The aim of this study is to understand first line managers experiences of the impact leadership have on the health of employees. The study focuses on leadership behaviours and actions, experienced by first line managers working in elderly care, with either positive or negative outcomes on the employees health. To answer the purpose of the study a qualitative method was used and the data was collected through seven individual interviews. The analyse was conducted using theories of transformational, transactional and laissez-faire leadership. To enable a broader dimension to the study the concept of health-promotion leadership was also used in the analysis. The first line managers experiences showed that communication, motivation and relationships were important parts of a leadership that could affect the employees health both positive and negative. Overall a leaders communication should be clear and meaningful, a leader should motivate the employees by showing interest in their work and a leader should build a relationship with the employees that are based on equality.

Formål: Å få frem førstelinjelederes oppfatninger om hva som ligger til grunn for måten de utøver sitt lederskap på, og om det helsefremmende aspektet spiller inn i forhold til hvordan de utøver sin personalledelse. Metode: Studien er gjennomført som en singel case studie. Data er innhentet fra et helseforetak med flere driftsenheter i Norge. Det er brukt data- og metodetriangulering. Spørreskjemaer ble sendt ut til 15 førstelinjeledere. Svarene fra disse dannet grunnlaget for intervju med tre førstelinjeledere. Dokumenter som handlingsplaner og funksjonsbeskrivelser ble hentet inn og gransket. Intervjuene ble analysert ved hjelp av innholdsanalyse. Resultater: Tilretteleggelse for et helsefremmende lederskap hadde stor plass i arbeidet som leder. Lederne hadde stort fokus på å tilrettelegge for et godt både fysisk- og psykososialt arbeidsmiljø. De opplevde seg som rollemodeller, og mente at deres lederstil kunne ha betydning både for trivsel og i noen grad produktivitet og måloppnåelse. Valg av lederstil var basert på kunnskaper og erfaring, men krav til aktivitet og effektivitet var også styrende elementer i utøvelsen av lederskapet. I spørreskjemaundersøkelsen svarte nesten alle lederne at de hadde faste treffpunkter med de ansatte, alle svarte at de involverte dem i planlegging og målarbeid. Imidlertid kom det frem at det ikke var like enkelt for alle lederne å ta selvstendige avgjørelser. I dokumentgranskningen kom det frem at overordnede ledere forventet at førstelinjeledere skulle legge til rette for et godt arbeidsmiljø, dette for både å sikre de ansatte gode arbeidsforhold, og for å sikre god kompetanse og kvalitet i utøvelse av arbeidsoppgavene.   Konklusjon: Funnene tyder på at førstelinjelederne var bevisste i forhold til å ha et helsefremmende perspektiv i sitt lederskap. Men det kom også frem at det å sitte som førstelinjeleder, kan sammenlignes med ”å sitte mellom barken og veden”. / Intention: This study aimed to explore the perceptions of first-line managers regarding the reasons they practice leadership, and to determine whether health-promoting aspects are essential to personnel management skills. Method: The study was conducted as a single case study that triangulated both data and methods. Data were collected from a multi-site health trust in Norway. I sent questionnaires to 15 first-line managers, whose responses provided the basis for interviews with three first-line managers. I also collected and examined documents such as action plans and work instructions. I used content analysis to analyze interviews. Results: Arrangements for health-supporting leadership were a major focus in the leaders’ daily work. They also focused on arrangements that could figure importantly in attaining good physical and psychosocial working environments. The leaders considered themselves role models, and they thought that their way of practicing leadership could influence the well-being of their employers as well as worker productivity and goal attainment. While their options for practicing leadership were based primarily on knowledge and experience, demands concerning activity and effectiveness were also important elements of their leadership. Results from the questionnaires showed that almost all first-line managers met regularly with their employers, and all respondents indicated that they involved their employers in the determination of plans and goals. However, making independent decisions did not come easily for all first-line managers. Examination of work instructions showed that their superiors expected first-line managers to emphasize arrangements that would lead to good working environments, thus ensuring good working conditions, and securing professional competence and high quality service provision. Conclusion: Findings indicate that first-line managers want to include a health-promoting aspect in their leadership skills. Interestingly first-line managers feel they -“sit between the devil and the deep sea”-. / <p>ISBN 978-91-85721-83-2</p>

Syftet med uppsatsen är att undersöka nytillsatta förstalinjes chefers upplevelser i en nyskapad tjänst, som benämns funktionschef, med 50 procent arbete i produktionen och 50 procent chefsuppgifter. Cheferna har tillträtt tjänsten internt och har ingen erfarenhet av ledarskap sen tidigare. Uppsatsen bygger på nio intervjuer och materialet analyserades genom en grundläggande kvalitativ metod. Resultatet visar att funktionscheferna upplever det positivt att ha blivit internt tillsatt till tjänsten då de har en större förståelse för myndigheten och arbetsuppgifterna samt en kännedom om sina medarbetare. Funktionscheferna upplever att en tjänst med två befattningar, arbete i produktionen och chefsuppgifter, är positivt för egen utveckling och gynnar arbetsgruppen och myndigheten. I dagsläget uppnår funktionscheferna inte 50 procent på vardera uppgifter vilket skulle vara önskvärt. Utvecklingsmöjligheter hos en arbetsgivare är av stor vikt för arbetstagare i dagens samhälle. Vetenskaplig forskning påvisar att ledare med erfarenhet om organisationen har bättre förutsättningar att lyckas som ledare. / The purpose of this study is to look at first-line managers engaged in a new role with 50 percent still working in the production and 50 percent working as a manager. The managers have no experience of leadership and are internal recruited to the position as a first line manager after a reorganization one year ago. The essay took form from nine interviews and the data were analyzed using a basic qualitative research. The result shows that the manager experiences of internal recruitment are positive. It gives them a deeper understanding of the authority, the work tasks and their coworkers. The possibilities of development are an important thing an employer should offer the employees. A leader with experience from the organization has better conditions to be a successful leader.

The purpose of this study is to investigate what arguments business management in home services uses to motivate the choice of timeplanning-system with, and what effects this gives first-line executives.  Method: I have used a qualitative approach in this study, with standardized and semi-structured interviews as data-collection method. I interviewed five first-line executives and one operations manager. Two of those were from private sector and three from local government. The operations manager was active in local government. Theory:  empirical data is analyzed using Ritzer's thesis about McDonald's and theories of leadership, which helped thematization and examination of the subject of this study. Result:  The studys result is thematic from Ritzer's McDonaldization-thesis and compared to the effect of the different themes on leadership. The study results show that the timeplanning systems implemented in the business affect the managers of the first line, to the extent that this increases their leadership in the direction of system control, focusing on quantity rather than quality.

The purpose of this study was to find out from an ethical perspective how researchers describe a good leadership. The study tried to investigate more specifically the leadership styles and attributes of first-line managers which according to an ethical perspective characterized a good leadership in elderly care. The background used was the reforms that occurred in elderly care, the implementation of national values in elderly care and the laws governing leadership in elderly care. The method used was a text analysis of two books which focussed on leadership in elderly care and in social work. An inductive approach was used meaning that the study took the facts from the two books as a starting point and applied the theory to it. The theory used in the study was normative ethics. An analysis was made and it could be seen that there were different views on what constituted a good leadership and different views on the leadership styles and attributes of first-line managers that were considered to characterize a good leadership. Sometimes would a good leadership be described in terms of values such as  achievement, human value and high performance. Sometimes would a good leadership be described in terms of values like dignity, knowledge, self-responsibility and responsibility for others.   The study also found out that there were different leadership styles of first-line managers that created the conditions for a good leadership. These were leadership styles that included empowerment, good attitude, good communication and empathy. Moreover, the attributes that were considered to make first-line managers into good leaders were clarity, accessibility, humor, courage, authority, communicative skills, language skills and especially empathy and an equal attitude. Some researchers even pointed out that there was no particular type of leadership that could be considered the best and that there was no leadership style either that could be considered as a template for all leaders and organizations in elderly care to follow. It was thus found that without ethics as a theory, all of these findings would have been very confusing. Thanks to normative ethics as a tool, it could be understood why there were so many different views on what was considered to be a good leadership. Ethics casted light upon the fact that there were different values, norms, virtues, and motives behind an action that were given priority in different contexts explaining why there were so many different types of leadership styles and attributes that were considered appropriate in different situations. The study found out that a special emphasis was laid on the fact that a leader should know himself or herself and his or her view on mankind as well as his or her ethical values. Then he or she would know what his or her strengths and weaknesses were. It was also observed in the study that the virtues of a good leadership were never-ending. This was why training of first-line managers was considered central and it was found that training was to be organized for them on a more regular basis.

The manager is a leading figure in the success of the private sector, an individual who has many tasks and areas of responsibility, one of which is performance appraisals (PA). This study uses the following definition of PAs coined by Fletcher (2001, p. 473) "a variety of activities through which organizations try to assess employees and develop their skills, improve performance and distribute rewards." Performance appraisal is one of the most used recipes in the Human Relations sector. The recipe that is used within organizations has a historically long connection back to the 1970s when the recipe first began to be implemented. Despite the fact that it is a well-known and well-used recipe, there are divided opinions about whether PAs are effective and legitimate.  Studies have shown that there are three variables that can affect the effectiveness of PAs, in those variables we find the most significant for this study as the appraisers role in the PAs. The problem formulated was; How do managers perceive performance appraisal? With this study we aim to understand first line managers' perceived reality of performance appraisal. Previous studies show that the inefficiency of employee interviews can depend on three different variables. The main factor in the variables lies with the appraiser, such as, managers. This study provides a deeper insight into the role of first-line managers at Scania and their experience of PAs, the purpose is to gain an understanding of their perceived reality of the phenomenon as an effective instrument.   When conducting this study, we have used an abductive approach, where we used a qualitative method. Ten semi-structured interviews have formed the basis for the collection of empirical data. Each of the respondents who participated in the study was selected through subjective selection. The interviews were conducted through video link, recorded and transcribed. Prior to the analysis, a coding was performed that resulted in three themes; process, experience and relationship. The empirical material together with the theories formed the basis for the analysis, which then led to the final analysis that revolves around employee conversation venn diagram that visualize the purpose of the study.  A common perception among all participants was that they had a positive mindset towards the instrument and the guidelines provided by the organization, Scania. The study concluded that first line managers perceive PAs as a good instrument that is being used in their daily process. Furthermore, they perceived the reality of the phenomenon were based on the following key variables; Balance, Communication and Responsibility. Additionally, the study confirmed that the managers perceive PAs as an effective tool for their own daily use. Finally, we found that the human factor in PA is perceived to be of great importance for managers in their managers culture. / Chefen är en ledande figur för den privata sektorns framgång, en individ som har många uppgifter och ansvarsområden, varav ett av dem är medarbetarsamtal. Denna studie använder sig av följande definition av medarbetarsamtal som är myntad av Fletcher (2001, s. 473) “a variety of activities through which organizations seek to assess employees and develop their competence, enhance performance and distribute rewards.”. Medarbetarsamtal erkänns som ett viktigt och användbart HR-recept som används inom organisationer och har historiskt sett en lång koppling ända till1970-talet där receptet först började implementeras. Trots att det är ett så pass känt och välanvänt recept så finns det delade meningar kring om medarbetarsamtal är effektivt och legitimt. Tidigare studier visar på att ineffektiviteten av medarbetarsamtal kan vara beroende av tre olika variabler. Den tyngsta faktorn i variablerna ligger på bedömaren, såsom chefen. Detta ledde tillstudiens frågeställning; Hur upplevs medarbetarsamtal av chefer? I denna studie ges en djupare inblick i första linjens chefsroll på Scania och deras upplevelse av medarbetarsamtal, syftet är attfå en förståelse för deras upplevda verklighet av fenomenet medarbetarsamtal. I genomförandet av denna studie har en abduktiv ansats använts, där vi använt oss av en kvalitativmetod. Tio semistrukturerade intervjuer har legat till grund för empiriinsamlingen, där respondenterna som deltog i studien valdes ut genom ett subjektivt urval. Intervjuerna genomfördes via videolänk, spelades in och transkriberades. Inför analysen genomfördes en kodning som mynnade ut i tre teman; process, upplevelse och relation. Materialet tillsammansmed teorierna utgjorde grunden för analysen, vilket sedan ledde till slutanalysen som kretsar runt medarbetarsamtals-venndiagram som visualiserar studiens syfte.  I studien kom vi fram till följande slutsatser. Den första slutsatsen är att balans, kommunikation och ansvar är tre nyckelbegrepp som beskriver chefernas upplevda verklighet av medarbetarsamtal. Den andra är att medarbetarsamtal som fenomen upplevs som ett effektivt verktyg för den enskilda chefen. Den tredje och sista slutsatsen visar att den mänskliga faktorns roll i medarbetarsamtal upplevs vara av stor vikt för chefer i deras chefskultur.

Studiens syfte är att undersöka enhetschefers upplevelse av anhörigas delaktighet i brukarens liv inom funktionshinderomsorgen och hur enhetscheferna påverkas av detta i sin professionsutövning. Vidare kommer det även att undersökas hur enhetschefernas arbetssätt ser ut vid anhörigas delaktighet. Genom kvalitativa semistrukturerade intervjuer har studiens syfte kunnat besvaras. Intervjuerna har genomförts på sex enhetschefer inom funktionshinderomsorgen, med en yrkeserfarenhet på minst två år. Studien antar en teoretisk utgångspunkt i teorin om gräsrotsbyråkrati.   Sammanfattningsvis framkommer det i studien att enhetschefer överlag upplever anhörigas delaktighet som positiv och att kontakten med anhöriga värderas högt eftersom anhöriga utgör en viktig roll i brukarens liv. Det finns vissa förväntningar som enhetschefen har på anhörigas delaktighet som bland annat är att brukaren ska vara i fokus och att det ska finnas en flexibilitet i att lösa saker på ett bra sätt. Hur mycket anhöriga är delaktiga i sin närståendes liv kan se lite olika ut beroende på om brukaren är yngre eller äldre. Några av intervjupersonerna lyfte fram att en liten del av alla anhöriga kan vara svårare att bemöta inom professionen och att det då finns olika strategier och arbetssätt som chefen använder sig av. I vissa fall finns det även anhöriga som kan försvåra verksamhetens arbete som rör brukaren och brukarens utveckling. Sammantaget upplevde enhetscheferna att de flesta anhöriga har förståelse för verksamhetens riktlinjer och arbetssätt samt att anhöriga vill ha ett samarbete med de professionella. En slutsats som kom fram i studien var att de anhöriga som enhetscheferna upplever svårare att bemöta är även de anhöriga som har mindre förståelse för verksamhetens arbetssätt, eller att det kan bero på att den anhöriga själv har en egen problematik.

As market conditions constantly change in today's competitive landscape, businesses must invest in organizational changes to stay relevant. Despite the high frequency of change projects worldwide, multiple sources state that 70% of all change projects fail. Consequently, change management has become a highly researched area to understand and propose strategies to organizations to increase the chance for successful change implementation. The literature reviewed in this study indicated a gap in current research in understanding the feasibility of managerial strategies and employee preferences. Therefore, the research purpose was to address what preferences can be identified amongst the employees and when assessing the appropriate timing for incorporating employee preferences throughout the implementation stage of a change project. To provide practical implications to managers, the research question addressed was formulated as “How do management utilize employee preferences in preparing for a strategic change project?" To address the research question and purpose, the study conducted an employee survey to identify employee preferences in a strategic change project. Additionally, semi-structured interviews were conducted with first-line managers to evaluate their current strategies in change projects. The sample consisted of employees and managers from a large 200-year-old multinational organization in finance. The study indicated that employees and managers preferred transparent and frequent communication. However, employees highlighted that the possibility to provide feedback and input was higher than the ability to impact the change project. This discrepancy indicates a misalignment of whether the feedback and input can reach the project leaders or if the preferences are neglected for other reasons. To address the appropriate timing of when management could consider employee preferences, a framework has been developed in relation to the data collected and best practices according to the literature reviewed. The framework proposes a practical implication to management when preferences are to be considered in terms of what type of change project is performed to increase the likelihood of the change project implementation. / Eftersom marknadsvillkoren ständigt förändras i dagens konkurrensutsatta landskap krävs det att företag investerar i organisatoriska förändringar för att fortsätta vara relevanta. Trots den höga frekvensen av förändringsprojekt runt om i världen, hävdar flera källor att 70\% av alla förändringsprojekt slutar i misslyckande. Som en följd har förändringsledning blivit ett mycket forskat område, för att förstå och föreslå strategier till organisationer och ledare om hur man kan öka chansen för en lyckad förändring. Litteratur-genomgången i denna studie indikerade en brist i nuvarande forskning i förståelsen av genomförbarheten av ledningsstrategier och anställdas preferenser. Därför var syftet att undersöka vilka preferenser som kan identifieras bland de anställda och när det är lämpligt att ta hänsyn till de anställdas preferenser under implementeringen av ett förändringsprojekt. För att ge praktiska implikationer till chefer formulerades forskningsfrågan som "Hur använder chefer anställdas preferenser i förberedelsen av ett strategiskt förändringsprojekt?" För att adressera forskningsfrågan genomförde studien en enkätundersökning bland anställda för att identifiera deras preferenser i ett strategiskt förändringsprojekt. Dessutom genomfördes halvstrukturerade intervjuer med första linjens chefer för att utvärdera deras nuvarande strategier i förändringsprojekt. Urvalet bestod av anställda och chefer från en stor 200-årig multinationell organisation, verksamma inom finanssektorn. Resultaten av studien visade att både anställda och chefer föredrog transparent och frekvent kommunikation. Anställda betonade att möjligheten att ge feedback och input var högre än förmågan att påverka förändringsprojektet. Denna diskrepans indikerar en brist på överensstämmelse, där feedback och input inte når projektledarna eller att preferenser försummas av andra skäl. För att adressera den lämpliga tidpunkten för när chefer kan överväga anställdas preferenser har ett ramverk utvecklats utifrån den insamlade datan och den granskade litteraturen. Ramverket föreslår en praktisk tillämpning för chefer när preferenser ska beaktas i relation till vilket typ av förändringsprojekt som utförs, detta för att öka sannolikheten för genomförandet av förändringsprojektet.

This thesis is composed of two economic evaluations: one trial-based study and one model-based study. In a recent study published in Clinical Infectious Diseases in 2011, a team of OUCRU investigators found that immediate antiretroviral therapy (ART) was not associated with improved 9-month survival in HIV-associated TBM patients (HR, 1.12; 95&percnt; CI, .81 to–1.55; P = .50). An economic evaluation of this clinical trial was conducted to examine the cost-effectiveness of immediate ART (initiate ART within 1 week of study entry) versus deferred ART (initiate ART after 2 months of TB treatment) in HIV-associated TBM patients. Over 9 months, immediate ART was not different from deferred ART in terms of costs and QALYs gained. Late initiation of ART during TB and HIV treatment for HIV-positive TBM patients proved to be the most cost-effective strategy. Increasing resistance of Plasmodium falciparum malaria to artemisinin is posing a major threat to the global effort to eliminate malaria. Artesmisinin combination therapies (ACT) are currently known as the most efficacious first-line therapies to treat uncomplicated malaria. However, resistance to both artemisinin and partner drugs is developing and this could result in increasing morbidity, mortality, and economic costs. One strategy advocated for delaying the development of resistance to the ACTs is the wide-scale deployment of multiple first-line therapies. A previous modeling study examined that the use of multiple first-line therapies (MFT) reduced the long-term treatment failures compared with strategies in which a single first-line ACT was recommended. Motivated by observed results of the published modelling study in the Lancet, the cost-effectiveness of the MFT versus the single first-line therapies was assessed in settings of different transmission intensities, treatment coverages and fitness cost of resistance using a previously developed model of the dynamics of malaria and a literature –based cost estimate of changing antimalarial drug policy at national level. This study demonstrates that the MFT strategies outperform the single first-line strategies in terms of costs and benefits across the wide range of epidemiological and economic scenarios considered. The second analysis of the thesis is not only internationally relevant but also with a focus towards healthcare practice in Vietnam. These two studies add significant new cost-effectiveness evidence in Vietnam. This thesis presents the first trial-based economic evaluation in Vietnam considers patient-health outcome measures as the participants have cognitive limitations (tuberculous meningitis), dealing with missing data along with the potential ways to handle this common problem by the use of multiple imputation, and the issues of censored costs data. Having identified these issues would support the decision makers or stakeholders including the pharmaceutical industry to devise a new guideline on how to implement a well-design trial-based economic evaluation in Vietnam in the future. Another novelty of this thesis is the introduction of the detailed of costing of drug regimens change in which the economic evaluations considering the drug policy change often do not include. This cost could be substantial to the healthcare system for retraining the staff and publishing the new guidelines. This thesis will document the costs incurred by the Vietnamese government by changing the first-line treatment of malaria, from single first-line therapy (ACT) to multiple first-line therapies.

Krav och kontroll utgör delar av den så kallade krav, kontroll, och stödteorin som ofta används för att förklara hälsoutfall i arbetslivet. En organisations ledarskap tillskrivs ofta den stödjande funktionen i krav, kontroll, och stödteorin. Genom teorin tilldelas ledaren ett ansvar för såväl anställdas hälsa som välbefinnande i arbetslivet. Att inneha en chefsroll i en organisation kan utifrån detta betraktas som utmanande. Ledarskapsforskningen innehåller en teori om hur ledaren kan anpassa nivån av stöd i relation till motstridiga krav i arbetslivet. Andra studier menar att ledarskap är ett resultat av den kontext ledarskapet utövas i. Första linjens chefer beskrivs genom forskning som en chefsposition utsatt för höga krav i kombination med begränsade kontrollutrymmen. Särskilt utsatta anses första linjens chefer inom hälso-, och sjukvården vara. Studier inom ämnet fokuserar främst på första linjens chefer med en vårdrelaterad yrkesroll där patientkontakt ingår, som verkar inom den offentliga hälso-, och sjukvården. Då den privata vårdsektorn växer sig allt större kan forskning med inriktning mot privat hälso-, och sjukvård ses som intressant att studera. Studiens syfte är att undersöka och beskriva första linjens chefers upplevelser av krav och kontroll inom den privata psykiatri-, och missbruksvården. Studiens datamaterial har samlats in genom semistrukturerade intervjuer och sammanställts genom en fenomenografisk analysansats. Resultatet av studien visar att första linjens chefers upplevelser av krav och kontroll är ett relaterade till chefsrollens ansvarområden, kontext och möjlighet att utöva ledarskap. Första linjen chefernas möjlighet att utöva ledarskap är i sin tur ett resultat av omgivande kontext. Att addera kontext som en faktor i den befintliga krav, kontroll stödteorin kan utökas förståelsen för chefers arbetsmiljö, möjlighet att utöva ledarskap och möjlighet att ge underordnade anställda stöd. / Aim: Examine and describe first line managers’ perceptions of demand and control within the private psychiatric, and treatment care. Background: First line managers’ (FLM) work in health care contains high demands and limited control space. It is claimed through leadership research that leaders can adapt the amount of support and control to a given work situation. Other leadership studies claims that a certain work situation, context, can affect the leadership performance. Due to the demand, control, support model, work situations containing high demands and limited control space effects the individuals’ experience of work in a negative way that can affect health and wellbeing. Method: Ten first line managers’ from the private psychiatric and treatment care were interviewed. The interview material was analyzed and presented through a phenomenographic analysis. Result: FMLs’ experiences of demand and control were a result of manager role’s responsibilities, context and opportunity to exercise leadership. FMLs’ opportunity to exercise leadership was in turn a result of surrounding context. Conclusion: Adding context to the existing demand, control and support model can develop an understanding of managers' work environment, opportunity to exercise leadership and ability to support subordinate employees.