Members' sensemaking in a multi-professional team.

PURPOSE: The aim of this study is to investigate sensemaking as interaction among team members in a multi-professional team setting in a new public management context at a Swedish Child and Youth Psychiatric Unit. DESIGN/METHODOLOGY/APPROACH: A discursive pragmatic approach grounded in ethonomethodology is taken in the analysis of a treatment conference (TC). In order to interpret and understand the multi-voiced complexity of discourse and of talk-in-interaction, the authors use dialogism in the analysis of the members' sensemaking processes. The analysis is based on the theoretical assumption that language and texts are the primary tools actors use to comprehend the social reality and to make sense of their multi-professional discussions. Health care managers are offered insights, derived from theory and empirical evidence, into how professionals' communications influence multi-professional cooperation. The team leader and members are interviewed before and after the observed TC. FINDINGS: Team members create their identities and positions in the group by interpreting and "misinterpreting" talk-in-interaction. The analyses reveal the ways the team members relate to their treatment methods in the discussion of a patient; advocating a treatment method means that the team member and the method are intertwined. PRACTICAL IMPLICATIONS: The findings may be valuable to health care professionals and managers working in teams by showing them how to achieve greater cooperation through the use of verbal abilities. ORIGINALITY/VALUE: The findings and methods contribute to the international research on cooperation problems in multi-professional teams and to the empirical research on institutional discourse through text and talk.

Integrating or disintegrating effects of customised care: the role of professions beyond NPM.

PURPOSE: This paper aims to describe the integrating and disintegrating effects of professional actions in customised care. DESIGN/METHODOLOGY/APPROACH: Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units (CAP) charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days. FINDINGS: The social embeddedness of action is crucial to understanding the professions' integrating/disintegrating activities. In the internal social context of CAP, the professions adapt to productivity-enhancing new public management (NPM) principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations. PRACTICAL IMPLICATIONS: The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPM/customised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices. ORIGINALITY/VALUE: Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of de-emphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.

Lower-status experts' influence on health-care managers' decision-making.

PURPOSE: The purpose of this paper is to investigate and theoretically explain how line managers and lower-status experts work together in public health-care organizations. Hence, this study explores how lower-status experts influence line managers' decision-making and task prioritizing in order to guide staff experts' cooperation and performance improvements. DESIGN/METHODOLOGY/APPROACH: The authors used a qualitative method for data collection and analysis of the experts' and line managers' explanations about their cooperation. A theoretical approach of experts' identity positioning, in terms of differences and similarities, was used in analyzing the interaction between managers and experts. FINDINGS: This study shows that similarities and differences in positioning acts exist simultaneously. Similarity is constructed by way of strategic and professional alignment with the line managers' core tasks. Differences stem from the distinction between knowledge-grounded skills and professional attributes such as language, analytical tools, and jargon. Lower-status experts need to leave their entrenched positions and match the professional status of line managers in both knowledge aspirations and appearance to reach a respected approach of experts' identity positioning. ORIGINALITY/VALUE: Unlike many previous studies, this study demonstrates that similarities and differences in positioning acts exist simultaneously.