Managing clinical integration: a comparative case study in a merged university hospital.

PURPOSE: This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase the understanding of why clinical integration succeeds or fails. DESIGN/METHODOLOGY/APPROACH: The authors compare two cases of clinical integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged clinical departments of the same specialty from each hospital site. In total, 53 interviews were conducted with individuals representing various staff categories and documents were collected to check data consistency. FINDINGS: The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts and these are clinical management's interpretation of the mandate; design of the management constellation; and approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top-down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom-up management approach within planned boundaries. These findings are basically consistent with the literature's prescriptions for managing professional organisations. PRACTICAL IMPLICATIONS: Managers need to understand that public healthcare organisations are based on competing institutional logics that need to be handled in a balanced way if clinical integration is to be achieved--especially the tension between managerialism and professionalism. ORIGINALITY/VALUE: By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

Destructive managerial leadership and psychological well-being among employees in Swedish, Polish, and Italian hotels.

OBJECTIVE: The aim of this cross-sectional exploratory study was to investigate destructive managerial leadership in the hotel industry in Sweden, Poland, and Italy in relation to psychological well-being among employees. METHODS AND PARTICIPANTS: 554 questionnaires were collected from employees in all occupational groups within hotels. The Copenhagen Psychosocial Questionnaire (COPSOQ) measured working conditions, particularly iso-strain or high work demands combined with low control and poor social support, and psychological well-being, defined in terms of mental health, vitality, and behavioural stress. Items adapted from the Global Leadership and Organisational Behaviour Effectiveness (GLOBE) research program questionnaire measured autocratic, malevolent, and self-centred leadership styles. Differences in ratings between countries were estimated, as well as the relationship between destructive managerial leadership on an organisation level and employee psychological well-being on an individual level. The relationship between destructive leadership and psychological well-being among employees was adjusted for employees' reported iso-strain. RESULTS: Autocratic and malevolent leadership were at the organisation level related to low vitality among employees and self-centred leadership was significantly associated with poormental health, low vitality, and high behavioural stress. Autocratic and malevolent leadership were more strongly related to iso-strain than was self-centred leadership. Variations in leadership practice between countries were seen in autocratic and malevolent leadership. CONCLUSION: This exploratory study suggests a significant association between destructive managerial leadership on the organisation level and poor psychological well-being among employees on an individual level. Interventions to decrease iso-strain and enhance psychological well-being among employees could be directed at an organisation level.