Introduction: Flexible Work Arrangements (FWA) have become increasingly prevalent, offering employees flexibility in time, tasks, and location. While extensively researched at the employee level, FWAs organizational impact, particularly on innovation, productivity, and perceived organizational attractiveness, is less explored, especially in small and medium-sized enterprises (SMEs). This study aims to explore how FWAs influence these key areas from the perspective of SME managers.

Method: A qualitative study used semi-structured interviews with 17 managers from SMEs in Sweden. Participants were selected based on diversity in industry, gender, and experience. Data were analyzed using thematic analysis to identify recurring themes regarding innovation, productivity, and company attractiveness in relation to FWA.

Results: The results revealed that while FWAs can enhance innovation by promoting employee autonomy and diverse work settings, they may also hinder long-term innovation by reducing spontaneous discussions and collaboration. FWAs may improve individual performance but pose challenges to productivity in coordinating teams and maintaining project timelines, necessitating increased managerial oversight. Additionally, while offering an FWA attracts employees, it may weaken employee loyalty.

Discussion/conclusion: These findings highlight the need for SMEs to carefully balance the benefits of FWAs with potential drawbacks, to maintain a competitive edge, suggesting the importance of structured management processes, regulated onsite workdays, and strategies to strengthen organizational connections. This balance is essential for sustaining innovation, productivity, and organizational cohesion. The findings also underscore the complexity of implementing FWAs in a way that supports long-term organizational success.

Purpose

The purpose of this paper is to describe first-line managers’ (FLMs’) experiences and reflections on structural conditions for management practice within hospital settings using Kanter’s theory of structural empowerment.

Design/methodology/approach

A qualitative deductive approach with a descriptive design was used. Interviews were conducted with 11 FLMs in charge of medical or surgical hospital units spread across Sweden. Data were analyzed using a directed content analysis, based on Kanter’s theory of structural empowerment, encompassing such as access to necessary and sufficient resources, information, support and opportunities to learn and develop.

Findings

Findings of this study from the FLMs’ descriptions and reflections shed light on the impact of power dynamics on the structural conditions for management practice. The availability of nursing staff was a fundamental resource in the FLMs’ work performance, ensuring delivery of care to patients and a sound work environment for staff. Additionally, the other structural elements outlined in Kanter’s theory were evident in the findings, as the FLMs wished for structured information flow, identified potential and challenged opportunities for development and emphasized the importance of receiving support from people with a genuine understanding of their work situation.

Originality/valueThe results of this study contribute to the understanding of FLMs’ structural conditions for management practice in hospital settings. The paper’s originality stems from the use of a deductive approach, providing a structured lens with the potential to inform future research and practice in the field of health-care management.

Background

Span of control (SOC) has been used as a description of the number of individual employees that a manager is responsible for and is often used for assessing first-line managers' (FLMs') scope of responsibilities. However, there are arguments that SOC should include more factors than number of direct reports to illustrate the diversity and complexity of FLMs' responsibilities in hospital settings. Mentions of being an objective instrument including such factors have been made of 'The Ottawa Hospital Clinical Managers Decision-Making Tool' (TOH-SOC) which includes three decision-making categories: unit-, staff- and program-focused. The unit-focused category includes two indicators: unit complexity and material management. The staff-focused category includes four indicators: volumes of staff directly reporting to the FLM, autonomy of the team, staffing stability, and diversity of staff. The program-focused category includes two indicators: diversity and budgetary responsibilities. The TOH-SOC tool is referred to in both international reviews and Swedish reports as an instrument for assessing FLMs' scope of responsibilities, but published results from using it are limited. Hence, there is a need to further test the instrument's validity, reliability, and generalizability in different settings and countries. 

Aim

The aim of this study is to investigate how the TOH-SOC describes the span of control of hospital first-line managers at medical and surgical units in Sweden and what descriptions and reflections first-line managers have regarding the instument's content validity and clinical usefulness.

Methods

A mixed method design with an explanatory sequential approach is used and includes three stages; the first is quantitative data collection and analysis, the second is asking how the results from stage one can be used in stage three, which, last and ongoing, includes a quantitative and qualitative data collection and analysis. The participants in stage one was driven from a randomized sample of Swedish hospital FLMs at medical and surgical units, and in stage three, the participants consisted of a subsample of FLMs included in stage one. Descriptive statistics are used to describe respondents' demographics and their span of control. From the interviews, quantitative and qualitative viewpoints on the TOH-SOC is analyzed with the standard method for computing an item-level content validity index (I-CVI) .78 or higher and qualitative content analysis.

Results

Results from the first stage showed how the majority out of the total 33 FLMs scored as having an appropriate span of control, according to the scoring guidelines described in the TOH-SOC tool. Although the results from the first stage are in line with earlier research, questions for clarification regarding the instrument have been identified. These questions, along with initial results from the second and last stage, identifying how norms differ between the origin of the instrument and the Swedish context, imply a need to further test and develop the instrument to be relevant in hospital context and, in particular, Swedish hospital medical and surgical units. More detailed results will be presented later this year.

The study aimed to investigate how child welfare social workers assessed the leadership of their first-line managers over a period of fifteen years and to examine whether the assessments have changed over time. More specifically, the analysis focused on the extent to which social workers perceive the leadership of their first-line managers to be empowering, supportive and fair. Data were collected in the years 2003 (n = 293), 2014 (n = 300) and 2018 (n = 309) using the same questionnaire, mainly based on QPS Nordic, which was distributed to social workers working with investigations of children and youth. The results show that the social workers assessed all measured aspects of their first-line managers' leadership as better in 2014 compared to 2003 and significantly better in 2018 compared to 2003. In light of previous studies showing that child welfare managers experience less optimal conditions for their leadership, the results are surprising. How is it possible that the first-line managers, despite their own descriptions of a more difficult leadership situation, are seen as more supportive, empowering and fair in their leadership from the social workers' perspective? Possible explanations for the social workers' better assessments over the years, such as specialisation, are discussed.

This article investigates how child welfare social workers have assessed the leadership of their first-line managers over a period of fifteen years. Questionnaires were collected in the same geographical areas in 2003, 2014 and 2018. The results show that child welfare social workers assessed the leadership of their first-line managers as increasingly empowering, supportive and fair over the years. In light of previous studies showing that child welfare managers experience less optimal conditions for their leadership, the results are surprising. How is it possible that the first-line managers, despite their own descriptions of a more difficult leadership situation, are seen as more supportive, empowering and fair in their leadership from the social workers' perspective? Potential explanations as to why assessments have improved are discussed.

Background: Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce.

Aim: To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level.

Methods: A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models.

Results: Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables.

Conclusion: Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

This study investigates experiences of temporary work among care personnel in eldercare. Semi-structured interviews were performed with fifteen temporarily employed care personnel in municipal nursing homes or home care and analysedusing phenomenography. The informants’ experiences of having temporary employment were characterised by either a sense of flexibility or, more commonly,uncertainty, lack of control over life, time and economic situation, as well as difficulties associated with always being available. The informants’ experiences of working as temporary employees were characterised by the enjoyment of work and job satisfaction, differing experiences regarding the division of work and communication, but also being in an exposed position. The results reflect an experience of being in avulnerable position. Taking these results into consideration in developing interventions to enhance the working conditions for temporarily employed might as a secondary result decrease the turnover and increase the continuity of the care for the elder.

Purpose

Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager’s job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers’ perceptions of, prerequisites for and experiences from the implementation of changes in their manager’s work conditions.

Design/methodology/approach

A grounded theory–based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis.

Findings

Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers’ descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process.

Originality/value

This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

Postures at work are paramount in ergonomics. They can be determined using observation and inclinometry in a variety of measurement scenarios that may differ both in costs associated with collecting and processing data, and in efficiency, i.e. the precision of the eventual outcome. The trade-off between cost and efficiency has rarely been addressed in research despite the obvious interest of obtaining precise data at low costs. Median trunk and upper arm inclination were determined for full shifts in 28 paper mill workers using both observation and inclinometry. Costs were estimated using comprehensive cost equations; and efficiency, i.e. the inverted standard deviation of the group mean, was assessed on basis of exposure variance components. Cost and efficiency were estimated in simulations of six sampling scenarios: two for inclinometry (sampling from one or three shifts) and four for observation (one or three observers rating one or three shifts). Each of the six scenarios was evaluated for 1 through 50 workers. Cost-efficiency relationships between the scenarios were intricate. As an example, inclinometry was always more cost-efficient than observation for trunk inclination, except for observation strategies involving only few workers; while for arm inclination, observation by three observers of one shift per worker outperformed inclinometry on three shifts up to a budget of €20000, after which inclinometry prevailed. At a budget of €10000, the best sampling scenario for arm inclination was 2.5 times more efficient than the worst. Arm inclination could be determined with better cost-efficiency than trunk inclination. Our study illustrates that the cost-efficiency of different posture measurement strategies can be assessed and compared using easily accessible diagrams. While the numeric examples in our study are specific to the investigated occupation, exposure variables, and sampling logistics, we believe that inclinometry will, in general, outperform observation. In any specific case, we recommend a thorough analysis, using the comparison procedure proposed in the present study, of feasible strategies for obtaining data, in order to arrive at an informed decision support.

Verksamheten vid akademin för hälsa och arbetsliv utgör en kollegial och tvärvetenskaplig miljö som tar avstamp i människors olika livsvillkor och sammanhang med fokus på människan som individ, i grupper, organisationer och samhällen. Fysisk, psykisk och social hälsa utgör den gemensamma nämn-aren. Utbildningen och forskningen kring dessa livsvillkor handlar om människors välbefinnande i en gynnsam ekologisk, ekonomisk och social miljö.

För att lösa de samhällsutmaningar vi står inför är forskningen och skapandet av ny kunskap viktig. I denna rapport samlas projektbeskrivningar kring den forskning som pågår vid akademin. Forsknings-projekten är sorterade under temporära samlingsrubriker som vi idag ser som starka inriktningar. Forskning och kunskapande formas och omformas vilket ger att projekt och inriktningar ändras över tid. Titeln på rapporten ”Forskning pågår” signalerar just denna föränderlighet.

Rapporten innehåller över 100 projekt som svarar mot samhällsutmaningar inom hälsa och välfärd. Den kunskap som utvecklas genom vår forskning skapar goda förutsättningar för att vi ska kunna bidra till en positiv utveckling inom dessa områden. Ny kunskap kan göra skillnad!

AIM: The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff. Furthermore, to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

BACKGROUND: Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

METHOD: Five first-line managers were observed for two workdays. Managers and staff (n=13) were thereafter interviewed. Field notes and interviews were analyzed using directed content analysis.

RESULTS: The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

CONCLUSION: Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures.

IMPLICATIONS FOR NURSING MANAGEMENT: The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.