Kerneopgave, målopfyldelse og mening i et paradigmeskifte…: en case fra det danske sygehusvæsen

Helle Gert Christensen & Bettina Ekvall Filtenborg-Barnkob

Student thesis: Master executive thesis


This master thesis addresses the actual experience of managing technology by the health professionals. This is based on a case study, on achievement of objectives (performance management) and the Karl E. Weick's theory of sensemaking as a reference. We seek to explain and understand how these hospital staffs, physicians and nurses, make sense of this management technology within their system. The idea of this topic came easy to us because as managers with in the hospital system, in our daily practice we experience that the delivery is not engrained among doctors and nurses. We experience increasing demand for achievement of objectives, both in terms of results, number of screenings and registrations. When we review the results we realise that there is fare from overall satisfaction in achieving the objectives. Therefore, we decided to investigate it further. Based on a socially constructive and hermeneutic perspective we carried out semi-structured interviews of two hospital based doctors and two nurses in the same hospital. We have used an open coding and looked for unexpected and interesting quotes and metaphors. We have organized the recorded material as per Toulmin’s argument model and analysed the sequential discussion with the help of Weicks theory of sensemaking. The project result shows that the hospital based doctors and nurses use different ways to described and narrate the concept of core task and achievement of objectives. This is a complex and continuous process. Sensemaking is an on-going and ever changing process and so is the sense narrating. “It makes sense” is an expression of having gained an understanding that provides platform to the “correct” feeling – the feeling of this is “right”. People have narrated sense after having created (narrated) a set of ideas, thoughts and arguments, which explains (makes) sense, and by doing so it makes us understand the sense and we feel the “correct” (righteous) feeling. The sense making theory of Karl E. Weick – can be successfully used to clarify some of the ideas that are the basis of the sensemaking and its consequential sense narrating. Doctors and nurses sense to the core task as professionals and with regard to the patientrelationship, based on their identity as a professional and their social relations as part of it. This has large implication on the choice making and important factor in decision making. They find it important to prioritize tasks related to the “warm hands” in contrast to the “cold hands”. On top of that their previous experiences play an important role. The lack of improvement in results on goal fulfilments show that there has been no education/learning, and they are themselves part of creating the social setting which they find is right by articulating that the patient-relationship is most important. Last but not the least the sensemaking is continuous and based on reaching the right feeling and not necessarily by a comprehensive argument. During the interviews, there was often a shift in sensemaking, depending upon the questions directed in context of their work. Kerneopgave, målopfyldelse og mening i et paradigmeskifte Helle Gert Christensen og Bettina Ekvall Filtenborg-­‐Barnkob 6 Masterprojekt, 2014, Master of Public Governance The informants create distance to performance management by sensemaking it to the identity as “cold hands” and with no patient-relationship. Only in a few cases the doctors and nurses identify performance management as a part of the core task. This happens when performance management gives health education or when it validate own needs. But doctors and nurses are challenged on the core task, when they are not the only ones narrating sense to it. A shift in paradigm in the health system means that administrators and patients seek and are involved in defining the core task. It has become clear to us that there is a discourse of “too little time” among the informants. This discourse becomes the rational point of actions, a kind of “saying” that is brought into discussion in a multitude of situations and it has implication on the way they make and narrate sense to the definition of the core task and performance management as a whole.

EducationsMaster of Public Governance, (Executive Master Programme) Final Thesis
Publication date2014
Number of pages76