Table 12 Overview of organizational issues challenging the innovation process as reported by managers
From: Trust-based service innovation of municipal home care: a longitudinal mixed methods study
Managerial issues | Subthemes and illustrative quotes |
|---|---|
1. Organizational complexity | • Piloting the TM through two iterations across four autonomous districts was much more complex than expected |
2. Organizational autonomy | • The feeling of ownership among leaders on different levels varied between districts, influencing local choices during the two iterations |
3. Competing organizational logics | • The TM challenge the existing NPM principles of management by objectives, but without really replacing it • “We get conflicting steering signals from above” |
4. Parallell change projects | • One's own and other districts were involved in parallel organizational change processes while running the TM iterations, which made it hard to give the necessary priority to the TM • “There are so many changes happening at the moment” |
5. Balancing trust and controle | • Challenging finding the balance between trust and control, giving rise to considerable uncertainty concerning trust-based management • “As a leader you cannot just say, ‘I trust you with the full responsibility’. You need to govern as well.” |
6. Leadership anxiety | • Feeling of unease or uncertainty concerning the ambitions of the TM project and their new role, • A fear that trust-based management would jeopardize budgets and/or service quality. “It was so much anxiety.” |
7. Team member mindset | • Need for a change of staff mindset or culture • Team members were used to performing detailed tasks defined by others • Team members are not used to exercise their power of discretion, co-operate closely across professions and make shared decisions with patients in a team setting. “This is a huge cultural change, and it will take time” |
8. Team member competence | • Hard to trust their teams with the intended full responsibility for making decisions and providing the daily care • Young RNs lack educational preparation for working in self-managed teams • A need for team development and competence building in areas like multi-professional co-operation, problem solving, person-centred communication and shared decision-making |
9. Team capacity | • Concerns about the staff capacity. “When sick leave occurs it becomes chaos because it is so vulnerable.” • A fear of pressure from above to “realize benefits” by reducing the staff to a minimum as soon as the TM was implemented |
10. Digital support | • Patient record system did not support the TM and the new way of working • “It [the patient record system] is too cumbersome, I mean, it is too much a set up for the PPS.” |