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Unit managers and employees in schools, social services, and child and adolescent mental health services (CAMHS) were asked to describe their views on children's and adolescents' psychosocial needs when collaboration was required. A descriptive case study design was employed and data were gathered from 23 professionals in six focus groups. The data were analysed by the use of an inductive content approach. Disparities were identified that were interpreted as different approaches to children's needs, which we designated individual (CAMHS), contextual (social services), and educational (schools) approaches. These were perceived as emerging from the professional representations of children's needs that were created within each working group. The organisational affiliation seemed however to have a stronger influence than professional education, regarding the view of children's needs. We suggest that it would be an advantage for professionals to be able to participate in dialogue groups to discuss the meaning of their organisational and professional affiliations, and how this affects their views. Rather than formal knowledge, such dialogues should contain more essential knowledge related to the professionals' approaches to children's needs and to the diversities in the way they think and work in a "give-and-take" process. This might influence their way of thinking and working with children and adolescents, and strengthen their understanding of each other's work.

Purpose – This paper aims to explore if and how employees in a healthcare organisation perceive changes in their managers’ leadership behaviour over time. Design/methodology/approach – An interview study was conducted with employees whose managers had participated in a two-year leadership development programme offered by their employer, Healthcare Provision Stockholm County. Qualitative content analysis was applied, and the interview discussions focused on areas in which the majority of the informants perceived that a change had occurred over time and their answers were relatively consistent. Findings – The majority of employees did discern changes in their managers’ leadership over time, and, with very few exceptions, these changes were described as improvements. Practical implications – The knowledge that employees perceived changes in their managers’ leadership supports investments in leadership development through courses, programmes or other initiatives. Originality/value – The present findings contribute to a deeper empirical understanding of leadership as it is practised over time in everyday contexts among employees in healthcare organisations.

Purpose The purpose of this paper was to assess two different leader development interventions by comparing their effects on leadership behaviour and evaluating their combined impact after two years, from the viewpoints of both the participating managers and external raters. Design/methodology/approach The study was a longitudinal randomised controlled trial with a cross-over design. Health care managers (n = 177) were first randomised to either of two 10-month interventions and a year later were switched to the other intervention. Leadership behaviour was rated at pre-test and 12 and 24 months by participating managers and their superiors, colleagues and subordinates using a 360-degree instrument. Analysis of variance and multilevel regression analysis was performed. Findings No difference in effect on leadership behaviour was found between the two interventions. The evaluation of the combined effect of the interventions on leadership behaviour showed inconsistent (i.e. both increased and decreased) ratings by the various rater sources. Practical implications This study provides some evidence that participation in leadership development programmes can improve managers’ leadership behaviours, but the results also highlight the interpretive challenges connected with using a 360-degree instrument to evaluate such development. Originality/value The longitudinal randomised controlled design and the large sample comprising both managers and external raters make this study unusually rigorous in the field of leadership development evaluations.

The aim was to evaluate effects of leadership courses based on the developmental leadership model at the leadership behavioral level. A longitudinal design was employed with assessments before, one and six months after the leadership courses. The sample consisted of 59 leaders who made self-ratings and were rated by at least three subordinates on each occasion. Leadership behaviors were measured with the Developmental Leadership Questionnaire (DLQ). A limited increase of favorable leadership behaviors and a significant reduction of unfavorable leadership behaviors were found, particularly according to the subordinates' ratings. A cluster analysis yielded three meaningful leader profiles and showed that this pattern was found in all three profiles, irrespective of how favorably they were rated before the onset of the intervention.

PurposeThe purpose of this paper is to examine the aspects of being a physician that such medical professionals mention in dialogue groups when given the opportunity to choose their own topics of discussion.Design/methodology/approachOver a period of two years, 60 physicians participated in eight dialogue groups at one of the main hospitals in Stockholm, Sweden. Five focus group interviews were performed after the final dialogue group session.FindingsQualitative content analysis showed that three themes dominated in the physicians' perceptions of their role: hierarchy and subgroups; understanding of learning and knowledge; clinical work. Very little time in the dialogue groups was spent discussing the third theme, i.e. problems or issues related to patients or their families. The hierarchy among doctors seemed to influence many aspects of the role of these individuals, their healthcare organisation and their work environment. The methodology in the dialogue groups challenged the prevailing hierarchical structures and seemed to improve the relations between different groups of doctors in the hierarchy. For some of the physicians, this also resulted in a new way of perceiving and acting in their professional role.Research limitations/implicationsThe results of this study represent only one hospital.Practical implicationsThe findings may help healthcare managers understand physicians' conceptions of their role.Originality/valueFew intervention studies have considered management programmes directed towards physicians. The present investigation is the first qualitative analysis of the use of dialogue groups within a healthcare setting.

Research into the efficacy of programs of leadership and group dynamics in undergraduate medical education is sparse.The aim of this study was to apply and test a pre- post evaluation design of a one-week experiential learning based course of group dynamics.Two questionnaires were sent to 160 medical students, before and after the course. The response rate was acceptable (73%).While there was a small change in attitudes towards openness in their professional role and group dynamics, there was a major change in two subgroups of students to these topics. The students who were least interested in collaborative constructivist learning and those students who mainly looked for practical value were the students who changed their attitudes most towards openness in their professional role.It appears that those students who would be least likely to voluntarily attend such a course were the ones who learned the most. This study does not allow for any generalizations regarding the outcome of experiential learning of group dynamics, but it is an argument for the use of systematic evaluations in order to identify students who can benefit from courses aimed at improving profound knowledge.

PurposeThe purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment.Design/methodology/approachThe study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n=68) in 1999, 2001 and 2003. Follow‐up data were collected after the termination of the groups.FindingsThe overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified.Research limitations/implicationsIn a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research.Practical implicationsThe results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians.Originality/valueThere is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time.Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n = 133) and 2011 (n = 130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis.At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p = 0.02) and the Ward-II (p = 0.04), but not at Ward-I (p = 0.11).Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members' relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging.This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.

Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs).The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support).Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire.Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support.Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work.The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Patients on long-term sick-leave (> 90 days) from white collar work, with a diagnosis of work-related depression, dysthymia, or maladaptive stress reaction were randomized either to cognitive group therapy (CGT), focused psychodynamic group therapy (FGT), or to a comparison group. All patients were interviewed and responded to self-report questionnaires before the start of treatment and at 6 and 12 months. At the 12-month follow-up, 70% of the patients met the criteria for reliable change of the target symptom (depression), and the sample as a whole improved significantly on all measures used. However, there were no differences in outcome between the three treatment groups.

The aim of this study was to describe first-line nurse managers' (F-LNMs) and subordinate registered nurses' (RNs) conceptions and experiences of their routine work and how leadership was exercised.Extensive changes in health care organisations have had a powerful impact on leadership in nursing management. Nursing leadership, in turn, has an affect on both the quality of care and the subordinates' work environment. Therefore, it is important to enhance our understanding of current leadership in nursing management.This is a descriptive qualitative study carried out in three units at three Swedish hospitals.Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis.The result of this study was illustrated in one main theme referred to in this study as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining).The reciprocal relation between being and doing, which can be described as the development of virtues, was a central point in the professional work of the F-LNMs and RNs. The development of virtues is also a strategy to attain the goals of nursing and establish a work climate that motivates staff and improves performance. RELEVANCE TO CLINICAL PRACTICES: The implication for nursing management is to create ample space to develop strategies and knowledge about how leadership in nursing management can stimulate the development of a common perspective of good care and professional virtues appropriate for health care praxis.

Objectives. The relationship of treatment preferences and experiences to outcome was explored in patients with generalized anxiety disorder (GAD). Design. Patients were randomly allocated to either affect-focused body psychotherapy (ABP) (N=26) or standard psychiatric out-patient treatment (N=17). Method. Initial preferences and subsequent experiences of treatment interventions were measured using a questionnaire focusing on support, inward reflection, concrete and directive problem solving, and affective expression. Outcome was assessed after 1 and 2 years in relation to symptom change. Results. ABP patients reported being helped by supportive and reflective treatment interventions to a greater extent than controls. ABP patients also had more positive experiences of supportive and emotionally expressive interventions than they had expected at initial assessment. When patients were divided into two groups on the basis of patterns of preferences and experiences using cluster analysis, it was found that differences in outcome were considerably more marked for clusters than treatment groups. Conclusions. It is concluded that treatment preferences may have considerable interpersonal potential in therapy; how therapists utilize this potential may be important for improving outcome.

Eighteen patients diagnosed with burnout-related depression and receiving short-term psychodynamic group psychotherapy were included in this study. The participants completed the group version of the California Psychotherapy Alliance Scales (CALPAS) five times during treatment and evaluated the relationship positively. Alliance increased significantly as treatment progressed; however, the amount of change was small. Level of alliance to the group-as-a-whole, averaged over time, was predictive of two out of three outcome measures, whereas growth in alliance during the early phase of therapy was not predictive of outcome. Exploratory examination of the alliance at different time points showed that alliance to the group-as-a-whole at mid-phase of treatment was substantially correlated with outcome. Personality features such as dismissing attachment style and being overly nurturant or exploitable were predictive of early growth in alliance.

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which assesses daily drinking patterns), and (b) Inventory of Drinking Situations (IDS, which assesses antecedents to "heavy" drinking). Clients (N = 308) were outpatient alcohol abusers from four countries (Australia, Canada, Mexico, and Sweden). Generally, the Alcohol TLFB and IDS were shown to be reliable and valid with outpatient alcohol abusers in four countries, and in three languages. These results suggest that the Alcohol TLFB and the IDS can be used in clinical and research settings with Swedish-, Spanish-, and English-speaking alcohol abusers.

In recent years a number of drinking-related assessment instruments have undergone extensive developmental work and are in widespread use. These include measures that are designed to assess: 1) patterns of alcohol consumption. Timeline Followback Method (TLFB); and 2) antecedents to alcohol use, Inventory of Drinking Situations (IDS)-two constructs that would be expected to be sensitive to cross-cultural variability in drinking practices. These assessment tools present opportunities for the study of cross-cultural differences in drinking patterns and the circumstances under which drinking occurs. A World Health Organization project utilizing these assessment tools is currently underway in five countries (Australia, Canada, Mexico, Poland, and Sweden). This project focuses on the identification of profile differ.

The effects of brief group psychotherapy in relapse prevention were tested. The groups focused on the clients' capacity to formulate their own treatment goals, including controlled drinking, programmed relapse, and total abstinence. Twelve months after completion of the eight-week outpatient group treatment, thirty-five clients were followed up. There appeared to be no harmful effects as a result of the treatment. Nobody in the follow-up group had a deteriorated drinking pattern as compared to pretreatment data. The follow-up results were significantly better than before treatment and also than in a comparison group of alcohol dependent patients. It seemed as if those patients who could benefit from the treatment had a shorter duration of abuse and had a later onset of uncontrolled drinking compared to those who continued with a negative drinking pattern and the dropouts. The clients assigned the positive treatment effects to course leaders' encouragement of personal decision making, increased awareness of risk situations, and improved coping skills. The group situation in itself seemed to be of special importance for this result. The degree of structure implemented by course leaders allowed a free and respectful openness to develop between group members.

This study reports on a replication of Marlatt and Gordon's (1980) findings concerning relapse determinants among alcoholics. It was undertaken in a somewhat different drinking culture (Sweden) and with a group of alcoholics also containing patients relapsing after a longer period of abstinence than those in the Marlatt and Gordon study. The difference in drinking culture is reflected in the finding that most subjects in this study took their first drink at home. The group studied by Marlatt and Gordon in Seattle most frequently started to drink in a bar or restaurant. In spite of the differences between the groups, we arrive at a similar picture when it comes to the distribution of relapse determinants according to the model proposed by Marlatt and Gordon. The categories not only have face validity but also construct validity, reflected in meaningful correlations with results on an intelligence test and a personality inventory. A descriptive analysis shows that subjects with poorer results on the intelligence test and having a high tendency to muscle tension and somatized anxiety tended to relapse in intrapersonal situations. Patients who do not readily adjust to other persons' opinions relapsed in interpersonal conflicts, and patients who are more impulsive could not resist social pressure to drink.

In this study a simple interview method to identify patients with potential alcohol problems was tested in a clinical setting. Nurses interviewed an unbiased sample of 393 patients attending practices within occupational health care. The technique used was a day by day follow back procedure covering the preceding two weeks. The time needed to accomplish the interviews varied between 2 and 15 minutes, depending on how much alcohol consumption was reported. Nurses and doctors reported that the interview was easily integrated in daily working routines. When defining the limit of high consumption as more than 200 g absolute alcohol for the two week period, 11% of the group studied (17% among men and 2% among women) were regarded as high consumers. Strategies for confronting and motivating patients for further analysis of their alcohol habits and for treatment are discussed.