interculturelles font partie de leur quotidien. Il s’agit également de contraster les discours qui représentent l’entreprise comme une organisation à l’ordre social statique, basé sur une culture d’entreprise consolidée, avec le quotidien des salariés qui essaient de se trouver un espace d’expression de leur différence culturelle face à la culture de l’entreprise, ce qui remet en cause l’idée de l’environnement interne d’entreprise solide et inerte.Pour faire ressortir les écarts entre les discours et la réalité du travail dans l’entreprise multinationale, nous avons construit un cadre conceptuel basé sur la théorie de la régulation sociale de J.-D. Reynaud, en faisant l’hypothèse que la communication entre la culture de l’entreprise et les cultures des salariés se manifesterait via un jeu de règles permanent, et sur la théorie de l’ordre négocié de A. Strauss qui représente l’organisation en construction permanente de son ordre social basé sur la négociation des compromis entre acteurs. Les concepts du pouvoir et des représentations sociales sont utilisés pour renforcer l’idée selon laquelle toute interaction au sein de l’entreprise ne peut exister sans la présence des différentes manifestations de ces deux concepts.Pour formuler des conclusions, nous avons adopté une méthodologie de recherche basée sur l’étude de cas durant laquelle nous avons eu recours à l’observation participante, aux entretiens semi-directifs et à l’analyse du contenu des publications de la communication interne. / One of the characteristics of multinational enterprises is their implementation in countries geographically and culturally diverse. Internal communication services are represented mostly as the solution to build support for the corporate culture and to develop synergy around it beyond workers' cultural considerations. The dominant discourse states that the corporate culture is to be accepted in the same way by all employees, notably through internal communication services, which are defined as a strategic actor playing an active role in everyday business. The objective of this thesis is to contrast the discourse of internal communication services with the conclusions drawn from the observation of tasks performed by its officials in three subsidiaries of multinational companies, in particular to see how cross-cultural issues are part of their daily lives. It aims also at contrasting how discourses that represent the company as an organization whose static social order is based on a consolidated corporate culture, with employees trying to find a space to express their cultural difference against the company culture in their daily life. In order to highlight the gaps between the rhetoric and reality of working in a multinational enterprise, we assembled a conceptual framework based on J.-D. Reynaud's theory of social regulation, assuming that communication between the corporate culture and the cultures of the employees would manifest itself through a set of permanent rules, and A. Strauss' negotiated order theory, which represents the organization permanently constructing its social order through the negotiation of compromises between actors. The concepts of power and social representations are used to highlight the idea that any interaction within the company can not exist without the presence of different manifestations of these two concepts. In order to draw conclusions, we have adopted a research methodology based on case studies. We have therefore used participant observation, semi-structured interviews and content analysis of the publications of internal communication services.