Chalmers University of Technology
Fashionable ideas like 'Lean', 'Value-based healthcare' and 'Learning health systems' tend to succeed each other as contemporary ideas on how to improve healthcare. But how can healthcare managers handle these management innovations in a way that results not only in pretty words but in actual improvements? Christian Colldén is a physician and healthcare manager who in his doctoral thesis at Chalmers has studied how management innovations can be understood and translated into a local context to improve the quality and efficiency of care.
What challenges do you focus on in your research?
"All those who have tried to improve healthcare systems have probably realised that it is a very challenging undertaking. Demands often come from many directions, strong professions with diverse opinions and views are to be brought on the same track, and processes are seldom straight and separate. Management innovations are often presented as comprehensive and consummate concepts, which will solve the problems of healthcare, but earlier research have shown that they often do not deliver the promised improvements. Healthcare professionals also often meet management innovations with skepsis. On the other hand, there are examples of management innovations being positively received and resulting in improved quality and efficiency. The challenge that I focus on is how managers can improve the complex healthcare systems that they act in, and how management innovations can become useful tools in that work."
How do you address the problem with your research?
"I have been inspired by action research, which implies that I have tried to achieve improvements in my own context at the same time as I have collected data to analyse what me and my colleagues have done in practice. I have worked in psychiatry within the Sahlgrenska University Hospital and, hopefully, the projects have created better conditions for innovativeness quality improvements. At the general level I try to contribute to a better understanding of how to use management innovations so that they are positively received by different actors in healthcare and create improvements. That general knowledge can be used in education for managers and staff who support managers in development and improvement work."
What are the main findings?
"Different actors in healthcare, like nurses, physicians, politicians, and care developers, have different views on what quality in care means, how care should be provided in a high-quality fashion, and how improvements can be achieved. Thus, they can be seen to rely on different logics. In the same way, different management innovations rely on one or several logics. By mapping underlying logics, healthcare managers can create an appreciation for the complex system and match concepts with the context."
"Next, managers should translate rather than implement management innovations, which implies that one should view them not as fixed concepts but as mouldable ideas. A concrete example is Value-based Healthcare, which can be seen as relying on both a logic of standardisation (of care processes for defined patient groups) and a logic of goal orientation (that if we measure outcomes and costs, the manager need not decide how the result is to be achieved). Based on the understanding of what is needed and/or will be best received in the specific organisation, different aspects of management innovations can be emphasized to make a positive impact and drive change. Management innovations in themselves seldom solve the problems but they can be used as strategic tools and sources of inspiration."
What do you hope your research will lead to?
"Unfortunately, there are no shortcuts to improvements in healthcare, but research can provide some advise on how to take on the task. For example, appreciation of the surrounding system and its components - especially what drives the individuals that you want to involve in new ways of working. I hope that managers and others who drive development in healthcare can adopt that approach and that it is also highlighted in management training programmes, by internal support functions for care development, and by external consultants. If this view gains impact, I believe that frustration can be turned into constructiveness and real improvements."
Text compilation: Daniel Karlsson
Read the thesis "Managing management innovations: Contextual complexity and the pursuit of improvements in healthcare"
The author will defend the thesis on 7 October 2022 at 13.15, see link on the thesis' page
More about Christian Colldén
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