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Lundin, K., Skytt, B., Silén, M., Engström, M. & Strömberg, A. (2025). First-line managers’ experiences of and reflections on structural conditions for management practice in hospital settings. Leadership in Health Services, 38(5), 1-15
Open this publication in new window or tab >>First-line managers’ experiences of and reflections on structural conditions for management practice in hospital settings
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2025 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 38, no 5, p. 1-15Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Emerald, 2025
Keywords
hospitals, leaders, managaement, working conditions, qualitative research, nurses
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-46202 (URN)10.1108/lhs-07-2024-0060 (DOI)001379344200001 ()39692171 (PubMedID)2-s2.0-85213333402 (Scopus ID)
Available from: 2024-12-18 Created: 2024-12-18 Last updated: 2025-02-18Bibliographically approved
Engström, M., Björkman, A., Silén, M., Wahlberg, A. C. & Skytt, B. (2025). Thriving at work as a mediator between nurses’ structural empowerment and job performance, work-personal life benefits, stress symptoms and turnover intentions: a cross-sectional study. BMC Nursing, 24(1), Article ID 175.
Open this publication in new window or tab >>Thriving at work as a mediator between nurses’ structural empowerment and job performance, work-personal life benefits, stress symptoms and turnover intentions: a cross-sectional study
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2025 (English)In: BMC Nursing, E-ISSN 1472-6955, Vol. 24, no 1, article id 175Article in journal (Refereed) Published
Abstract [en]

Background

Nurses work in a knowledge-intensive sector with high demands for lifelong learning. Thriving is a positive psychological state, including a sense of mutual learning and vitality at work. Research on thriving, its antecedents and outcomes is called for. The study aim was to examine thriving as a mediator in the relationships between telephone nurses’ structural empowerment and the outcomes work-personal life benefits, job performance, work-related stress symptoms and turnover intentions, as well as to psychometrically test the Thriving Scale (Swedish version).

Methods

Questionnaire data, a national sample of 409 Swedish telephone nurses, were collected, and relationships were examined using multiple regression analyses with PROCESS macro. Factorial validity of the Thriving Scale was tested using confirmative factor analyses.

Results

There were statistically significant relationships between structural empowerment and the outcomes (work-personal life benefits, job performance, stress symptoms, turnover intentions), and these relationships were mediated by thriving. The Thriving Scale showed good internal consistency, and an acceptable to borderline mediocre fit for factorial validity. Thirty-two percent reported turnover intentions.

Conclusions

Good access to structural empowerment increases nurses’ thriving, which in turn improves work-personal life benefits, job performance, and decreases stress symptoms and turnover intentions. Managers should strive to improve nurses’ thriving at work, emphasizing good access to empowering structures.

Place, publisher, year, edition, pages
Springer, 2025
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-46542 (URN)10.1186/s12912-025-02828-0 (DOI)39953533 (PubMedID)
Available from: 2025-02-18 Created: 2025-02-18 Last updated: 2025-02-18Bibliographically approved
Skytt, B., Högberg, H. & Engström, M. (2024). An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care. Leadership in Health Services, 37(5), 66-83
Open this publication in new window or tab >>An explorative and confirmative factor analysis of the Leadership and Management Inventory-II among staff working in elderly care
2024 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 37, no 5, p. 66-83Article in journal (Refereed) Published
Abstract [en]

Purpose

The Purpose of the study was to investigate the construct validity and internal consistency of the LaMI among staff in the context of elderly care in Sweden.

Design/methodology/approach

Questionnaire data from a longitudinal study of staff working in elderly care were used. Data were collected using the Leadership and Management Inventory. First data collection was for explorative factor analysis (n = 1,149), and the second collection, one year later, was for confirmatory factor analysis (n = 1,061).

Findings

The explorative factor analysis resulted in a two-factor solution that explained 70.2% of the total variance. Different models were tested in the confirmatory factor analysis. The final model, a two-factor solution where three items were omitted, showed acceptable results.

Originality/value

The instrument measures both leadership and management performance and can be used to continually measure managers’ performances as perceived by staff to identify areas for development.

Place, publisher, year, edition, pages
Emerald, 2024
Keywords
Health leadership competencies; Leadership; Management; Nurses; Statistical analysis
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-43286 (URN)10.1108/lhs-01-2023-0004 (DOI)001101160900001 ()37962108 (PubMedID)2-s2.0-85176883614 (Scopus ID)
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2024-01-24Bibliographically approved
Lundin, K., Engström, M., Strömberg, A., Silén, M. & Skytt, B. (2024). First-line managers' span of control in hospital settings. In: : . Paper presented at Sustainable HRM and Working-Life Practices, 17-19 June, 2024, Gothenburg, Sweden.
Open this publication in new window or tab >>First-line managers' span of control in hospital settings
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2024 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

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.

Keywords
span of control, hospital, nurse manager, mixed method
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-46160 (URN)
Conference
Sustainable HRM and Working-Life Practices, 17-19 June, 2024, Gothenburg, Sweden
Available from: 2024-12-12 Created: 2024-12-12 Last updated: 2024-12-13Bibliographically approved
Björkman, A., Engström, M., Skytt, B., Nilsson, A., Tao, R. & Xu, L. (2024). From on-site education and examination in Lishui, China of Swedish lecturer to seminars and examination via Zoom. In: Kolbrún Sigurlásdóttir (Ed.), : . Paper presented at Nordic Forum for Nurse Educators 2024, November 11 - 13, 2024,  University of Akureyri, Iceland.
Open this publication in new window or tab >>From on-site education and examination in Lishui, China of Swedish lecturer to seminars and examination via Zoom
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2024 (English)In: / [ed] Kolbrún Sigurlásdóttir, 2024Conference paper, Oral presentation with published abstract (Refereed)
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-45342 (URN)
Conference
Nordic Forum for Nurse Educators 2024, November 11 - 13, 2024,  University of Akureyri, Iceland
Funder
University of Gävle
Available from: 2024-08-15 Created: 2024-08-15 Last updated: 2024-08-20Bibliographically approved
Lundin, K., Engström, M., Skytt, B., Strömberg, A. & Silén, M. (2024). Individual and unit level insights from hospital staff ratings on structural empowerment, leadership-management performance, well-being, and quality of care. BMC Health Services Research, 24(1), Article ID 1491.
Open this publication in new window or tab >>Individual and unit level insights from hospital staff ratings on structural empowerment, leadership-management performance, well-being, and quality of care
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2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 1491Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer, 2024
National Category
Nursing
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-46159 (URN)10.1186/s12913-024-11945-6 (DOI)001366326500003 ()39604932 (PubMedID)2-s2.0-85211052100 (Scopus ID)
Available from: 2024-12-12 Created: 2024-12-12 Last updated: 2025-02-18Bibliographically approved
Lindberg, M., Skytt, B., Lindberg, M., Wijk, K. & Strömberg, A. (2023). A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model. Leadership in Health Services, 36(2), 236-246
Open this publication in new window or tab >>A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model
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2023 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 36, no 2, p. 236-246Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Emerald, 2023
Keywords
Change management; Health services; Implementation; Leadership; Organisation and administration; Qualitative research
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-40080 (URN)10.1108/lhs-05-2022-0055 (DOI)000863665800001 ()36193881 (PubMedID)2-s2.0-85139172682 (Scopus ID)
Available from: 2022-10-07 Created: 2022-10-07 Last updated: 2023-04-25Bibliographically approved
Arvidsson, L., Skytt, B., Lindberg, M. & Lindberg, M. (2023). Nurses’ assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress. Work: A journal of Prevention, Assessment and rehabilitation, 74(2), 501-513
Open this publication in new window or tab >>Nurses’ assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress
2023 (English)In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 74, no 2, p. 501-513Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nurses’ working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees’ behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions.

OBJECTIVE: To investigate the relationship between nurses assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress.

METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed.

RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254–0.268. Significant differences in self-efficacy were found in the grouped working conditions.

CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Place, publisher, year, edition, pages
IOS Press, 2023
Keywords
infection prevention, working conditions, registered nurses, licensed practical nurses
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-40325 (URN)10.3233/wor-211305 (DOI)000939517200013 ()36314182 (PubMedID)2-s2.0-85148963932 (Scopus ID)
Available from: 2022-10-31 Created: 2022-10-31 Last updated: 2024-10-07Bibliographically approved
Arvidsson, L., Skytt, B., Lindberg, M. & Lindberg, M. (2023). Nurses’ assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress. In: : . Paper presented at Forskning i Fokus.
Open this publication in new window or tab >>Nurses’ assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress
2023 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-45788 (URN)
Conference
Forskning i Fokus
Available from: 2024-10-07 Created: 2024-10-07 Last updated: 2024-10-07Bibliographically approved
Roos, C., Swall, A., Marmstål Hammar, L., Boström, A.-M. & Skytt, B. (2023). Promoting the person-centred aspects of dignity and well-being: learning from older persons’ experiences of living in residential care facilities. Working with Older People, 27(3), 219-229
Open this publication in new window or tab >>Promoting the person-centred aspects of dignity and well-being: learning from older persons’ experiences of living in residential care facilities
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2023 (English)In: Working with Older People, ISSN 1366-3666, E-ISSN 2042-8790, Vol. 27, no 3, p. 219-229Article in journal (Refereed) Published
Abstract [en]

Purpose: Dignity and well-being are key aspects of the legislation and policies that regulate care of older persons worldwide. In addition, care of older persons should be person-centred. Dignity and well-being are described as results of person-centred care (PCC). The purpose of this study was to gain an understanding of important aspects for older persons to experience dignity and well-being in residential care facilities (RCFs).

Design/methodology/approach: This study had a qualitative approach, and individual semi-structured interviews were conducted with 20 older persons living in RCFs. Data were analysed using inductive content analysis.

Findings: To experience dignity and well-being older persons emphasized the importance of preserving their identity. To do this, it was important to be able to manage daily life, to gain support and influence and to belong to a social context. However, the findings indicate a need for improvements. Practical implications: Insights into older persons’ experiences of important aspects for experiencing dignity and well-being in RCFs can be used by first-line managers and registered nurses when designing improvement strategies to promote PCC.

Originality/value: Dignity and well-being are described as results of PCC. The findings provide an understanding of what older persons perceive as important for experiencing dignity and well-being in RCFs. The findings are useful when designing improvement strategies to promote PCC.

Place, publisher, year, edition, pages
Emerald, 2023
Keywords
Care; Dignity; Older persons; Person-centred care; Person-centred practice framework; Residential care; Residential care facility; Well-being
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-39995 (URN)10.1108/wwop-08-2022-0034 (DOI)2-s2.0-85137680136 (Scopus ID)
Available from: 2022-09-26 Created: 2022-09-26 Last updated: 2023-08-14Bibliographically approved
Projects
Äldreomsorgens vårdare och ledare; samspelet mellan strukturella förutsättningar, chef- ledarskap, arbetssituation och personalens hälsa [110043]; University of Gävle
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1495-4943

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