<p>En kvalitativ intervjustudie har genomförts på fem vårdcentraler i Stockholms län där syftet var att undersöka om nio distriktssköterskor upplever att deras psykosociala arbetsmiljö har förändrats sedan införandet av Vårdval Stockholm. Jag ville också undersöka hur de i sådana fall upplevde att det har förändrats, om det fanns skillnader i denna upplevelse beroende på i vilket socioekonomiskt område de arbetar inom samt hur förändringarna skiljer sig från effekter av tidigare vårdreformer. Eftersom Vårdvalsreformen infördes i årsskiftet 2007/2008 finns det knappt någon forskning om denna reform och därför skulle den här studien kunna bidra med intressanta resultat. Teorier och tidigare forskning behandlar psykosocial arbetsmiljö, arbetsmiljöns utveckling under 1990-talet inom välfärdstjänsteområdet samt effekter av ett New Public Management-inspirerat styrsystem på sjukvårdens arbetsmiljö. Resultaten av den här studien visar att på alla vårdenheter upplever respondenterna en förändring i den psykosociala arbetsmiljön efter införandet av Vårdval Stockholm som ofta uttrycks som en utveckling åt det sämre, men förändringen är olika stor på de olika vårdenheterna. De största förändringarna har skett i området Sydvästra 1 och i Innerstadsområdet, medan Norrortsområdet tycks ha påverkats minst. Förändringarna tar sig uttryck i minskade resurser, främst i form av personal som leder till stress och ohälsa. Detta gäller dock inte alla enheter. Tidsbristen leder till ett minskat socialt stöd vilket bidrar till minskad arbetsglädje. Nya krav anses främst felaktiga och svåra att hantera, dessutom undergräver de det egentliga distriktssköterskearbetet. I det empiriska materialet finns det inga skillnader i deras upplevelser som enligt denna studiens omfattning kan förklaras av den socioekonomiska situationen i de olika områdena. Det är inte mycket i resultaten som verkar skilja sig från situationen under 1990-talet och alltså därmed från effekter av tidigare vårdreformer. Därför är det svårt att avgöra om de upplevda förändringarna beror på Vårdvalet, om de förstärkts av Vårdvalet eller om de inte alls påverkas av reformen.</p>

<p><strong>Problem.</strong> With the Swedish public sectors problem with efficiency in mind, several reforms have beeninitiated during the last decades. These reforms go, in academic contexts, under the name“New public management”. The reforms have resulted in, among other things, an increasedcompetition, privatization and goal-orientation in the public sector. These new conditionshave changed the public leadership challenge and demand an increased focus on innovation todecrease costs and increase value as a central aspect of the Swedish public leadership.</p><p><strong>Purpose.</strong> The purpose for this research has been to examine the conditions for innovation in a publicorganization and how the leadership can improve the organizational innovativeness.</p><p><strong>Method</strong>. This research does not aim to measure the innovativeness in a public organization, instead itfocuses on understanding the condition for innovation and how the leadership can affect theorganizational innovativeness. Hence, it is motivated that I use a qualitative approach in theresearch process. Semi structured interviews and precedent research are being used as afoundation for the results and recommendations given.</p><p><strong>Conclusion.</strong> The leadership’s opportunities to improve the organizational innovativeness depend on anumber of independent organizational variables and the adaption of the variables to oneanother and the system as a whole. Leadership includes both the formal boss and the coworkerin a relationship that ought to be characterizing by reciprocity and cooperation. Bothmanagement and leadership are vital competences for the formal boss as both structure andculture must support each other. The conditions for organizational innovativeness improve ifthe organization has a structure and a culture that enhances: transboundary cooperation, spaceand energy for creative activities, a common context that contributes to an organizationalidentity and motivation and competence and organizational learning. The examinedorganization needs to decentralize the right to make decisions, improve the openness of theculture, and strengthen the organizational identity and audit structures in purpose to facilitatetransboundary cooperation.</p>

La performance s'impose aujourd'hui dans le secteur public. Néanmoins le contenu que recouvre la notion reste sujet à débat. L'objectif de cette recherche est de comprendre comment les responsables publics prennent en charge concrètement le devoir de performance. Il s'agit de décrire à la fois les conceptions qu'ils s'en font et d'identifier les outils de gestion censés y conduire. Pour atteindre cet objectif, la recherche se concentre sur les établissements publics de coopération intercommunale (EPCI) à fiscalité propre institués depuis 1999. Ces organisations ont récupéré les principales compétences traditionnellement dévolues aux communes, dans le but d'en optimiser la gestion et de réaliser des économies d'échelle. Elles constituent de ce fait le lieu privilégié pour l'éwtude du management de la performance dans le secteur public local. Deux études de cas ont été menées, s'appuyant sur 47 entretiens semi-directifs. Elles décrivent de manière transversale les outils de gestion utilisés dans les services opérationnels et fonctionnels. Ce faisant, l'architecture globale du système de management de la performance de l'organisation est reconstituée et permet d'identifier les valeurs centrales. Les résultats révèlent que, contrairement à une idée répandue, les responsables intercommunaux ont de longue date été confrontés à l'exigence de performance. Ils mobilisent cette expérience en développant des stratégies de bricolage et d'appropriation des outils de gestion. Elles visent tant à ancrer les outils dans les pratiques qu'à soumettre au débat la normativité qu'ils véhiculent. En résultent des systèmes de management de la performance fragmentaires, dont la principale mission est d'exercer les responsables à l'art du compromis entre des exigences contradictoires.

<p>Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.</p>

En kvalitativ intervjustudie har genomförts på fem vårdcentraler i Stockholms län där syftet var att undersöka om nio distriktssköterskor upplever att deras psykosociala arbetsmiljö har förändrats sedan införandet av Vårdval Stockholm. Jag ville också undersöka hur de i sådana fall upplevde att det har förändrats, om det fanns skillnader i denna upplevelse beroende på i vilket socioekonomiskt område de arbetar inom samt hur förändringarna skiljer sig från effekter av tidigare vårdreformer. Eftersom Vårdvalsreformen infördes i årsskiftet 2007/2008 finns det knappt någon forskning om denna reform och därför skulle den här studien kunna bidra med intressanta resultat. Teorier och tidigare forskning behandlar psykosocial arbetsmiljö, arbetsmiljöns utveckling under 1990-talet inom välfärdstjänsteområdet samt effekter av ett New Public Management-inspirerat styrsystem på sjukvårdens arbetsmiljö. Resultaten av den här studien visar att på alla vårdenheter upplever respondenterna en förändring i den psykosociala arbetsmiljön efter införandet av Vårdval Stockholm som ofta uttrycks som en utveckling åt det sämre, men förändringen är olika stor på de olika vårdenheterna. De största förändringarna har skett i området Sydvästra 1 och i Innerstadsområdet, medan Norrortsområdet tycks ha påverkats minst. Förändringarna tar sig uttryck i minskade resurser, främst i form av personal som leder till stress och ohälsa. Detta gäller dock inte alla enheter. Tidsbristen leder till ett minskat socialt stöd vilket bidrar till minskad arbetsglädje. Nya krav anses främst felaktiga och svåra att hantera, dessutom undergräver de det egentliga distriktssköterskearbetet. I det empiriska materialet finns det inga skillnader i deras upplevelser som enligt denna studiens omfattning kan förklaras av den socioekonomiska situationen i de olika områdena. Det är inte mycket i resultaten som verkar skilja sig från situationen under 1990-talet och alltså därmed från effekter av tidigare vårdreformer. Därför är det svårt att avgöra om de upplevda förändringarna beror på Vårdvalet, om de förstärkts av Vårdvalet eller om de inte alls påverkas av reformen.

Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.

The group of elderly people in Sweden will increase significantly in the future and science point out that the future elderly people will not accept today’s standards and offers of assistance in today’s public elderly care. Therefore public elderly care stands before a significant challenge in terms of development that has to be sustainable. New research also points out that middle managers can be a great strategic resource, and a founder of success, in the challenge of sustainable development. The aim of the report was to increase the knowledge about what middle managers in public elderly care think sustainable development has to embrace, when it comes to quality and personnel administration, in order to meet the needs of the future elderly people. The aim was also to deepen the knowledge of how formal and informal organizational factors facilitate or limit middle managers possibilities to work with development in general and sustainable development in specific in their units. Interviews, as a qualitative method, were used to gather empirical data and the result was analyzed with theories as Domain theory, New Public Management and Situational leadership. Our findings showed that middle managers have little possibilities to work with sustainable development in their units and that formal factors as budget had a great impact of the middle managers overall possibilities in their work. According to the result it seemed that development and long term planning in this particular organization were tasks mainly for the management and political domain. According to our findings it seemed as if the introduction of New Public Management increased the underlying initial problems of human service organizations. According to Domain theory these problems consists of disjunction, discordance and conflicts due to the differences between the three domains when it comes to principles, success measures, structure and work modes.

No description available.

This thesis evaluates the current transformation of the concept of public service, which has been reflected as new trends in the domain of the public services, within the context of changes in the role of state and the discipline of public administration that have been experienced under the influence of neo-liberal policies of the post-1980s. In the thesis, the concept of public service, which has been used in reference to administrative law, and dynamics of its transformation have been analyzed from the perspective of public administration discipline. In this regard, besides examining what public service is and its basic features, the connection between the transformation of the concept of public service and new genre of public administration, subsumed under the title of new public management, has been investigated. Throughout the study, the process, in which the transformation has taken place, has been examined in the light of the basic tenets of neo-liberalism, new public management, reinventing government and governance approaches by focusing on their distorting impacts on the public characteristics of the public services.

<p>The group of elderly people in Sweden will increase significantly in the future and science point out that the future elderly people will not accept today’s standards and offers of assistance in today’s public elderly care. Therefore public elderly care stands before a significant challenge in terms of development that has to be sustainable. New research also points out that middle managers can be a great strategic resource, and a founder of success, in the challenge of sustainable development. The aim of the report was to increase the knowledge about what middle managers in public elderly care think sustainable development has to embrace, when it comes to quality and personnel administration, in order to meet the needs of the future elderly people. The aim was also to deepen the knowledge of how formal and informal organizational factors facilitate or limit middle managers possibilities to work with development in general and sustainable development in specific in their units. Interviews, as a qualitative method, were used to gather empirical data and the result was analyzed with theories as Domain theory, New Public Management and Situational leadership. Our findings showed that middle managers have little possibilities to work with sustainable development in their units and that formal factors as budget had a great impact of the middle managers overall possibilities in their work. According to the result it seemed that development and long term planning in this particular organization were tasks mainly for the management and political domain. According to our findings it seemed as if the introduction of New Public Management increased the underlying initial problems of human service organizations. According to Domain theory these problems consists of disjunction, discordance and conflicts due to the differences between the three domains when it comes to principles, success measures, structure and work modes.</p>