Elderly care and its first-line managers are an essential part of social work. As the demographic changes since the demands for efficiency in elderly care are increasing. The profession of the first-line managers is complex. They need to make well-balanced priorities for the good of the organizations and the wellbeing of patients and employees. Based on that our study aims at increasing the knowledge about how first-line managers of elderly care experience and handle their profession. Furthermore the study aims to explore how support around first-line managers can look like and how they achieve balance between their profession and private life. To answer the aim of the study six semi-structured interviews were performed with first-line managers, who are active in elderly care, equally many men as women. The first-line managers are active in publicly organized elderly care in three municipalities in southern Sweden. The results show that the first-line managers experience of their profession is positive, all of them experiencing a meaningfulness. However, the results show that the first-line managers are experiencing demands of availability and the management position in itself implies an exposure. Based on this study, we can conclude that the six first-line managers included in this study perceive their profession as stimulating and meaningful, which is also in line with previous research. Only two of six first-line managers have negative experiences related to their profession. The first-line managers use both work experience as well as a functioning support structure to handle the demands and expectations. In order to achieve a balance between profession and private life the professional distance to their employees is crucial.

This thesis is about the healthcare managers, working at operational levels, defined as the first-line managers. These managers often are given the role and responsibility to integrate improvements into daily work. A stronger development ability of Swedish healthcare requires first-line managers with a developed ability to lead change. Thereby efforts must be made to provide these managers with supportive work conditions when leading and developing organizations. One approach to organizational development is Lean, which refers to a strong improvement culture based upon a supportive and highly engaged leadership as well as a strong customer focus. The purpose of this thesis is to contribute to knowledge about and an understanding of the conditions that influence first-line healthcare managers’ abilities to drive improvement work based on Lean. Some of the conditions investigated are; time, receiving support from the own manager, feeling joy in improvement work and being assured about the effects of Lean. The thesis is based on three separate analyses of a web-based survey, which relate to the two research questions. The study was conducted in a Swedish healthcare organization two years after the initiation of Lean. The analyses are presented in three separate papers. The first research question considers; How can an instrument be developed that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? The second question is; What can be learned from using the instrument that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? A qualitative study based on a hermeneutic, inductive, qualitative research approach was conducted in order to meet the research purpose and answer the research questions. The thesis is mainly based on three papers. In paper 1 it is stated that the assuredness about the effects of Lean was quite high among the managers when the survey was conducted, such as that Lean contributes to a greater patient focus and to the development of an improvement culture. In paper 2 it is noted that the first-line managers view their role as crucial in improvement work based on Lean. Time, support from coworkers, and a clear vision and clear goals were the three conditions they considered to be most important for their ability. The results presented in paper 3 show that to initiate improvement work based on Lean, they ask for own managers who are assured about Lean and include them in discussions. They view their role and responsibility in relation to their coworkers as extensive, for instance increating a culture where problems and mistakes are viewed as possibilities to improve and for encouraging that new work procedures are tested. The findings indicate a need for a deeper understanding of Lean. It is concluded that a thorough understanding of Lean is a main condition for the first-line managers´ ability to drive improvement work based on the approach. Developing a common view of Lean takes time, which is important to emphasize in the practical setting to motivate for a long-term perspective. This development takes highly motivated, assured and persistent leaders with a continuous improvement attitude and a mission to improve healthcare together. There is also an applied research question; How can the use of the instrument contribute to developing first-line managers’ role, conditions, and ability to drive improvement work based on Lean? In its essence, Lean is concerned with improving a system and since the instrument raises questions about relationships between organizational members, it sets focus on the system and calls on a system view. The responsibility for one management level must continuously be set I relation to another, when putting the pieces together in the “improvement puzzle”. Change depends on adjustments in human behavior and the instrument establishes a focus on the people in the processes necessary for development and results. The instrument also provides opportunity and structure to investigate and talk about the soft conditions important for the ability, such as receiving support from the own manager, and feeling inspiration and being assured. The practice of Lean requires changes in attitudes, new habits, new skills in the whole system, meaning in each individual from the executive management to the front-line workers. Thereby self-reflection becomes important, which requires forums for dialogue. It is concluded that such forums can influence first-line healthcare managers’ abilities to drive improvement work based on Lean. In dialogue forums improvement work can be reflected upon and learned from together. / <p>Vid tidpunkten för framläggningen av avhandlingen var följande delarbeten opublicerade: delarbete 2 (accepterat), delarbete 3 (inskickat).</p><p>At the time of the defence the following papers were unpublished: paper 2 (accepted), paper 3 (submitted).</p>

<p>Syftet med uppsatsen är att öka förståelsen för vilken betydelse kommunikation har för frontpersonalens reaktion på en fusion mellan tjänsteföretag.</p><p>Fusioner är ett vanligt förekommande bland dagens företag, så även för tjänsteföretag. Frontpersonal anses vara särskilt viktig i tjänsteföretag då de i interaktion med företagets kunder förmedlar kvalitet. Vid fusion är det därför viktigt att skapa förutsättningar för att två mötande personalgrupper tillsammans kan verka för fortsatt god kvalitet. Ett verktyg för att skapa sådana förutsättningar är kommunikation.</p><p>Formell kommunikation kan användas till att skapa acceptans för en fusion och införa förändringar vid denna. En förutsättning för att frontpersonalen skall uppnå en högre förståelse har visat sig starkt beroende av möjligheten att föra tvåvägskommunikation.</p><p>Informell kommunikation har visats fungera som ett starkt stöd för att skapa acceptans och en positiv föreställning av en fusion. Särskilt viktig är den informella kommunikationen för att underlätta social integration.</p> / <p>The purpose of the study is to increase understanding of the value of communication for first line staffs reactions to a merger between service organisations. Mergers are in modern age common between organisations and so also for service organisations. The first line staff are considered particularly important for service organisations due to their mediating role between company and customers where quality is transferred. At a merger it is therefore important to create conditions where two meeting personal groups together can continue to supply sufficient quality. A tool to create such conditions is communication.</p><p>Formal communication can be used to create acceptance for a merger and to introduce changes in it. A prerequisite for front staff to achieve a higher understanding has proven to be highly dependent of the opportunity to conduct two-way communication.</p><p>Informal communication has proven to function as strongly supportive in creating acceptance and a positive conception of a merger. Especially important is informal communication to facilitate social integration.</p>

<p></p><p>BAKGRUND: Antalet multisjuka äldre personer ökar och ett omfattande vårdbehov kan skönjas. Vårdens organisation och hur den fylls med innehåll påverkar relationen till patienten. Ledarskapsstilen påverkar upplevd arbetstillfredsställelse och den kultur som vårdpersonalen skapar tillsammans avgör livskvalitet och vårdandets kvalitet för patienten. SYFTE: Syftet med studien är att utifrån semistrukturerad observation beskriva arbetsinnehållet och ledarskap för en första linjens chef inom kommunal äldreomsorg. METOD: En fallstudie, a single case study, med semistrukturerad observation av en första linjens chef inom kommunal äldreomsorg. Studien hade en deskriptiv design med en kvalitativ ansats. Observatörens nedskrivna texter analyserades med latent innehållsanalys. RESULTAT: Utförande av arbetsuppgifter hade genomgående karaktär av ledarskap. Administration och organisering av arbete var en stor del av arbetsuppgifterna och övervägande var oplanerade. Ansvarstagande, problemlösning, bekräftelse, tjänstvillighet och organisering av arbete där personlighet, kunskap och yrkeserfarenhet påverkade ledarskapet och informantens upplevelse av utförandet av arbetsuppgifter. SLUTSATS: En första linjens chefs arbetsuppgifter är mångfacetterande och spänner sig över kvalificerat arbete där specifik utbildning krävs och till att serva boende och däremellan ge direktiv och organisera för att få arbetet utfört samt medverka vid möten med ledning och chefsgrupp. En dialog som exempelvis öppet informerar om förändringar och varför samt att medarbetare accepterar och samarbetar för att underlätta arbetet där perspektivet utgår från den boende vilket skulle påverka vårdkulturen i positiv riktning och öka möjligheten till en kreativ och livsbejakande miljö kring den boende.</p>

<p>The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.</p>

Syftet med uppsatsen är att öka förståelsen för vilken betydelse kommunikation har för frontpersonalens reaktion på en fusion mellan tjänsteföretag. Fusioner är ett vanligt förekommande bland dagens företag, så även för tjänsteföretag. Frontpersonal anses vara särskilt viktig i tjänsteföretag då de i interaktion med företagets kunder förmedlar kvalitet. Vid fusion är det därför viktigt att skapa förutsättningar för att två mötande personalgrupper tillsammans kan verka för fortsatt god kvalitet. Ett verktyg för att skapa sådana förutsättningar är kommunikation. Formell kommunikation kan användas till att skapa acceptans för en fusion och införa förändringar vid denna. En förutsättning för att frontpersonalen skall uppnå en högre förståelse har visat sig starkt beroende av möjligheten att föra tvåvägskommunikation. Informell kommunikation har visats fungera som ett starkt stöd för att skapa acceptans och en positiv föreställning av en fusion. Särskilt viktig är den informella kommunikationen för att underlätta social integration. / The purpose of the study is to increase understanding of the value of communication for first line staffs reactions to a merger between service organisations. Mergers are in modern age common between organisations and so also for service organisations. The first line staff are considered particularly important for service organisations due to their mediating role between company and customers where quality is transferred. At a merger it is therefore important to create conditions where two meeting personal groups together can continue to supply sufficient quality. A tool to create such conditions is communication. Formal communication can be used to create acceptance for a merger and to introduce changes in it. A prerequisite for front staff to achieve a higher understanding has proven to be highly dependent of the opportunity to conduct two-way communication. Informal communication has proven to function as strongly supportive in creating acceptance and a positive conception of a merger. Especially important is informal communication to facilitate social integration.

The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.

 BAKGRUND: Antalet multisjuka äldre personer ökar och ett omfattande vårdbehov kan skönjas. Vårdens organisation och hur den fylls med innehåll påverkar relationen till patienten. Ledarskapsstilen påverkar upplevd arbetstillfredsställelse och den kultur som vårdpersonalen skapar tillsammans avgör livskvalitet och vårdandets kvalitet för patienten. SYFTE: Syftet med studien är att utifrån semistrukturerad observation beskriva arbetsinnehållet och ledarskap för en första linjens chef inom kommunal äldreomsorg. METOD: En fallstudie, a single case study, med semistrukturerad observation av en första linjens chef inom kommunal äldreomsorg. Studien hade en deskriptiv design med en kvalitativ ansats. Observatörens nedskrivna texter analyserades med latent innehållsanalys. RESULTAT: Utförande av arbetsuppgifter hade genomgående karaktär av ledarskap. Administration och organisering av arbete var en stor del av arbetsuppgifterna och övervägande var oplanerade. Ansvarstagande, problemlösning, bekräftelse, tjänstvillighet och organisering av arbete där personlighet, kunskap och yrkeserfarenhet påverkade ledarskapet och informantens upplevelse av utförandet av arbetsuppgifter. SLUTSATS: En första linjens chefs arbetsuppgifter är mångfacetterande och spänner sig över kvalificerat arbete där specifik utbildning krävs och till att serva boende och däremellan ge direktiv och organisera för att få arbetet utfört samt medverka vid möten med ledning och chefsgrupp. En dialog som exempelvis öppet informerar om förändringar och varför samt att medarbetare accepterar och samarbetar för att underlätta arbetet där perspektivet utgår från den boende vilket skulle påverka vårdkulturen i positiv riktning och öka möjligheten till en kreativ och livsbejakande miljö kring den boende.

The aim of this qualitative study is to examine the experience of participation among first line managers within community home care. The study is based on eight interviews with first line managers operating in a metropolitan area in Sweden. A majority of the interviewees worked in private companies. We have used two theories to interpret our empiri: Lean Production and Human Resource Management. The analysis resulted in seven themes: economy, leadership, participation, view on the organization, first line manager, private or municipally operated organization and expectations on the manager. Our results showed that all the interviewees experienced that they were participant in the organization. The participation however differed from interviewee to interviewee. The staff affected how the first line manager experienced participation. All interviewees believed that accessibility and presence were important factors for participation.

Service industries increase every year in global industry, more and more labors work in this industry, thus this research is aimed at understanding the current situation of management development of first-line manager in service industry. The population of our survey is confined to the first-line manager of service industry. The questionnaire survey was adopte for the study. Of totally 332 distributed questionnaires, there are 91 effective. Through statistics analysis, the main results of the study are concluded as follows: 1.About managerial competency demand, ¡§customer service-oriented¡¨ and ¡§relationship competencies¡¨ are most important in all service industries, ¡§joint venture¡¨ and ¡§balance life and work¡¨ are relative not important. As the scope of management becomes wider, ¡§nurturing¡¨ and ¡§problem solving¡¨ become important. 2.As regard to management development techniques, ¡§personal skills training¡¨ is most important, ¡§talent selection¡¨ is second. Different services industries may use some techniques upon industries characteristics. 3.Management development assessments are not popular in service industries, only ¡§group discussion¡¨ and ¡§simulation game¡¨ are used often, both of them could be related to work in practice. 4.In all service industries, ¡§on-the-job-experiences¡¨ and ¡§management skill training¡¨ are most used management development techniques, ¡§evaluate past experiences¡¨ and ¡§evaluate competencies¡¨ are most used management development assessments.