Mid Sweden University

Purpose: To explore the concept of nursing homes as attractive workplaces perceived by staff and interpreted through the lens of the Magnet Model®.

Methodology: Two workshops with staff from two departments at a nursing home and one workshop with registered nurses, occupational therapists and physiotherapists were held to explore attractive workplaces. Additionally, interviews were conducted with 12 registered nurses, occupational therapists and physiotherapists in another municipality. For the analysis, the authors combined all of the text from the workshops and the interviews and analysed it versus the five core components from the Magnet Model®: 1) transformational leadership, 2) structural empowerment, 3) exemplary professional practice, 4) new knowledge, innovation, and improvements, and 5) empirical quality results as a deductive frame of analysis.

Findings: The analysis revealed how the staff perceived nursing homes as attractive workplaces through the lens of the Magnet Model®. When sorting the material versus the five core components, all the components contributed attractive workplace examples even though innovation and improvements had the fewest examples and empirical quality results the second least.

Research limitations/implications: This study was limited to staff from one nursing home and all registered nurses, occupational therapists and physiotherapists in another municipality. Further research can be conducted at several nursing homes to explore their view of attractive workplaces. 

Originality/Value: The originality of this research is the use of the Magnet model to analyse an attractive workplace in nursing homes within a municipality context.

Aim To explore how chief nursing officers perceive and enact their leadership within bureaucratic healthcare systems, with a particular focus on patient safety, strategic responsibilities and the advancement of nursing care quality.Methods A qualitative study design was used. Semistructured interviews were conducted between October 2023 and May 2024 with nine female Chief Nursing Officers, representing diverse regional healthcare settings across Sweden. The interviews were analysed using reflexive thematic analysis, which was informed by the theory of bureaucratic caring to support interpretation.Findings Chief nursing officers described navigating hierarchical and bureaucratic systems while promoting person-centred care and professional governance. Their work involved balancing strategic mandates with ethical imperatives, advocating for workforce development and fostering a culture of proactive safety. The analysis generated four interrelated themes: (1) grappling with complexity and power structures; (2) guided by ethics, compassion and purpose; (3) empowering the nursing workforce to provide improved care; and (4) shaping quality care through innovation, evidence and technology.Conclusion Chief Nursing Officers can act as key agents of transformation at the intersection of structure and care. Their leadership extends beyond administrative functions to encompass strategic influence, ethical advocacy and system-level improvement. The findings underscore the need to further formalise and institutionalise the role, ensuring it is equipped with the mandate and structures required to lead across organisational levels. Strengthening such roles calls for leadership models that foster collaboration, support shared governance and enable flatter organisational hierarchies-structures designed to enhance participation, distribute decision-making and promote professional autonomy.Reporting Method This study followed reporting standards for qualitative research by adhering to the EQUATOR Network guidelines and using the COREQ checklist.Patient or Public Contribution Only health care staff participated in this study.Implications for the Profession and/or Patient Care This study highlights the strategic, ethical and relational dimensions of chief nursing officers' leadership and its impact on patient safety, quality improvement and workforce development. The findings demonstrate that they can play a pivotal role in embedding ethical perspectives into healthcare leadership-bridging professional nursing values with structural and strategic priorities. This underscores the importance of enabling nurses to shape care systems in ways that promote safety, professional governance and person-centredness.

Purpose: To present the results of a research project aimed at developing and improving team-based ways of working and methods of creating functional teams and a sustainable quality culture (SQC).

Methodology: A department within a Swedish municipality was studied with an interactive research design. Both the management team (MT) and the workers participated in the study and engaged in parallel with activities to improve teamwork and strengthen their SQC. Baseline and follow-up measurements were obtained with a questionnaire, and the results were statistically analysed.

Findings: Comparison between the baseline and follow-up measurements revealed that the members of the MT generally agreed to a greater extent with the statements regarding SQC in both measurements, indicating that they believed the culture to be stronger than it may have been. However, the MT members’ perceptions of statements regarding teamwork decreased in the follow-up measurement. One reason for this decrease could have been the reorganization of the MT during the project. Furthermore, the workers agreed to a greater extent with the statements regarding teamwork in the follow-up measurement than in the baseline measurement, but only a few factors measuring SQC increased in the follow-up measurement, namely, the pride and internal systems view. Interestingly, assessments of leadership commitment decreased in the follow-up measurement, indicating a decline in leadership quality.

Research limitations/implications: This research was limited to one department in one municipality. Its significance could be strengthened by applying the same interactive approach to other parts of the municipality or other municipalities or organizations.

Originality/Value: Working with an MT and workers of an organization in parallel and in an interactive way benefited both the studied organization, by creating a learning environment, and the research society, by bringing theoretical development into SQC and teamwork.

Abstract

Purpose: To explore the concept of teamwork between professionals perceived by staff at nursing homes and interpreted through the lens of the Magnet model. 

Methodology: Two workshops with assistant nurses from two departments and one workshop with registered nurses (RNs), occupational therapists and physiotherapists at a nursing home were performed to explore teamwork between professionals. The workshops were held between November 2024 and January 2025. Data were deductively analyzed using the Magnet model’s core component, Exemplary Professional Practice and its five Magnet forces as an analytical framework. 

Findings: Findings from the analysis were that all Magnet forces for Exemplary Professional Practice were embraced by the data. However, the Magnet forces for Autonomy and Nurses as Teachers only included a few reflections from the healthcare professionals. The Magnet model can function as a structural model for describing and improving teamwork in nursing homes. However, other data collection methods and the voices of relatives could complement the present research.

Research limitations/implications: This study was limited to one nursing home. Further research will be conducted at several nursing homes in different municipalities and with other stakeholders to more broadly explore the concept of teamwork between professionals.

Originality/value: The originality with this research is the use of the Magnet model to analyse and improve teamwork in nursing homes within a municipality context.

PurposeResearch has underscored the significance of quality culture in relation to employee performance and stakeholder value. This study aims to develop and assess an extended quality culture framework to align quality culture with organisational values and further identify positions and transformations of quality cultures in organisations through behaviours. Through knowledge of the variation among employee behaviour preferences, it is plausible to increase the organisation's awareness of its current progress in quality cultural transformations.Design/methodology/approachThis study employs a holistic multiple-case study design, encompassing three cases in a county that encompasses 12 municipalities. Drawing on prior research, an extended quality framework was tested through a survey to test and evaluate constructs that measure quality culture using vignettes based on organisational values operationalised as behaviours.FindingsThis study examines the relationship between organisational values and quality culture. It extends quality culture measurement research by operationalising an organisation's values as sustainable behaviours in practice. Combining preferences of behaviours with variations among employees across different values can increase the awareness of the organisation's progress in quality culture transformations with four different positions in terms of their status. Moreover, these four combinations follow different positions with respect to transformations along a quality culture continuum.Originality/valueThis study contributes to the discourse on interpreting and managing quality culture by focusing on organisational values and their expression as behaviours. Moreover, it contributes to the micro-level aspects of quality culture, linking values to the core operations to foster sustainable behaviour within organisations.

Patient safety culture is a critical component of health care quality in nursing homes. Surveys on patient safety culture can be helpful tools to evaluate care. The aims of the study were to translate a survey on patient safety culture, namely, the Nursing Home Survey on Patient Safety Culture (NHSOPS 1.0) from English into Swedish and to adapt it to Swedish conditions and to validate the translation. The survey was translated into Swedish following the TRAPD translation process —translate, review, adjudicate, pre-test, and document, as suggested by the provider of the original survey. The validity of the items was measured by Cronbach's alpha. Some changes in wording were made according to Swedish conditions. A pre-test with staff working in nursing homes showed adequate results for the translation. In this pilot study, all items and questions were considered valuable for measuring patient safety and were therefore retained in the Swedish version. The translated survey may be a helpful tool for measuring patient safety in nursing homes and prompting staff to reflect on their workplaces.

Purpose

Adapting to continuously changing environments is a challenge facing todays organisations (Fundin et al., 2018). A way to meet this challenge is by working systematically with Quality Management (QM) e.g., having a focus on the customer, empowering the co-workers, and having a committed leadership (Mohammad and Rad, 2006). The culture within an organization is pointed out as a crucial factor as the organization’s existing culture could hinder or help QM implementation (ibid). According to Ingelsson et al. (2018) the culture that needs to be created should promote a more holistic view on the organization and society as well as continuous work with improvements. Moreover, due to the demanding and complex nature of today’s organisations working in teams becomes more relevant than ever as working in teams makes both co-workers and organizations more effective, flexible, and adaptable for solving complex problems (Kozlowski and Ilgen, 2006).

Leaders, and management teams, influences both the organisation’s culture and teams and team performance. According to Schein and Schein (2016), creating, developing, and maintaining an organisational culture is the main task for leaders as their behaviours and attitudes have a great impact on the culture. The same goes for team effectiveness and performance where the leadership is an important element (Colbert et al., 2014). However, working systematically with the culture in an organization is not an easy undertaking (Ingelsson et al., 2018; Sten et al., 2021) and in order to know what to do there is a need to find out where we are, i.e. assessing and monitoring the culture (Bäckström et. al., 2016).  

In QM research the purpose is often to create value for both organizations and the research community and one research approach aiming at achieving this in cooperation is interactive research. Two basic ideas for interactive research identified by Ellström (2008) are: 1) the triple task of interactive research; contribute to practical results, create scientific knowledge, and develop the competencies of the involved parties, and 2) creation of knowledge by co-operation between practitioners and researchers. He proposes a model in an attempt to describe the interactive part of the research process as “a two-way flow of problems and knowledge between research and practice” (Ellström, 2008, p. 6).

The purpose of this paper is to present the design of an interactive research project aiming at changing the culture through the development of teams and teamwork. The purpose is also to present the result from the baseline measurement of quality culture and teamwork. 

Method

The presented research project is a collaboration between a municipality and the university with the purpose to develop and improve team-based ways of working and methods to create functional teams and a sustainable quality culture. The participants from the organisation are co-workers from two departments with assumed different cultures and the management team heading both departments. The intention is to develop an interactive project design that it will be developing the management team in parallel and in cooperation with the co-workers. 

To assess the quality culture, a previously developed and tested questionnaire will be used on both co-workers and leaders and to assess the level of teamwork additional factors will be developed and tested based on previous research (see e.g., Sten et al., 2023). The result from the questionnaire will be analysed using SPSS to examine the baseline as well as any differences or similarities between the groups. 

Findings

The first assessment of quality culture and teamwork both from co-workers and the management team will be carried out and analysed during the first quarter and presented in the full paper, as will the generic research process developed in the beginning of the project. The model is inspired by Ellström’s (2008) model of “Knowledge Creation Through Interactive Research” but also incorporates the challenge of working with both co-workers and leaders in parallel.

Relevance/contribution

The use of interactive model, such as the one developed and used in this project, can benefit both the research community as well as practice as a way to actively co-create and build culture and develop teamwork in an organization.

Developing ways of working with teamwork in management teams in parallel with co-workers organization can accelerate the work with building a sustainable quality culture. 

References

Bäckström, I., & Ingelsson, P. (2016). Measuring appreciative inquiry, lean and perceived co-worker health. Quality Innovation Prosperity, 20(2), 105-118.

Colbert, A.E., Barrick, M.R. and Bradley, B.H. (2014), “Personality and leadership composition in top management teams: implications for organizational effectiveness”, Personnel Psychology, Vol. 67, pp. 351-387

Ellström, P.-E. (2008). “Knowledge creation through interactive research: a learning approach”, The European Conference on Educational Research, Gothenburg, September 10–12.

Fundin, A., Bergquist, B., Eriksson, H. and Gremyr, I. (2018), “Challenges and propositions for research in quality management”, International Journal of Production Economics, Vol. 199, pp. 125-137

Ingelsson, P., Bäckström, I., and Snyder, K. (2018), “Strengthening quality culture in private sector and health care.” Leadership in health services, 31(3), pp. 276-292.

Kozlowski, S.W.J. and Ilgen, D.R. (2006), “Enhancing the effectiveness of work groups and teams”, Psychological Science in the Public Interest, Vol. 7, No. 3, pp. 77-124,

Mohammad, A. and Rad, M. (2006), “The impact of organizational culture on the successful implementation of total quality management”, The TQM Magazine, Vol. 18, No. 6, pp. 606-625.

Schein, E.H. and Schein, P. (2016), Organizational Culture and Leadership, 5th ed., Wiley, NJ.

Sten, L. M., Ingelsson, P., Bäckström, I., and Häggström, M. (2021), “The development of a measurement instrument focusing on team collaboration in patient transfer processes”. International Journal of Quality and Service Sciences, Vol. 13, No. 1, pp. 45-62.

Sten, L. M., Ingelsson, P., and Häggström, M. (2023), “The development of a methodology for assessing teamwork and sustainable quality culture, focusing on top management teams”. The TQM Journal, Vol. 35, No. 9, pp. 152-172.

Purpose

This paper aims to explore how leaders can develop value-based leadership for sustainable quality development in Lean manufacturing.

Design/methodology/approach

A qualitative meta-analysis was conducted using data from a three-year study of Lean manufacturing in Sweden using the Shingo business excellence model as an analytical framework.

Findings

This study demonstrates that leaders can develop value-based leadership to support Lean manufacturing by defining and articulating the organization’s values and accompanying behaviors that are needed to support the strategic direction; creating forums and time for leaders to identify the why behind decisions and reflect on their experiences to be able to lead a transformative process; and using storytelling to create a coaching culture to connect values and behaviors, to the processes and systems of work.

Research limitations/implications

This paper contributes insights for developing value-based leadership to support a systemic approach to sustainable quality development in lean manufacturing. Findings are based on a limited case sample size of three manufacturing companies in Sweden.

Originality/value

The findings were derived using a unique methodological approach combining storytelling, appreciative inquiry and coaching with traditional data collection methods including surveys and interviews to identify, define and shape value-based leadership in Lean manufacturing.

The purpose of this paper was to explore the concept of emotional commitment and its relationship to real teamwork and quality culture. Results from a literature review showed that most of the reviewed articles had quantitative design, were produced during the last ten years and that the concept of commitment was described in various ways. Research indicated a relationship between emotional (affective) commitment and real teamwork and quality culture. However, qualitative, and empirical research is needed. Such research could deepen knowledge about different types of commitment and their relationships to real teamwork and quality culture, aiming to achieve organizational success.