Adolescent substance use frequently co-occurs with mental-health difficulties and social adversity. Existing research highlights heterogeneous risk profiles and a paucity of integrated service models that bridge health- and social-care sectors. A qualitative case study was undertaken at the newly established MiniMaria treatment centre in Sweden. Data were gathered through participant observation of 18 steering-, project- and operative-group meetings, four workplace meetings, and semi-structured interviews with five staff members. Reflexive thematic analysis was applied iteratively, guided by a conceptual framework of collaborative advantage (power, trust, organizational culture, leadership, goal management). This study adheres to the Standards for Reporting Qualitative Research (SRQR) checklist. Four overarching themes emerged: (1) divergent organizational cultures and power; (2) fragmented goal management; (3) fluctuating trust and leadership; and (4) operational-level impact on staff. Middle-management pragmatism compensated for strategic indecision, sustaining service delivery despite resource constraints (for instance absence of a dedicated physician). The MiniMaria project demonstrates that clear, enforceable governance structures are vital for integrated youth services. When senior-level alignment falters, empowered front-line managers can preserve continuity of care, but the sustainability of such models hinges on explicit memoranda, shared information systems and ongoing cultural monitoring.

Background: Healthcare management entails navigating considerable complexity, requiring managers to balance diverse and often competing responsibilities such as staff supervision, patient care, and resource allocation within evolving organizational contexts. Traditional measures rarely capture this multifaceted reality of managerial complexity. The Ottawa Hospital Model of Nursing Clinical Practice and Clinical Management Span of Control Decision-Making Indicators tool (TOH-SOC) provides a broad understanding of managerial span of control.

Objective: To evaluate the extent to which the TOH-SOC items provide valid measurement of the latent construct of managerial complexity, and to examine the degree to which the empirical response patterns fit with the a priori specified hierarchical conceptual framework.

Methods: This methodological study uses previously collected data from a convenience sample of 71 first-line healthcare managers, applying items from the TOH-SOC tool. An unrestricted polytomous Rasch model was used to evaluate response category functioning, model fit, targeting, reliability, and empirical item ordering. Polyserial correlation was applied to analyze the concordance between empirical estimates and conceptually expected item hierarchies.

Results: Three items were found to have response categories that did not function as intended. In one case, this could justifiably be addressed by collapsing the response options. Two of the items with problematic response categories, as well as one additional item, were found to show misfit with the assumptions of the Rasch measurement model.

Conclusion: Among first-line healthcare managers, 13 of the 16 items function well in reliably capturing lower levels of managerial complexity. However, further development of the TOH-SOC tool is required to ensure valid and reliable measurement across the full continuum of managerial complexity, and to strengthen its capacity for detecting changes over time.

Background

Antibiotic-resistant bacteria pose a significant challenge in healthcare. Many studies have examined this concern from the perspective of healthcare personnel, highlighting hygiene precautions. Research on patients’ perspectives, particularly regarding vancomycin-resistant enterococci (VREs) carriership, remains limited. The aim of this study was to describe individuals’ experiences of living with VRE.

Methods

In this study, a descriptive design was applied using qualitative content analysis. Twenty-two informants with VRE carriage participated in semi-structured individual interviews.

Results

The main theme, Life goes on despite the different circumstances illustrates how VRE carriers navigate daily life. The informants reported that overall, VRE carriage had a minimal impact on their lives; however, it caused uncertainty, particularly in healthcare interactions.

Conclusions

The findings showed that information about VRE carriage is unclear and contributed to uncertainty in healthcare contacts. Carriership, however, does not have a major impact on daily life. To ensure greater clarity, there is a need for increased knowledge of VRE and its management among healthcare personnel and an increased focus on person-centred care to improve healthcare interactions.

Implementing cancer rehabilitation in primary care that addresses the physical, psychological, social, and existential consequences of cancer is considered important.

Aim: To describe primary care practitioners' self-reported preconditions-including facilitators and barriers-related to cancer rehabilitation and physical activity, as well as their interest in responding to questions about cancer rehabilitation.

Methods: This convergent mixed-methods study collected self-reported quantitative questionnaire data using 0 to 10 scales (10 = maximum) from 229 primary care practitioners (104 rehabilitation practitioners and 125 healthcare center practitioners), and written qualitative data from a sub-sample of 120.

Results: Among rehabilitation practitioners, 20% provided some form of cancer rehabilitation and 70% prescribed physical activity to consulting cancer survivors. Corresponding figures for healthcare center practitioners were 10% and 15%, respectively. Both rehabilitation and healthcare center practitioners reported a median score of 0 (no knowledge) regarding physical activity advice for cancer survivors, and 95% of participants had not read cancer rehabilitation guidelines. Rehabilitation practitioners gave median ratings of 8 and 9 for the importance of providing cancer rehabilitation and physical activity advice, respectively, compared with 6 and 7 among healthcare center practitioners. Median ratings among rehabilitation practitioners were 3 for workplace preparedness and 3 for sufficient time for cancer rehabilitation, compared with 2 and 0 (no time at all) among healthcare center practitioners. Facilitators of the implementation were that providing cancer rehabilitation was considered important, and that practitioners were experienced in rehabilitation and physical activity counseling in non-cancer populations. To have committed and motivated co-workers facilitated a positive work culture for cancer rehabilitation. Primary barriers were the limited knowledge and skills and perceived unsatisfactory organizational preconditions, shaping an uncertainty on if primary care has any responsibility for cancer rehabilitation. Of the 168 rehabilitation practitioners invited, 104 (62%) were interested in answering questions regarding cancer rehabilitation. Among the 1055 invited healthcare center practitioners, 125 (12%) were interested.

Conclusions: Given the limited preconditions for cancer rehabilitation and physical activity implementation, the described barriers and facilitators, and the varying interest among practitioners, educational interventions and support strategies tailored to both individuals and organizations appear necessary.

Purpose – The purpose of this study is to explore hospital managers’ experiences and reflections concerning the influence of working conditions on nursing staff’s infection prevention behaviours and strategies used by the managers to promote infection prevention work among staff. Design/methodology/approach – The qualitative study uses a reflexive thematic analysis. Six first-line and five second-line managers at surgical and orthopaedic hospital units were interviewed. Findings – Reflecting a balance between resources and responsibility in promoting infection prevention behaviours, four themes were generated: (1) being attentive to staff needs and taking action in a changing healthcare environment, where managers adjust working conditions to minimise interruptions and manage workload; (2) bultivating a positive work climate for both the team and the individual, emphasising team collaboration and role modelling in infection prevention; (3) providing resources for knowledge development and understanding, including appointing hygiene representatives and promoting accessible infection control information; and (4) promoting personal responsibility for compliance and infection-safe workflows, highlighting staff responsibility regardless of working conditions. Originality/value – This study provides new insights into hospital managers’ perspectives on how working conditions influence nursing staff’s infection prevention behaviours and the strategies managers use to support compliance. Unlike prior research focused on frontline staff, this reflexive thematic analysis highlights the managers’ role in balancing organisational support with staff accountability, offering valuable insights into infection control in complex healthcare environments.

The integration of artificial intelligence (AI) into healthcare, particularly through generative AI models like ChatGPT, presents both transformative opportunities and significant challenges. This discussion article explores the systemic impacts of generative AI, highlighting the ethical concerns, particularly around biases, and the shifts in patient-provider dynamics that could disrupt traditional healthcare. Democratising medical knowledge through ChatGPT tools offers new avenues for patient engagement, yet it may affect existing health disparities and erode trust if not responsibly implemented. As generative AI increasingly influences healthcare, it is critical to recognise the intricate feedback loops and dependencies within these complex adaptive systems so that innovations augment rather than destabilise the overall structure. This article advocates an ‘embrace with caution’ stance, calling for reflexive governance, heightened ethical oversight, and a nuanced appreciation of systemic complexity to harness generative AI’s benefits while preserving the integrity of healthcare delivery.

Background

First-line healthcare managers navigate complex organizational demands to ensure a good work environment and quality care. Key factors such as expanded span of control, leadership and management performance, and work-related stress significantly influence their job satisfaction. However, how these factors evolve over time in organizational settings remains unclear.

Objective

To examine expanded span of control, leadership and management performance, work-related stress, and job satisfaction among first-line healthcare managers and assess whether the relationships between these variables remained stable over time.

Methods

A repeated cross-sectional design was used to collect annual data from 2020 to 2023 among first-line managers in a Swedish healthcare organization. The Ottawa Hospital Span of Control tool, the Leadership and Management Inventory, the Health & Safety Executive stress tool, and a single-item job satisfaction measure were used to collect data. Kruskal-Wallis tests and Spearman correlation analysis were performed.

Results

An expanded span of control negatively impacted job satisfaction in certain years. Leadership and management performance showed a positive but inconsistent association with job satisfaction. Factors in work-related stress, particularly high demands and strained relationships, consistently had a negative relationship with job satisfaction, whereas control and support positively contributed to greater job satisfaction.

Conclusions

Work-related stress, driven by high demands and poor relationships, significantly decreases job satisfaction. Leadership and management performance influence satisfaction, but inconsistently. Reducing workload and improving support structures can enhance job satisfaction and managerial effectiveness.

Purpose

The purpose of this study is to examine if and how an expanded span of control, management performance and work-related stress indicators (control, support and relationships) influence the time until first-line managers leave their position.

Design/methodology/approach

A prospective longitudinal cohort design involving 87 first-line managers in a Swedish health-care region. Cox proportional hazards regression was used to analyse expanded span of control, work-related stress indicators and management performance as predictors of turnover.

Findings

The findings indicate that first-line managers who were categorized as having moderate concern and a need for improvement in the work-related stress indicators control and manager support had a significantly higher risk of turnover. In contrast, expanded span of control and the number of employees managed per first-line manager did not significantly influence turnover risk. In addition, the work-related stress indicator relationships was not significantly associated with risk of turnover.

Originality/value

This study expands the understanding of actual turnover among first-line managers in health care by exploring how organizational factors influence the decision to leave. Unlike previous research, which primarily examines turnover intentions, this study takes a longitudinal perspective, capturing real turnover events over time. The findings contribute to future research on organizational conditions, providing a basis for developing strategies to improve retention and working conditions for first-line managers in health care.

BackgroundThe Utrecht Work Engagement Scale is a frequently used instrument for measuring work engagement. However, the instrument’s conceptual underpinnings, theoretical clarity and dimensional structure has been criticized, and its construct validity has not been evaluated appropriately in samples of nurses. The study purpose was to assess the psychometric properties of the Utrecht Work Engagement 9-item Scale (UWES-9) in a sample from the haemodialysis nurse population using approaches that take the ordinal nature of the data into account.

Methods

The psychometric properties were evaluated in accordance with classical test theory focusing on data completeness, unidimensionality, scaling assumptions, targeting and reliability. The analyses were conducted using data derived from a cross sectional study.

Results

Missing item responses were < 2%. Exploratory factor analysis based on polychoric correlations and parallel analysis identified one factor. Scaling assumptions were supported based on desirable levels of corrected item-total correlations. The targeting analyses displayed expected score distribution, no floor effect and acceptable ceiling effect. However, the mean total score was above the scale midpoint. The reliability, estimated using Ordinal alpha, was 0.93.

Conclusions

The study findings, evaluated using methods that consider the ordinal nature of the scale ratings, indicate that the UWES-9 is a reliable and valid unidimensional measure with high data completeness, strong internal consistency, and a supported factor structure. These results support the use of the UWES-9 in research and practice for assessing work engagement. However, further studies are recommended to examine its applicability across diverse populations and settings.

Background

Healthcare-associated infections are a global concern and can be dependent on the infection prevention behaviours of nursing staff, which in turn can be influenced by working conditions. Qualitative studies are scarce, and a greater understanding of the relationship between working conditions and nursing staff behaviour is needed.

Aim

The aim was to describe nursing staff’s experiences and reflections on working conditions and infection prevention behaviours.

Methods

A qualitative study with semi-structured focus group interviews at four surgical units and two orthopaedic hospital units. Twenty-seven nursing staff (12 registered nurses and 15 assistant nurses) participated. Data was analysed using qualitative content analysis.

Results

We generated one theme: Navigating in a complex and shifting context. The result indicates that working conditions are sometimes inadequate, which can hinder the nursing staff’s infection prevention behaviours. Even when working conditions seemed to be sufficient, hygiene routines could fail, since situations constantly arise in a hospital unit that are difficult to predict and regulate.

Discussion

This study highlights the complexities faced by nursing staff in maintaining infection prevention behaviours within the dynamic hospital work environment. While nursing staff are professionally obliged to comply with hygiene routines, organisational support is essential for fostering sustainable working conditions. A multi-tiered approach is needed, from first-line managers to decision-makers, to promote a supportive environment that sustains safe practices.