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ABSTRACT
To increase efficiency and quality process development has been implemented in many Swedish hospitals. These hospitals are usually organized as professional bureaucracies in which health care managers have limited decision control. The new governance principles has been implemented without removing bureaucratic elements. This study analyzes how managers implement planned change in these professional bureaucracies, considering if managers coaching style, organizational preconditions, implementation strategy appraisal of change and clinic autonomy is associated with health care process quality (HPQ). The study is based on interviews with health care managers and longitudinal assessments of HPQ. The results revealed significant differences between coaching style, organizational preconditions, and HPQ over time.The conclusion is that leadership and preconditions is of importance for the health care manager's ability to work with planned change, as that the health care managers understand how management methods, governance principles, and professional bureaucracies work in practice.
KEYWORDS
Bureaucracy / health care organizations / health care managers / implementation / lean management / planned change
INTRODUCTION
Over the last few decades, increasing health care expenditures have forced health care organizations, such as hospitals, to find new ways to run their operations. One focus has been to increase efficiency and quality by means of process development, seeking to improve patient care in the health care system (Mazzocato et al., 2010). A method that over the last few years has started to spread and now is being tested in the Scandinavian health care is Lean production (Andersen et al., 2015; Dammand et al., 2014; Edwards et al., 2011; Kamp et al., 2016). In Sweden, over 85% of the hospitals claims they are working according to Lean in their daily operations (Weimarsson, 2011). Previous research into methods for planned change, such as Lean management, has demonstrated that implementing new ideas and methods can be difficult and that the risk of failure is often great (Lee & Alexander, 1999; Sederblad, 2013). This is due to factors such as governance principles, organizational type, and the manager's daily working situation that either can contribute or counteract the organizations possibilities to work with planned change. However, an important success factor when implementing Lean management or other ways to organize work is effective leadership (Holden, 2011; Kotter, 1996; Robertson et al., 1993). An earlier...