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  • 1.
    Hansen, Niklas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Arbetsvillkor i privat och offentlig sjukvård: Implikationer för personalens attityder och hälsa2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The shift in health care towards marketization and new types of ownership has mainly been carried out for financial and political reasons aimed at increasing care efficiency and quality. Good working conditions for the personnel are essential for these goals. However, knowledge of the implications at the individual level is still limited. Considering this, the aim of this thesis was to study working conditions, work-related attitudes and health in private for-profit (PFP), private non-profit (PNP), and publicly administered (PA) hospitals in three empirical studies. This was done by investigating how demands and resources at work predict the development of burnout, how control within and over work relate to employee job satisfaction, and how perceptions of empowerment change in connection with privatization and relate to attitudes and health. The empirical studies include cross-sectional and longitudinal questionnaire data from three Swedish acute care hospitals with different ownership types. The results showed higher levels of burnout among nurses at the PFP hospital than those at the PA hospital. There was no difference in levels of job satisfaction among the ownership types. Demands were associated with higher burnout levels and lower job satisfaction. Several job resources were associated with lower burnout, while control was related to higher job satisfaction. In a change from PNP to PFP, employees’ empowerment levels remained relatively stable. However, there was a tendency towards standardization as their degrees of empowerment became more similar after privatization. Also, a status-related differentiation in empowerment occurred among the occupational groups as some with low status experienced less empowerment. Altogether, the findings show more similarities than differences among the ownership types, suggesting that ownership is of less importance for both the levels and the impact of working conditions on attitudes and health.

  • 2.
    Hansen, Niklas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ska alla med?: Homogenisering och differentiering vid privatisering på ett svenskt akutsjukhus2011Conference paper (Other academic)
    Abstract [sv]

    Privatisering av sjukvården har såväl i Sverige som i andra länder ökat de senaste decennierna i syfte att förbättra kostnadseffektivitet och vårdkvalitet. Ett bakomliggande antagande är att HRM-systemen i privata driftsformer är mer inriktade på att tillvarata personalens ”inre resurser”.  Enligt ”kulturtesen” är arbetsmiljön i privata organisationer mer homogena på grund av en mer aktiv personalpolitik. Privatisering kan emellertid tänkas leda till en differentiering av arbetsvillkoren. Enligt ”winner-loser”-tesen skulle privata organisationer i högre utsträckning än icke-privata skilja ut anställda i hög- och lågpresterande, och på så vis bidra till en polarisering av arbetsstyrkan.  De få studier som undersökt psykologiska effekter av privatisering har uteslutande använt sig av en linjär variabelansats med delvis olika resultat. Användandet av en sådan ansats i syfte att studera komplexa organisationsfenomen har dock ifrågasatts (Uhl-Bien & Marion, 2009; Wang & Lee, 2009). Föreliggande studie belyser istället de psykologiska mekanismer som kan vara i spel vid privatiseringsprocesser med en personansats där individer ses som ett system av interagerande faktorer och där mönstret snarare än värdet på de enskilda variablerna står i fokus (Bergman, Magnusson & El-Khori, 2003). Ett sådant system är till exempel psykologisk empowerment. Begreppet har i tidigare forskning visat sig vara relaterat till positiva arbetsbeteenden, attityder och prestationer (Koberg, Boss, Senjem & Goodman, 1999). I denna studie antas att personal som bemyndigas med hög psykologisk empowerment är en viktig förutsättning för en lyckad privatisering i termer av högre effektivitet och vårdkvalitet. Syftet med denna studie var därför att undersöka hur empowerment förändras – både strukturellt och individuellt – bland sjukhusets personal under privatisering. Studien baseras på longitudinella enkätdata från ett svenskt akutsjukhus som analyserades med klusteranalys. Preliminära resultat pekar mot en allmän homogenisering av empowermentstrukturen, vilket korroborerar ”kulturtesen”. Emellertid visar analyserna på individuella förflyttningar från mittenprofiler mot mer extrema klusterprofiler, vilket går i linje med ”winner-loser”-tesen.  Klusterlösningarna valideras mot diverse arbetsmiljö- och hälsoutfall, som diskriminerar förväntat mellan klusterlösningarna. Bland annat framgår att vårdpersonalens upplevelser av ledarskap skiljer sig betydligt mellan klusterprofilerna efter privatisering. Resultaten diskuteras utifrån ett lednings- och maktperspektiv, där ett inkluderande ledarskap framhålls för att få med alla vid övergången till en privat organisationstyp. 

  • 3.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Baraldi, Stephan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Berntson, Erik
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    How is privatization related to empowerment?: A longitudinal study with a person-oriented approach in a Swedish hospital2011Conference paper (Other academic)
    Abstract [en]

    Privatization of health care has increased in recent decades in order to improve cost effectiveness and quality of care. An underlying assumption is that HRM systems in privatized organizations are more progressive and aimed at developing internal staff resources. According to the “cultural thesis”, work environments in privatized organizations are more homogeneous due to more active management systems. However, it has also been argued that privatization may lead to differentiation of working conditions. In this respect, the “winner-loser thesis” states that privatized organizations differ between high and low performing employees, thereby strengthening groups of both winners and losers. Using a person-oriented approach where individuals are seen as systems of interacting elements, the present study aims at identifying psychological mechanisms that may be central to the privatization process by highlighting patterns, rather than single variables. In this study, we propose that one such system of interacting elements may be psychological empowerment. Empowerment has in previous research been found to be related to positive work behaviors, attitudes and performance. It could therefore be assumed that psychological empowerment is an important prerequisite for successful privatization in terms of higher efficiency and quality of care. The purpose of this study was therefore to examine how empowerment changes – both structurally and individually – among hospital staff during privatization. Longitudinal questionnaire data was used and analyzed by means of cluster analyses. Preliminary results indicate a general homogenization of empowerment structure of the organization, supporting the “cultural thesis”. However, our analysis also indicate that health professionals with modest empowerment profiles tend to move to extreme cluster profiles after privatization. In addition, existing groups of extreme cluster profiles double in size after privatization, indicating an increased differentiation among hospital staff. Thus, privatization also seems to be related to an increasing polarization of health professionals' ability to deliver high quality care. The study contributes to existing knowledge of the psychological impact of financially driven change in organizations.

  • 4.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Baraldi, Stephan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Berntson, Erik
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Privatizing health care in times of new public management: Investigating the role of psychological empowerment using cluster analysis2013In: PsyCh Journal, ISSN 2046-0252, Vol. 2, no 3, p. 190-208Article in journal (Refereed)
    Abstract [en]

    Although privatization within health care is usually justified using arguments based on efficiency and productivity, the empirical investigations underpinning such arguments are few and ambiguous in their results. Presenting a new theoretical and analytical approach to this research field, we argue that psychological empowerment, reflecting individuals' intrinsic change motivation state, is a crucial prerequisite for the transformation of a nonprofit health care organization to a for-profit one. The general aims of this study were to explore empowerment cognitions during a privatization, to relate these to a selection of key work-related outcome variables, and to identify the effects of privatization in terms of individual level changes in empowerment after privatization. A sample of health care workers (n = 210) provided survey longitudinal data that were analyzed using cluster analysis. Eight clusters were identified at both pre- and postprivatization with each cluster mirroring specific empowerment patterns: Empowered, In Control, Quasi-Empowered, Competent/Normed, Reference, Underused, Misfit, and Powerless. The clusters discriminated on positive work attitudes, mental health complaints, and turnover intentions. The analysis also revealed the complexity of privatization in that a homogenization as well as a differentiation tendency was observed, thereby implicating both socio-structural equality and inequality effects. The results highlighted the relevance of allocating importance to health care workers' psychological empowerment during the privatization process, and of viewing such organizational transformations not as simple shifts in the state of affairs, but as nonlinear processes involving dynamic changes in individual perceptions over time.

  • 5.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hermansson, Daniel
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Erkännandets uttrycksformer och konsekvenser: en kvalitativ fallstudie på en arbetsplats2013In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 19, no 2, p. 55-71Article in journal (Refereed)
    Abstract [sv]

    Trots att erkännande ingår som en komponent i flera motivations- och hälsoteorier är kunskapen om dess uttryck outvecklad. Syftet med artikeln är att genom djupintervjuer och observation öka förståelsen för erkännandeprocessen. Resultatet visar att erkännande yttrar sig i flera former och förmedlas informatoriskt eller som ökat handlingsutrymme av ledning, kollegor och kunder. Erkännande uppgavs leda till höjd motivation och välmående. Avslutningsvis diskuteras erkännande som styrmedel utifrån ett kritiskt modernt arbetslivsperspektiv.

  • 6.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Two aspects of control and their importance for job satisfaction: Does ownership matter?Manuscript (preprint) (Other academic)
    Abstract [en]

    New ownership types have entered the health care sector that besides traditional public hospitals now includes private for-profit and private non-profit companies. The new hospital ownership types typically underscore increased cost and production efficiency, which may have implications for psychosocial work characteristics and job satisfaction among employees.

    Objectives: This study set out to investigate how job demands along with control over work (COW) and control within work (CWW) relate to job satisfaction in publicly administered, private non-profit and private for-profit hospitals.

    Methods: Questionnaire data came from employees at three hospitals; a publicly administered (n=774), a private non-profit (n=1481) and a private for-profit (n=694) hospital. Besides mean-level analyses, hierarchical regressions with multiple group tests were conducted.

    Results: Demands in terms of workload were significantly lower at the publicly administered hospital while control in terms of CWW was significantly higher. Background factors and their associations with job satisfaction differed slightly between ownership types. Notably, attitude to privatization was not associated with job satisfaction within any ownership type. Overall, psychosocial work characteristics, including job demands and control, were significantly associated with job satisfaction while their interactions showed no consistent associations with job satisfaction. As regards the strength of the associations between background factors, psychosocial work characteristics and job satisfaction, no consistent differences emerged between ownership types.

    Conclusions: The associations between psychosocial work characteristics at work and job satisfaction seem comparable across ownership types. This perhaps relates to societal demands on the structuring of costs, work and production efficiency that go beyond ownership types.

  • 7.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Näswall, Katharina
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Falkenberg, Helena
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Predicting burnout from demands and resources: A comparison between private and public hospitals2007In: XIIIth European Congress of Work and Organizational Psychology, 2007Conference paper (Other academic)
    Abstract [en]

    Burnout among health-care employees is an issue that has received considerable research attention, and numerous studies have found burnout to be predicted by various work-related demands and resources. However, despite the fact that health-care systems in many countries include public as well as private hospitals, our knowledge is limited when it concerns differences in the burnout process between health-care staff in hospitals with different ownership. Data from nurses at three Swedish acute care hospitals – a privatized for-profit, a publicly owned non-profit stock company, and a traditional public administration unit – were used to test (a) if burnout levels differed between hospitals with different ownership and (b) if demands and resources were differently related to nurses’ burnout in the three hospitals. Preliminary results indicate that the burnout level in the public hospital was lower compared to the private and the public companies. Certain demands, such as workload and role conflict, were consistently associated with burnout across hospitals. There were also important differences between private and public hospitals. While the results have immediate implications for hospital managements and efforts to improve employee work environment, they may also provide important insights for political decisions concerning the advantages and disadvantages of public and private ownership of acute care hospitals.

  • 8.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Näswall, Katharina
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Predicting nurse burnout from demands and resources in three acute care hospitals under different forms of ownership: A cross-sectional questionnaire survey.2009In: International Journal of Nursing Studies, ISSN 0020-7489, Vol. 46, no 1, p. 95-106Article in journal (Refereed)
    Abstract [en]

    Background: Health care organizations have changed dramatically over the last decades, with hospitals undergoing restructurings and privatizations.

    Objectives: The aim of this study is to enhance the understanding of the origin and prevalence of burnout in health care by investigating factors in the psychosocial work environment and comparing three Swedish emergency hospitals with different types of ownership.

    Design: A cross-sectional design was used.

    Participants: We selected a total sample of 1800 registered nurses from three acute care hospitals, one private for-profit, one private non-profit and one publicly administered. A total of 1102 questionnaires were included in the analyses.

    Settings: The examined ownership types were a private for-profit, a private non-profit and a traditional publicly administered hospital. All were situated in the Stockholm region, Sweden.

    Methods: Data were collected by questionnaires using validated instruments, in accordance with the Job Demands–Resources Model and Maslach’s Burnout Inventory. Descriptive statistics, correlation analyses, multivariate covariance analyses and multiple regression analyses were conducted.

    Results: The results showed that the burnout levels were the highest at the private for-profit hospital and lowest at the publicly administered hospital. However, in contrast to expectations the demands were not higher overall at the for-profit organization or lowest at the public administration unit, and overall, resources were not better in the private for-profit or worse at the publicly administered hospital. Multiple regression analyses showed that several of the demands included were related to higher burnout levels. Job resources were linked to lower burnout levels, but not for all variables.

    Conclusions: Profit orientation in health care seems to result in higher burnout levels for registered nurses compared to a publicly administered hospital. In general, demands were more predictive of burnout than resources, and there were only marginal differences in the pattern of predictors across hospitals.

  • 9.
    Hansen, Niklas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Näswall, Katharina
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Arbets- och organisationspsykologi.
    Utbrändhet i vården: Betydelsen av krav och resurser på tre sjukhus med olika driftsformer2008In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 14, no 3, p. 11-30Article in journal (Refereed)
    Abstract [sv]

    Hälso- och sjukvården har de senaste decennierna förändrats dramatiskt med bland annat bolagiseringar och privatiseringar. Samtidigt visar statistik på stora ohälsotal inom vårdsektorn. Studien syftar därför till att bidra till förståelsen av uppkomsten och utbredningen av utbrändhet i sjukvården. Detta görs dels genom att beakta faktorer i den psykosociala arbetsmiljön, dels genom att jämföra tre akutsjukhus i Stockholmsregionen som har olika typer av driftsform: traditionell förvaltningsdriven, bolagiserad och privat vinstdriven.

  • 10.
    Lantz, Annika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hansen, Niklas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Antoni, Conny H.
    University of Trier.
    Teamwork within lean production or the paradox between standardization of work and innovation2013In: Imagine the future world: How do we want to work tomorrow?: Abstract proceedings of the 16th EAWOP Congress 2013 / [ed] Guido Hertel, Carmen Binnewies, Stefan Krumm, Heinz Holling, Martin Kleinmann, 2013, p. 777-777Conference paper (Other academic)
    Abstract [en]

    Purpose: The core of lean production is founded on the concept of continuous product and process improvement and the elimination of nonvalue-adding activities and teamwork as a pillar to becoming lean. Autonomy has shown to be crucial for motivation, job satisfaction, performance and innovative teamwork. To reduce nonvalue-adding activities means to standardize work procedures and hence to reduce autonomy. Continuous improvement, on the other hand, relies on teams that are proactive. How can the paradox between the standardization of work and innovative teamwork be understood? The aim of the study is to explore job design practices that enhance team proactivity within a lean production system where autonomy is uttermost restricted. We hypothesize that job design parameters (team participation in decision making regarding job routines, participative leadership style, cross-functional cooperation) enhance team proactivity via team learning (building shared meaning) as a mediator. Design/Methodology: The hypotheses were tested using hierarchical multiple regression and mediation analysis with aggregated data consisting of 57 teams (N = 417 individuals) on shop-floor level within one production plant. Results: Results showed that the model explained 49% of team proactivity, of which building shared meaning was the major contributor and mediator between team participation, crossfunctional cooperation and proactivity. Limitations: Results are based on a cross-sectional study and cannot be interpreted causally yet. Research/Practical Implications: This study contributes to the research on team learning and transactive memory as it underline the importance of shared perceptions on team level for proactivity to emerge.

  • 11. Molin, Johanna
    et al.
    Åkerström, Lisa
    Baraldi, Stephan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hansen, Niklas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kompetensflykt i sjukvården: en fråga om ledarskap eller medarbetartrivsel?2012In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 18, no 3, p. 51-65Article in journal (Refereed)
    Abstract [sv]

    Vården har genomgått stora omstruktureringar följt av frivilliga uppsägningar, som kopplats till bristande ledarskap. Samtidigt har arbetsattityder visats hänga samman med frivilliga uppsägningar, vilket föranleder frågan om positiva arbetsupplevelser medierar sambandet mellan ledarskap och intention att säga upp sig. Detta testades med enkätdata från ett sjukhus som privatiserades. Resultaten visade att arbetstrivsel medierar sambandet mellan ledarskap och intention till uppsägning. Studien aktualiserar olika HR-strategier för att behålla organisationens humankapital.

1 - 11 of 11
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