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Background: Against the backdrop of worldwide increases in life expectancy, there is a growing concern about the future of health and social care services in many countries, including Sweden. This is not least due to expected cutbacks in tax revenues and increasing staff shortages in the welfare sector. Challenges such as these have spurred leadership reforms aimed at mobilizing employee engagement and promoting job attractiveness. For instance, distributed leadership, whereby leader responsibilities are distributed and shared among team members, has gained momentum in recent decades. Nevertheless, there is still limited knowledge as to whether and how organizational conditions impact first-line managers' inclination to distribute influence and control., Objective: This study aims to examine the organizational precursors of two interrelated aspects of distributed leadership among first-line managers in municipal elder- and disability care: collaborative decision-making and the presence (or lack of) a participatory leadership approach., Methods: Utilizing survey data from managers working in the elder- and disability care sectors in the municipality of Gothenburg, Sweden ( N  = 250), associations between conditions and aspects of distributed leadership were analyzed by means of Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM)., Results: Both aspects of distributed leadership were positively and significantly associated with managers' perceptions of having well-functioning collaborations with their employees ( β  = 0.277 [0.122-0.432]; β  = 0.492 [0.346-0.637]) as well as with the managers' active participation in development work aimed at, e.g., promoting organizational trust ( β  = 0.242 [0.039-0.446]; β  = 0.251 [0.103-0.398]). No significant associations between distributed leadership and support from senior management or positive collaborations with support functions were observed in the controlled analyses. However, managers' perceptions of organizational governance deficits were shown to be significantly and positively associated with having a more participatory leadership approach ( β  = 0.261 [0.032-0.491])., Conclusions: In line with the notion of distributed leadership as a "collective activity", which is realized in the interaction between managers and their employees, the findings demonstrate that trusting collaborations with responsible and knowledgeable employees play a key role in its practical implementation. Also, distributed leadership, and the work team relations through which it is enabled, are likely to mutually and positively reinforce each other. Additionally, the analyses revealed that managers' experiences of poor organizational governance appear to promote certain distributed leadership practices. Potentially, this could be because such deficits encourage them to seek support and guidance from their employees, but more research exploring these mechanisms is needed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Purpose: This qualitative narrative review aims to identify and evaluate the potential, challenges and pitfalls of pay-for-performance (P4P) schemes for the home care of adults with a disability. Due to a limited experimentation with P4P schemes in the context of the home and disability care sectors, the authors conducted a narrative review focusing on related areas of care, primarily nursing home care, to better understand the effectiveness of P4P schemes as a care intervention and evaluate the challenges associated with the introduction of these schemes., Design/methodology/approach: The authors employed a narrative review approach to examine the effectiveness of P4P schemes as a care intervention. The approach included a manual content analysis of the relevant academic and grey literature, focusing on the potential, challenges and pitfalls of P4P for care funders and providers., Findings: There is some, albeit limited, evidence from other related areas of care to support the effectiveness of P4P to improve the quality of care or the efficiency of its delivery for the home care sector. The results of prior studies are, however, often mixed and inconclusive, due to flaws with the design of schemes, including the nature of the incentives. Limited duration and poor-quality evaluations have further hampered the ability of studies to demonstrate the effectiveness of P4P schemes, which diminishes the credibility of these care interventions. When undertaken systematically, there seems to be some evidence that P4P can work; however, it requires careful design, implementation, measurement and evaluation., Practical Implications: Based on the challenges associated with the successful implementation of P4P schemes, the authors identified lessons for the design, implementation, measurement and evaluation of P4P schemes for care funders and policymakers., Originality/value: This study critically evaluates the potential of P4P as a care intervention for the home care and disability sectors. By evaluating the potential, challenges and pitfalls associated with P4P in related areas of care, the study provides guidance to home care funders, providers and policymakers in care settings., (© Emerald Publishing Limited.)

Background: In implementation science, vast gaps exist between theoretical and practical knowledge. These gaps prevail in the process of getting from problem analysis to selecting implementation strategies while engaging stakeholders including care users., Objective: To describe a process of how to get from problem analysis to strategy selection, how to engage stakeholders, and to provide insights into stakeholders' experiences., Design: A qualitative descriptive design., Setting and Participants: The setting was a care organization providing long-term care to people with acquired brain injuries who are communication vulnerable. Fourteen stakeholders (care users, professionals and researchers) participated. Data were collected by a document review, five interviews and one focus group. Inductive content analysis and deductive framework analysis were applied., Intervention: Stakeholder engagement., Main Outcome Measures: A three-step process model and stakeholders experiences., Results and Conclusion: We formulated a three-step process: (a) reaching consensus and prioritizing barriers; (b) categorizing the prioritized barriers and idealization; and (c) composing strategies. Two subthemes continuously played a role in how stakeholders were engaged during the process: communication supportive strategies and continuous contact. The experiences of stakeholder participation resulted in the following themes: stakeholders and their roles, use of co-creation methods and communication supportive strategies, building relationships, stimulus of stakeholders to engage, sharing power, empowerment of stakeholders, feeling a shared responsibility and learning from one another. We conclude that the inclusion of communication-vulnerable care users is possible if meetings are prepared, communication-friendly presentations and reports are used, and relationship building is prioritized., (© 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd.)